Late-onset idiopathic hypoparathyroidism as a cause of diarrhoea

A 62-year-old man presented with a 20-month history of intermittent watery diarrhoea and hypocalcaemia. At age 43 he had undergone partial gastrectomy with Billroth II anastomosis for perforated peptic ulcer and at age 57 developed megaloblastic anaemia with low serum cobalamin and folate levels. Exhaustive gastrointestinal studies performed to ascertain the cause of the diarrhoea were all negative. Plasma parathyroid hormone levels were undetectable and late-onset idiopathic hypoparathyroidism was diagnosed. Normalization of hypocalcaemia promptly corrected the bowel habit. Idiopathic hypoparathyroidism is an unusual cause of diarrhoea that should, however, be considered in patients with hypocalcaemia and associated diarrhoea without evidence of primary intestinal disease.