July - September 2014, Volume 10, Issue 3

Korkmaz H, Özkaya M, Akarsu E, Sahin AZ, Öztürk ZA, Yildiz H, Kisacik B, Araz M

Hypoparathyroidism Mimicking Ankylosing Spondylitis

Acta Endo (Buc) 2014, 10 (3): 495-501
doi: 10.4183/aeb.2014.495

Background. Idiopathic hypoparathyroidism is a rarely seen disease which progresses with the hypocalcaemia, hyperphosphatemia and low level of parathyroid hormones. The main symptoms such as leg cramps and generalized muscle weakness result from neuromuscular irritability due to hypocalcaemia, and skeletal abnormalities as well as ectopic calcifications are among the well known features. Case Report. A 32 year-old male patient was referred to our clinic with four years of progressive inflammatory low back and hip pain, prolonged morning stiffness. Upon physical examination limited movements and posture resembling that seen in patients with ankylosing spondylitis (AS) were observed. In laboratory investigation revealed hypocalcaemia (4.6 mg/dL), hyperphosphatemia (7.0 mg/dL) and hypoparathyroidism (7.2 pg/mL). Serum C reactive protein and erythrocyte sedimentation rate were normal. The direct graphic and sacroiliac magnetic resonance image were identified sacroiliitis. A rise in bone density in dual-energy x-ray absorptiometry was recorded. According to the Modified New York criteria, AS includes the whole diagnostic criterias completely. Conclusion. Idiopathic hypoparathyroidism, when undiagnosed for a long period, may result in extreme calcification of soft and bony tissues. The vertebral calcification may be so intense that it may result in an AS like clinical picture. Therefore, idiopathic hypoparathyroidism should also be considered in the differential diagnosis of AS .

Keywords: Ankylosing spondylitis, Hypocalcaemia, Hypoparathyroidism.

Correspondence: Hakan Korkmaz MD, Gaziantep University, Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, 27100 Sahinbey, Gaziantep, Turkey, E-mail: drhkorkmaz@yahoo.com.tr