Chronic secondary hypoparathyroidism

Case contributed by Dr Balint Botz

Presentation

Total thyroidectomy more than 20 years earlier due to papillary thyroid cancer. Secondary hypoparathyroidism treated with calcium and vitamin D supplementation since then. Presented with rapidly progressive headache. Subarachnoid bleeding?

Patient Data

Age: 40 years
Gender: Female
  • Marked calcification of the falx, especially considering the age group.
  • Predominantly frontal hyperostosis.
  • No other pathological findings (other multiplanar reconstructions and complete stacks not shown).
Ultrasound

Abdominal US requested due to elevated CRP two days later: 

  • Both kidneys (only right one shown) demonstrate a striking increase of medullary echogenicity (note partial distal acoustic shadowing).
  • Moderately increased reflectivity of the cortex.
  • With color Doppler the medullary pyramids demonstrate a marked, confluous twinkling-phenomenon due to severe calcification. 
  • Small, simple cortical cysts. 

Case Discussion

Severe, premature falcine calcifications and calvarial hyperostosis, as well as advanced medullary nephrocalcinosis resulting from the treatment of chronic hypoparathyroidism (with multiple episodes of significant hypocalcemia) treated with calcium and vitamin D supplementation. 

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Case information

rID: 74645
Published: 29th Feb 2020
Last edited: 3rd Mar 2020
System: Urogenital
Inclusion in quiz mode: Included
Institution: University of Pécs

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