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Pseudohypoparathyroidism, an often delayed diagnosis: a case series
Valentina Donghi1, Stefano Mora, Ilaria Zamproni
1Department of Pediatrics, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy. v.donghi@studenti.hsr.it
Insights
Pseudohypoparathyroidism is a rare genetic disorder causing parathyroid hormone (PTH) resistance. Early diagnosis is challenging due to variable symptoms, emphasizing thorough biochemical testing for calcium-phosphate metabolism.
Area of Science:
- Endocrinology
- Genetics
- Pediatrics
Background:
- Pseudohypoparathyroidism (PHP) encompasses rare genetic disorders marked by parathyroid hormone (PTH) resistance.
- PHP presents as heterogeneous subtypes, including Ia, Ib, Ic, and type II, with sporadic or inherited patterns.
Observation:
- This report details four pediatric cases (ages 8-13) diagnosed during the 2007-2008 winter season.
- The cases illustrate the diverse clinical presentations of PHP, complicating early identification.
Findings:
- Typical biochemical markers include hypocalcemia, hyperphosphatemia, increased phosphate tubular reabsorption, and elevated PTH levels.
- Diagnosis can be difficult even without the full spectrum of Albright hereditary osteodystrophy features.
Implications:
- Highlights the critical need for comprehensive biochemical assessment of calcium-phosphate metabolism in suspected PHP cases.
- Emphasizes that variable phenotypes necessitate a high index of suspicion for timely diagnosis and management of pseudohypoparathyroidism.
Abstract:
Pseudohypoparathyroidism refers to a heterogeneous group of disorders characterized by parathyroid hormone (PTH) resistance. Pseudohypoparathyroidism is an uncommon sporadic or inherited genetic disorder subdivided into several distinct entities (type Ia, Ib, Ic, type II). We report cases of four children (aged 8 to 13 years) in the winter season 2007-'08. The present work highlights the variable mode of presentation of pseudohypoparathyroidism and the difficulty of an early diagnosis. We stress the importance of a complete biochemical investigation of the calcium-phosphate metabolism to recognize typical biochemical alterations associated with this condition (hypocalcaemia, hyperphosphataemia with increased phosphate tubular reabsorption and elevated PTH levels) in spite of a phenotypic aspect that often lacks the presence of all the peculiar clinical features of Albright hereditary osteodistrophy.
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