You are rotating on the medical service and are asked to make a diagnosis in a 43-year-old
woman whose main complaint is muscle cramps and stiffness. She also states she has
been unusually nervousness and has increased hair loss. A picture of your eye exam
(panel A) and of her right hand and arm taken while you are measuring her blood pressure
(Panel B) are shown below.
What is your diagnosis, what test(s) would you perform to confirm your suspicions,
and what treatment, if any, do you recommend?
DIAGNOSIS: Hypoparathyroidism with a positive Trousseau's sign. The lack of sufficient
production of parathyroid hormone (PTH) by the parathyroid glands can lead to a range
of symptoms and signs related to low calcium levels. These can include: tingling and
numbness in the fingertips, toes, and periorally; muscle cramps and spasms; muscle
weakness; twitching, especially of facial muscles; seizures; dry skin and hair; cataracts
(as in the presented case); enamel hypoplasia and tooth decay; depression; anxiety;
cognitive impairment; and recurrent headaches.
In latent tetany, carpal spasm may be induced by occluding the brachial artery
for 3 minutes with a sphygmomanometer cuff (Trousseau sign). Also, tapping the facial
nerve just proximal to the ear may produce ipsilateral contraction of facial muscles
(Chvostek sign). Keep in mind that persons experiencing prolonged periods of hyperventilation
may lower blood levels of ionized calcium enough to develop carpalpedal spasm.
A. B.
Cataracts (see above) can occur in patients A positive Trousseau sign. Note
the flexion of hypoparathyroidism.
the wrist & metacarpophalangeal joints and the
hyperextension of the interphalangeal
joints.
.