Concurrent renal hypomagnesemia and hypoparathyroidism with normal parathormone responsiveness

A 24-year-old woman presented with clinical features suggesting hypoparathyroidism: tetany, basal ganglia calcification, and a history of a seizure disorder. Hypocalcemia was present on admission despite therapy with calcium and vitamin D. Hormonal evaluation revealed undetectable parathormone levels and a normal cyclic AMP and phosphaturic response to parathormone infusion, suggesting the diagnosis of idiopathic hypoparathyroidism. Additional testing, however, revealed hypomagnesemia and elevated urinary magnesium levels. Normomagnesemia could not be consistently achieved despite oral magnesium administration. When the serum magnesium level was temporarily normalized via intravenous magnesium supplementation, parathormone levels rose into the normal range. These data indicate that the patient's hypomagnesemia was most likely due to renal magnesium loss. The normalization of her parathormone level during magnesium replenishment, along with the parathormone infusion data, suggests that this patient's hypomagnesemia was responsible for decreased parathormone synthesis and/or secretion, while target tissue responsiveness to parathormone was maintained.