Reversible Parkinsonism in Idiopathic Hypoparathyroidism

ABSTRACT

BACKGROUND AND SIGNIFICANCE: Parkinsoinsm is characterized by clinical symptoms of igidity, bradykinesia, tremor, and gait disturbance. There are many causes of secondary parkinsonism. Hypocalcemia associated with hypoparathyrodism is a rare metabolic cause of secondary parkinsonism. We experienced a case presenting reversible secondary parkinsonism caused by hypocalcemia associated with idiopathic hypoparathyroidism. CASE A 35-year-old woman was admitted to our hospital because of generalized edema. She had been diagnosed as nephrotic syndrome for 1 year. During admission, slurred speech suddenly developed and hypocalcemia was founded. With replacement of calcium and dialysis, these symptom were improving. However, she complained of slowly progressive gait disturbance. On examination, she had parkinsonian features including masked face, slurred speech, rigidity of all extremities, bradykinesia, gait disturbance with short step, and stooped posture. Laboratory studies showed hypocalcemia, primary hypoparathyroidism, normal thyroid and parathyroid scan. Brain CT and MRI revealed normal. She was diagnosed as secondary parkinsonism following hypocalcemia associated with idiopathic hypoparathyroidism. She was started on levodopa and bromocriptine, and parkinsonian features slowly improved. One month later, she was fully recovered from parkinsonian features, and then levodopa and bromocriptine were discontinued. COMMENT: We report a case of reversible secondary parkinsonism caused by hypocalcemia with idiopathic hypoparathyroidism.