From Psychiatry to Neurology and Endocrinology: A Case of Hypoparathyroidism

Abstract

A 31-year-old male patient developed extrapyramidal symptoms while on treatment for depression. He was investigated and found to suffer from hypoparathyroidism. He had calcification in the brain, signs and symptoms of neuromuscular irritability, and QT prolongation on electrocardiogram. He was treated with calcium carbonate and calcitriol. Although he had marked improvement, bradykinesia persisted. This report highlights the importance of maintaining a high index of suspicion for hypocalcemia, and the importance of searching for an organic basis for psychiatric symptoms.

Keywords: basal ganglia; calcification; chvostek; depression; extrapyramidal; hypocalcemia; hypoparathyroidism; parkinsonism; qt interval; trousseau.

Figure 1. ECG showing sinus tachycardia with QTc prolongation (451 ms)

ECG, electrocardiogram; QTc, corrected QT The QT interval is marked with a black bar at the bottom of the figure.

Figure 2. Trousseau’s sign

Carpal spasm occurring after the cuff had been inflated to a pressure above the systolic blood pressure.

Figure 3. Axial sections of a CT scan of the brain showing bilateral symmetrical calcification

CT, computed tomography The calcification is evident as hyperdensity, predominantly in bilateral basal ganglia (red arrow) and thalami (yellow arrow). Smaller lesions are also seen in the frontal cortex (green arrow) and cerebellum (white arrow).

Figure 4. Axial sections of the SWI sequence of MRI brain showing bilateral symmetrical calcification

SWI, susceptibility-weighted imaging; MRI, magnetic resonance imaging The calcification is evident as blooming, predominantly in bilateral basal ganglia (red arrow) and thalami (yellow arrow). Smaller lesions are also seen in the frontal cortex (green arrow) and cerebellum (white arrow).

Figure 5. Saggital section of the T1W sequence of MRI brain

T1W, T1-weighted; MRI, magnetic resonance imaging No structural abnormality is seen in the brainstem.