Journal of the Formosan Medical Association
Volume 107, Issue 10 , Pages 806-810, October 2008

Transient Pseudohypoparathyroidism as a Cause of Late-onset Hypocalcemia in Neonates and Infants

Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan

Received 31 January 2008; received in revised form 11 April 2008; accepted 7 May 2008.

Article Outline

Background/Purpose

Transient pseudohypoparathyroidism is a rare cause of late-onset hypocalcemia in neonates and infants. The purpose of this study was to investigate the clinical presentation and natural course of transient pseudohypoparathyroidism in neonates and infants.

Methods

From 1995 to 2006, 21 patients under 3 months of age were admitted to our department because of late-onset neonatal hypocalcemia. Among these, five were noted to have transient hypocalcemia, hyper-phosphatemia and elevated serum parathyroid hormone levels. Their clinical data, biochemical findings and natural course were thoroughly analyzed.

Results

All five patients were boys with increased neuromuscular irritability as their initial clinical manifestation. Initial biochemical data showed calcium 1.5 ± 0.16 mmol/L, phosphorus 9.6 ± 1.5 mg/dL, intact parathyroid hormone 182 ± 93 pg/mL and tubular reabsorption of phosphorus 94.8 ± 3.7%. Two of the patients had magnesium deficiency. After reduction of phosphorus intake and supplementation with calcium and/or magnesium as indicated, the biochemical derangements resolved in 28 ± 3 days.

Conclusion

Neuromuscular irritability is usually the initial clinical presentation of transient pseudohypoparathyroidism. Aside from delayed renal maturation, pseudohypoparathyroidism is also caused by magnesium deficiency. Such a disturbance usually resolves before 3 months of age.

Key Words:  hyperphosphatemia , hypocalcemia , magnesium deficiency , pediatrics , pseudohypoparathyroidism

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Allgrove J . The parathyroid and disorders of calcium metabolism . In:  Brook CGD ,  Clayton PE ,  Brown RS editor. Clinical Pediatric Endocrinology . 5th edition. Oxford: Blackwell; 2005;p. 254–279
  2. Hsu BC , Levine MA . Perinatal calcium metabolism: physiology and pathophysiology . Semin Neonatol . 2004;9:23–36
  3. Salle BL , Delvin E , Glorieux F , et al.   Human neonatal hypocalcemia . Biol Neonate . 1990;58(Suppl 1):22–31
  4. Oppé TE , Redstone D . Calcium and phosphorus levels in healthy newborn infants given various types of milk . Lancet . 1968;1:1045–1048
  5. Specker BL , Tsang RC , Ho ML , et al.   Low serum calcium and high parathyroid hormone levels in neonates fed “humanized” cow's milk-based formula . Am J Dis Child . 1991;145:941–945
  6. Venkataraman PS , Tsang RC , Greer FR , et al.   Late infantile tetany and secondary hyperparathyroidism in infants fed humanized cow's milk formula. Comparison with breast-fed infants. Longitudinal follow up . Am J Dis Child . 1985;139:664–668
  7. Fujisawa Y , Yamashita K , Hirai N , et al.   Transient late neonatal hypocalcemia with high serum parathyroid hormone . J Pediatr Endocrinol Metab . 1997;10:433–436
  8. Minagawa M , Yasuda T , Kobayashi Y , et al.   Transient pseudohypoparathyroidism of the neonate . Eur J Endocrinol . 1995;133:151–155
  9. Manzar S . Transient pseudohypoparathyroidism and neonatal seizure . J Trop Pediatr . 2001;47:113–114
  10. Koklu E , Kurtoglu S . Natal teeth and neonatal transient pseudohypoparathyroidism in a newborn . J Pediatr Endocrinol Metab . 2007;20:971
  11. Kenny AP , Glen AC . Tests of phosphate reabsorption . Lancet . 1973;2:158
  12. Mallet E , Basuyau JP , Brunelle P , et al.   Neonatal parathyroid secretion and renal receptor maturation in premature infants . Biol Neonate . 1978;33:304–308
  13. Anast CS , Winnacker JL , Forte LR , et al.   Impaired release of parathyroid hormone in magnesium deficiency . J Clin Endocrinol Metab . 1976;42:707–717
  14. Rude RK , Oldham SB , Sharp CF , et al.   Parathyroid hormone secretion in magnesium deficiency . J Clin Endocrinol Metab . 1978;47:800–806
  15. Suh SM , Tashjian AH , Matsuo N , et al.   Pathogenesis of hypocalcemia in primary hypomagnesemia: normal endorgan responsiveness to parathyroid hormone, impaired parathyroid gland function . J Clin Invest . 1973;52:153–160
  16. Estep H , Shaw WA , Watlington C , et al.   Hypocalcemia due to hypomagnesemia and reversible parathyroid hormone unresponsiveness . J Clin Endocrinol . 1969;29:842–848
  17. Rude RK , Oldham SB , Singer FR . Functional hypoparathyroidism and parathyroid hormone end-organ resistance in human magnesium deficiency . Clin Endocrinol . 1976;5:209–224
  18. Tsau YK , Tsai WY , Lu FL , et al.   Symptomatic hypomagnesemia in children . Acta Paed Sin . 1998;39:393–397

PII: S0929-6646(08)60194-1

doi:10.1016/S0929-6646(08)60194-1

Journal of the Formosan Medical Association
Volume 107, Issue 10 , Pages 806-810, October 2008

Article Tools