January - March 2011, Volume 7, Issue 1

Azzoug S, Diab N, Chentli F

Reversible Cardiomyopathy Related to Hypoparathyroidjsm in a Subject with Fahr's Syndrome

Acta Endo (Buc) 2011, 7 (1): 101-110
doi: 10.4183/aeb.2011.101

Introduction.Cardiomyopathy secondary to severe hypocalcaemia can lead to death when misdiagnosed. However, it can respond favorably to calcium and vitamin D as in this observation.\r\nCase report. SB, 50 years old, was hospitalized for heart failure. He was operated on for cataracts and treated for epilepsy, but was not known as having heart problems.\r\nClinical examination revealed global heart failure. Chest x ray showed cardiomegaly with bilateral pleural effusion. Echocardiography demonstrated myocardium dilatation with an\r\nimpaired systolic function (ejection fraction = 38%, N≥ 60). Heart screening did not find any cause, but laboratory investigation diagnosed severe hypocalcemia (mean value: 26mg/L (N=80-105) or 0.65 mmol/L), high phosphorus (61.5mg/L, N=25-45), and low parathormone (6.51 pg/mL, N=15-65 pg/mL). Corrected calcium according to protidemia\r\nwas 0.69 mmol/L. Magnesium was normal. Brain CT scan showed bilateral and symmetrical calcifications of basal ganglia\r\narguing for Fahr?s syndrome. After calcium (1g) and vitamin D (2, then 3 μg/day) during one week, cardiac abnormalities improved promptly. Three months later seizures disappeared totally after stopping anti epileptic drugs.\r\nConclusion.The fast reversibility of heart failure and seizures under calcium suggests observed symptoms were due to hypocalcaemia, seemingly installed on a previously normal heart function. So, calcium assessment should be checked systematically in heart insufficiency.

Keywords: Fahr?s syndrome, severe hypocalcaemia, reversible cardiomyopathy.

Correspondence: Professor Chentli Farida, Bab El Oued Hospital - Endocrine and metabolic diseases,5 boulevard Said Touati Algiers 16000, Algeria, Tel: 0021321960040 Fax: 0021321960040, email: endofarida@hotmail.fr