Hypocalcaemia and hypoparathyroidism

Hypoparathyroidism (HPTH) refers to underactivity or complete loss of the parathyroid glands. This most commonly arises following neck surgery, but congenital, auto-immune and genetic causes are also seen. The diagnosis is confirmed biochemically with hypocalcaemia, hyperphosphataemia and low parathyroid hormone levels.

General examination

A full general examination is mandatory in the initial assessment of all endocrine patients. Cleft lip and palate may arise as part of di George syndrome. 

Abdominal examination

Renal abnormalities may arise as part of di George and Barakat syndromes.

Neurological examination

Examine the patient carefully for any neurological deficits, in particular if there is a history of seizures.

Patients with hypocalceamia may also be hyper-reflexic. 

Trousseau sign

Inflate a blood pressure cuff above the patient's systolic blood pressure, and wait for up to three minutes. If the patient develops carpopedal spasm, this is a positive Trousseau sign.

Note, to check for this sign properly, the cuff does need to remain inflated for significantly longer than usually necessary to check blood pressure, and both this, and the spasm may be uncomfortable for the patient.

Chvostek sign

Tap the facial nerve, just in front of the ear, with the patient's mouth slightly open. If this leads to repeated twitching of the facial muscles, this is Chvostek positive.

Ophthalmic examination

Examine the eyes for cataracts which may complicate HPTH. Other ocular problems may arise in di George syndrome.