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Calcium Fall – Tetany – Parathyroid insufficiency

parathyroid glands locationParathyroids insufficiency (tetany) is a condition that has as its starting point the secretory insufficiency of parathyroids glands. The product of secretion of parathyroids gland, parathyroid hormone, has major implications in the metabolism of calcium and phosphorus, its failure will lead to an imbalance of the metabolism, resulting in hypocalcemia.

Regarding the clinical manifestations of the disease, they may be acute, latent or chronic.

Acute manifestations are the most significant of the clinical picture of tetany and are given, as we said, by hypocalcemia, which causes a neuromuscular hyperexcitability, sensitive-sensory, autonomic and cerebral cortex hyperexcitability.

This can cause carpal spasm, pedal spasm (equine foot), laryngo-spasm (common in children), facial spasms (appearance of  “pike nose”), generalized seizures. Sensory manifestations, characterized by numbness, burning, tingling in extremities and around the mouth, precede the neuro-motor manifestations described above.

Also during acute manifestations of tetany can be mentioned the autonomic manifestations characterized by visceral and vascular spasm. Thus bronchial muscle spasm can occur, clinically translated by a pseudo-asthmatic crisis, coronary vascular spasm simulating a false angina, spasms in the arteries of the legs which simulates arteritis.

Other acute manifestations of tetany are those given by the central nervous system. The following symptoms can be present: increased irritability, phobias, tics, insomnia. More severe forms are characterized by feeling anxious, panic attacks, mental confusion, hallucinatory phenomena.

tetany - chvostek signLatent manifestations are present between paroxysmal crises. In this time the patient may present numbness and tingling in the extremities and around the mouth, spontaneous muscle contractions, decreased muscle strength, visceral spasms, faintness, headache.

Chronic manifestations of tetany are characterized by a range of trophic disorders occurring with predilection for the skin and appendages, teeth, eyes and skeleton.

Due to prolonged hypocalcaemia, the skin is dry, scaly, with eczema and exfoliative dermatitis, nails are thin and brittle, hair is dry and thin. At the eye level it may occur endocrine-related cataract. Dental disorders are clinically translated by several trophic abnormalities in the enamel (brown striations located with predilection to the incisors).

Also in the chronic manifestations of tetany can occur calcification in the brain gray nucleus. This translates clinically by vertigo, hallucinatory delirium, seizures, severe mental deficiency. All these events describe so-called Fahr’s syndrome.

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