Background: Transient neonatal hypoparathyroidism (hPT) by inhibition of fetal parathyroid secondary to undiagnosed asymptomatic hyperparathyroidism (HPT) in the mother often debuts as late neonatal seizures.
Objective and hypotheses: To emphasise the indication of maternal metabolic study (Cacium-Ca-, Phosphorus-P- and PTH) in addressing late neonatal hypocalcemia, especially in the case of late neonatal hypocalcemic seizures.
Method: We report the case of a male new born, the result of pregnancy and childbirth without incident. Mother of 33, healthy, two episodes of renal colic. The new born presented on the 9th postnatal day partial seizures. In the metabolic screening, hypocalcemia 5.4 mg/dl and hypomagnesemia 1.2 mg/dl. Receive calcium gluconate infusion and magnesium. Seizures last for 24 h. Cranial ultrasound and EEG were normal. iPTH lower limits of normal (15 pg/ml). He received oral contributions of calcium, magnesium and cholecalciferol until complete metabolic normalization at the 4th month of life. In the extension study the mother showed calcemias between 10.2 and 10.5 mg/dl, P and Mg normal, elevated iPTH (between 95 and 113 pg/ml) and hypercalciuria. Parathyroid ultrasound and scintigraphy, evidenced left higher adenoma of 2.5 cm. Video-assisted parathyroidectomy is performed with subsequent analytical standardization.
Conclusion: i) In a late neonatal hypocalcemia, the study of maternal calcium-phosphate metabolism is required since the mother HPT is usually asymptomatic in most cases. ii) The diagnosis of a maternal hypercalcemic HPT is simple, being more unusual the diagnosis of HPT with normal-slightly elevated Ca and normal P such as we present. Late neonatal seizures may be the first expression of an undiagnosed maternal parathyroid adenoma, so the study of an apparently healthy mother is a benefit for both. iii) The therapeutic approach of a transient neonatal hPT includes contributions of Ca and vitamin D and frequently Mg. The metabolic evolution is standardization in a few weeks.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology