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Lee, Kim, Lee, Kim, Hong, Kim, Choi, Ahn, and Kim: A Case of Pseudohypoparathyroidism with Graves' Disease
Case Report
Endocrinology and Metabolism

Endocrinology and Metabolism 2010; 25(3): 221-225.

Published online: 30 September 2010

DOI: https://doi.org/10.3803/EnM.2010.25.3.221

A Case of Pseudohypoparathyroidism with Graves' Disease

Gil Woo Lee, Jae Hoon Kim, Kang Won Lee, Sa Il Kim, Sang Mo Hong, Dong Sun Kim, Woong Hwan Choi, You Hern Ahn, Tae Wha Kim

Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea.

Corresponding author: Tae Wha Kim. Department of Internal Medicine, Hanyang University Seoul Hospital, Haengdangdong, Seongdong-gu, Seoul 133-792, Korea. Tel: +82-2-2290-8325, Fax: +82-2-2290-9299, kimth@hanyang.ac.kr

Received 12 January 2010       Accepted 28 February 2010

Copyright © 2010 Korean Endocrine Society

Abstract

Pseudohypoparathyroidism is a rare disease that is characterized by target cell resistance to the effects of parathyroid hormone and this disease is classified into various types depending on the phenotypic and biochemical findings. The patients with pseudohypoparathyroidism present with the clinical and biochemical features of hypoparathyroidism, but they have an increased serum level of parathyroid hormone. We experienced a case of pseudohypoparathyroidism in a 24 years old woman who had Graves' disease at that time. She had hypocalcemia, hyperphosphatemia, an elevated serum parathyroid hormone level and a normal urinary basal cyclic AMP(adenosine monophosphate) level. She also had a normal phenotypic appearance. Therefore, she was classified as suffering with pseudohypoparathyroidism type II. The clinical and laboratory abnormalities were improved by calcium supplementation in addition to vitamin D. To the best of our knowledge, this is the first case of pseudohypoparathyroidism combined with Graves' disease in Korea.

Keywords: Pseudohypoparathyroidism, Hyperthyroidism, Graves' disease

Figures and Tables

Fig. 1
Neck CT image. Bilateral enlargement of thyroid gland is noted.
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Fig. 2
Bone scan image. Delayed bone image shows an increased uptake of whole body bone.
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Table 1
Results of routine laboratory examination
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Table 2
Results of calcium, phosphorus and parathyroid hormone
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Table 3
Results of thyroid and basal hormone profile
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Table 4
Ellsworth-Howard test
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U[-2], urine 2 hours before parathyroid hormone (PTH) injection.

U[-1], urine 1 hour before parathyroid hormone (PTH) injection.

U[+1], urine 1 hour after parathyroid hormone (PTH) injection.

U[+2], urine 2 hours after parathyroid hormone (PTH) injection.

Table 5
Dual energy X-ray absorptiometry (DXA)
enm-25-221-i005

BMD, bone mineral density.

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