Hypoparathyroidism precipitated by mumps: An unusual temporal association

Abstract

Background: Hypoparathyroidism is a condition characterized by hypocalcemia and hyperphosphatemia due to insufficient secretion of parathyroid hormone (PTH). The common causes of hypoparathyroidism are postsurgical and autoimmune. We describe a case of hypoparathyroidism precipitated by mumps. Clinical Description: A 17-year-old boy was brought to us with altered sensorium following 2 episodes of generalized tonic-clonic seizures within the last 4 h. He required mechanical ventilation, but severe laryngospasm made intubation difficult. He had been suffering from a febrile illness that appeared to be mumps for the preceding 4 days. The only salient biochemical abnormality was hypocalcemia and hyperphosphatemia. Neuroimaging and cerebrospinal fluid examination were normal. Hypoparathyroidism was suspected and confirmed by low PTH levels. He also developed secondary hypothyroidism. Management and Outcome: The child had no symptoms of hypocalcemia in the past. He was started on intravenous calcium and calcitriol. He showed dramatic improvement in sensorium with normalization of serum calcium levels. He was extubated after a week. At discharge, there were no neurological sequelae and the sick euthyroid syndrome had resolved. Viral serology for mumps was reactive by the 3rd week of illness. Conclusion: Although viral infections have been described as triggers for other endocrinopathies, we could not find any association with hypoparathyroidism. An exhaustive literature search we could not find any similar case reports of hypoparathyroidism during or following mumps. Whether mumps infection had any role in the pathogenesis of the hypoparathyroidism or only unmasked an underlying endocrinopathy remains uncertain.

Keywords

• hypoparathyroidism
• mumps
• sick euthyroid syndrome