Resumo

HUNG HUANG, Seilee et al. Parathyroid hormone resistance as a rare cause of late-onset hypocalcemia in pediatric patients: Case report. Rev. Venez. Endocrinol. Metab. [online]. 2015, vol.13, n.3, pp.175-179. ISSN 1690-3110.

Objective: To present clinical case of a boy with resistance to parathyroid hormone (PTH) as a rare cause of hypocalcemia. Case Study: Preschool 5 years old, whose mother refers onset of symptoms from the three years old characterized by frequent muscle cramps in upper and lower limbs that resolve spontaneously. Two days earlier presented accentuation of the symptoms, accompanied by bilateral flexion of the four members, with difficulty walking, so he is admitted. Diagnosis of subclinical hypothyroidism was done at 3 years old, in treatment with levothyroxine 25 μg daily. No history of fractures. Physical examination: normal phenotype, weight: 25 kg (pc> 97) height: 112 cm (pc50-75), BMI 20 kg/m² (pc> 97): FC: 90 lpm, FR: 20 rpm. Good general conditions. As positive findings shows members with carpal-pedal contraction, and bending of the lower limbs, Trousseau and Chvostek+, neurological conscious, hypertonic. Paraclinical: calcium: 7 mg/dL, phosphorus 7.2 mmol/L, PTH: 1085 pg/mL (NV: 10-67 pg/mL), albumin: 4.5 g/dL, creatinine: 0.37 mg/dL, alkaline phosphatase: 370 mg/dL, FT4: 1.4 ng/dL, TSH: 1.22 mU/L. Pseudohypoparathyroidism diagnosing is performed. Treatment with intravenous calcium gluconate to correct symptoms was initiated followed with oral calcium and calcitriol, improvement is observed. At 14 years of age (nine years after diagnosis) is reassessed: phenotype, weight and height are normal, Chvostek and Trousseau negative, bone mass preserved and thyroid and parathyroid ultrasound unchanged. Conclusion: The resistance to PTH represents a rare cause of hypocalcemia in children. The diagnosis is clinical and paraclinical demonstrating hypocalcemia and hyperphosphatemia with elevated PTH. Treatment is calcium and vitamin D to maintain normal levels of serum calcium and phosphorus and decrease serum PTH levels.

Palavras-chave : Resistance to Parathormone; Pseudohypoparathyroidism; hypocalcemia.

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