Congenital hypoparathyroidism presenting as recurrent seizures in an adult

The Correlation of Mineral Density of Jaws With Skeletal Bone and Its Effect on Implant Stability in Osteoporotic Patients: A Review of Patient-Based Studies

Osteoporosis has been an enigma in terms of the administration of implant therapy. It has been implicated as a cause of implant failure as it directly affects the quality of the bone. The diagnosis of osteoporosis is mainly done by measuring skeletal bone mineral density (BMD). During implant therapy, the BMD of jaws can be evaluated on routine orthopantomogram (OPG) or cone beam CT (CBCT). The various advantages of CBCT include establishing a correlation between skeletal bone density and bone density of jaws and estimating its effect on implant stability in osteoporotic patients, which in turn will help in determining the prognosis of the implant in osteoporotic patients. This review is a summary of all patient-related studies conducted in the mentioned context of implant placement in patients with osteoporosis, treatment modalities, and prognosis. We performed a search of relevant articles on Google Scholar, PubMed, and Cochrane, which yielded a total of 25 articles for full-text reviews. After excluding some articles based on the exclusion criteria, a review was conducted along with a pilot study on implant placement in osteoporotic patients. Regional bone density can be a helpful parameter in predicting primary implant stability and it can be a useful indicator of skeletal BMD. With a careful evaluation of BMD, dental implants can be placed in patients with osteoporosis with a better prognosis for the treatment.

Is there a need for an emergency card in hypoparathyroidism?

BACKGROUND

Patients with hypoparathyroidism are at risk of both hypocalcemic and hypercalcemic crisis. Patients report that health professionals do not always respond adequately in an acute situation. The extent and handling of severe hypo- and hypercalcemia in hypoparathyroidism is unknown.

AIMS

To outline the need for a medical emergency card for primary hypoparathyroidism.

METHOD

Postal survey amongst Norwegian and Swedish patients with chronic hypoparathyroidism of all causes. Altogether 455 invitations were sent (333 from Norway and 122 from Sweden).

RESULTS

Three hundred and thirty-six of 455 (74%) patients responded (253 from Norway and 83 from Sweden). The majority were women (79%), and the main cause was postsurgical hypoparathyroidism (66%). Overall 44% and 16% had been hospitalized at least once for hypo- or hypercalcemia, respectively. Eighty-seven per cent felt that an emergency card would be highly needed or useful. Amongst those hospitalized for hypocalcemia, 95% felt a card was needed compared to 90% amongst those hospitalized for hypercalcemia. Five per cent believed that a card would not be useful.

CONCLUSIONS

The majority answered that an acute card is highly needed or useful. Hospitalization for acute hypocalcemia was more common (44%) than for acute hypercalcemia (16%). As a result of this survey, an emergency card will be distributed in three European countries to test its utility.

Hypoparathyroidism concomitant with macrothrombocytopenia in an elderly woman with 22q11.2 deletion syndrome

We describe the case of a 62-year-old woman with schizophrenia and intellectual disability, who presented with intermittent muscle cramping for 2 weeks. A dysmorphic face and a positive Trousseau's sign, but without ecchymosis or petechial lesion were noted. Laboratory data revealed impaired renal function (creatinine level = 1.6 mg/dL), severe hypocalcaemia (total calcium level = 5.7 mg/dL) with low urinary calcium excretion (13.2 mg/day), hyperphosphatemia (phosphate level = 7.3 mg/dL), and low intact parathyroid hormone level (52.5 pg/mL)-indicating primary hypoparathyroidism. A blood smear revealed thrombocytopenia (30,000 thrombocytes/µL) and giant platelets-indicating macrothrombocytopenia. Chromosome 22q11.2 deletion syndrome (22q11.2DS) in the deficient chromosome 22 was confirmed using multiplex ligation-dependent probe amplification showing haploinsufficiency in GP1BB and TBX-1. Cooccurrence of hypoparathyroidism and macrothrombocytopenia in 22q11.2DS is rare and can easily be misdiagnosed as idiopathic thrombocytopenia purpura and inappropriate splenectomy or chemotherapy can aggravate hypoparathyroidism. Early diagnosis of 22q11.2DS, characterized by hypoparathyroidism and macrothrombocytopenia, in elderly patients with schizophrenia can facilitate in avoiding circuitous diagnosis and inappropriate management.