| Objective To summarized the clinical characteristics of different types of hypoparathyroidism,discuss the risk factors of intracranial calcification and hypocalcemia myopathy through retrospective analysis,as well as improve the understanding of the disease.Methods The clinical data of 49 cases of hypoparathyroidism in Department of Endocrinology,First Hospital Affiliated to Lanzhou University,between June 2008 and August 2017 were collected.They were divided into three groups according to the etiology: idiopathic hypoparathyroidism(IHP)with 26 cases,postoperative acquired hypoparathyroidism(POHP)with 13 cases,pseudohypoparathyroidism(PHP)with 10 cases.To compare and summarize the clinical characteristics of different types of hypoparathyroidisms,analyze the risk factors of intracranial calcification and hypocalcemia myopathy.Results1.The median age of onset in group PHP was [7.5(3.5,26.2)years old],which was significantly less than that in group IHP [31.5(22.0,42.5)years old] and POHP group [46.0(40.5,54.5)years old(all P <0.01);The group of IHP was less than that of group POHP(P=0.002).The median diagnosis time of the patients in group POHP[1.0(0,24.0)month] was significantly shorter than that in group IHP [24.0(1.0,96.0)months] and PHP group [13.5(1.0,150)months,P=0.004 and P=0.028].There was no significant difference in the course of disease among the three groups(P>0.05).2.91.8% of the patients of hypoparathyroidism presented with tetany as initial symptoms,there was no significant difference among the three groups.Compared with the POHP group,epileptic seizure was more likely to occur in the PHP(50%)group and the group IHP(26.9%)(P=0.008 and P=0.002).Regression analysis showed that intracranial calcification was an independent risk factor for epileptic seizures(OR=10.7,95%CI 2.72~42.4,P= 0.001).3.The level of PTH in group PHP(380.74±364.46 pg/mL)was significantly higher than that in group IHP(7.34±5.77 pg/mL,P<0.05)and POHP group(12.96±6.32 pg/mL,P<0.05),There was no significant difference in level between IHP andPOHP group(P > 0.05).There was no significant difference in the level of blood calcium,phosphorus,24 h urinary calcium and phosphorus among the three groups of patients(P > 0.05).4.The level of muscle enzyme in 36/49(73.5%)patients were increased,and the changes were most obvious in the levels of LDH and CK.The level of ALP?LDH?CK and CK-MB in PHP groups were significantly higher than that in POHP group(P<0.05),The level of LDH?CK and CK-MB in IHP groups were significantly higher than that in POHP group(P<0.05),but when PHP group compared with group IHP,only ALP level were significantly higher in IHP group(P<0.01).Partial correlation analysis showed that the levels of muscle enzyme were negatively correlated with age of onset and blood calcium,and positively correlated with hand or foot convulsions,seizures(all P <0.05).5.The rate of intracranial calcification in group PHP(70%)was higher than that in group POHP(23.1%,P=0.018).There was no significant difference between PHP group and IHP group,IHP and POHP group(P value > 0.05).The regression analysis showed that the course of disease was an independent risk factor for intracranial calcification(OR=1.013,95%CI 1.001~1.026,P < 0.05).Conclusions1.The patients with pseudohypoparathyroidism had the youngest onset age,as well the epileptic seizures were more common and the misdiagnosis rate was high in these patients.Intracranial calcification was a risk factor for epileptic seizures.The risk of intracerebral calcification of patients with intracranial calcification was 10 times higher than that of patients without intracranial calcification.2.Patients with hypoparathyroidism can be accompanied by abnormal muscle enzymes,which were mainly elevated in levels of LDH and CK.The increases in muscle enzyme levels was most evident in patients with pseudohypoparathyroidism.Hypocalcemia,tetany and epileptic seizures may be the risk factors for muscle enzymes abnormalities.3.Intracranial calcification was a common manifestation of ectopic calcification in patients with hypoparathyroidism.The incidence of calcification with pseudo-hypoparathyroidism was significantly higher than that of secondary and idiopathic hypoparathyroidism.The duration of disease was a risk factor for intracranial calcification. |
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