American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2021, 9(8), 386-388
DOI: 10.12691/ajmcr-9-8-1
Open AccessArticle

Hypoparathyroidism with Cartwheel-like Change in Thoracic Vertebral Body

Hiroka Matsuda1, Kei Jitsuiki1, Ken-ichi Muramatsu1, Hiroki Nagasawa1, Ikuto Takeuchi1 and Youichi Yanagawa1,

1Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan

Pub. Date: April 23, 2021

Cite this paper:
Hiroka Matsuda, Kei Jitsuiki, Ken-ichi Muramatsu, Hiroki Nagasawa, Ikuto Takeuchi and Youichi Yanagawa. Hypoparathyroidism with Cartwheel-like Change in Thoracic Vertebral Body. American Journal of Medical Case Reports. 2021; 9(8):386-388. doi: 10.12691/ajmcr-9-8-1


A 34-year-old man was transported by ambulance to our hospital after experiencing generalized convulsions. He had been of short stature since birth, and had been diagnosed with growth hormone deficiency, which was treated with growth hormone therapy from 10 to 14 years of age. He experienced convulsions two times at 32 and 33 years of age, respectively, with spontaneous recovery. He had no specific family history. On arrival, he had clear consciousness and sinus tachycardia. A physical examination revealed short stature. A biochemical analysis of venous blood revealed hypocalcemia and a low level of parathyroid hormone. Head computed tomography (CT) revealed diffuse hyperostosis of the cranial vault and truncal CT revealed cartwheel apperance in the thoracic vertebral bodies from Th9 to Th12. He was treated with levetiracetam, alfacalcidol and calcium agents. Next-generation sequencing suggested heterozygous large deletion of T-box transcription factor (TBX1) gene. This is the first report of hypoparathyroidism with cartwheel-like change in the thoracic vertebral body. The further accumulation of cases is necessary to determine whether this change is specific to hypoparathyroidism.

convulsion hypocalcemia skull hyperostosis computed tomography

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[1]  Gafni RI, Collins MT. Hypoparathyroidism. N Engl J Med. 2019; 380(18): 1738-1747.
[2]  Hakami Y, Khan A. Hypoparathyroidism. Front Horm Res. 2019; 51: 109-126.
[3]  Clarke BL, Brown EM, Collins MT, Jüppner H, Lakatos P, Levine MA, Mannstadt MM, Bilezikian JP, Romanischen AF, Thakker RV. Epidemiology and Diagnosis of Hypoparathyroidism. J Clin Endocrinol Metab. 2016; 101(6): 2284-99.
[4]  Kaito Y. On the thickness of the Japanese skull. Tokyo Jikeikai Medical Journal, 1980; 95: 503-13. In Japanese
[5]  Li L, Yang H, Li J, Yu Y, Wang F, Zhu X, Liu G. Misdiagnosis of idiopathic hypoparathyroidism: A case report and literature review. Medicine (Baltimore). 2018; 97(9): e9884.
[6]  Kambo JS, Girgis CM, Champion BL, Wall JR. Delayed-onset hypoparathyroidism in an adolescent with chromosome 22Q11 deletion syndrome. Endocr Pract. 2011; 17(5): e123-5.
[7]  Jayaraman MV. Preoperative and therapeutic endovascular approaches for spinal tumors. Neupsy key. 2016 Aug 6.
[8]  Sartoris DJ, Resnick D, Guerra J Jr. Vertebral venous channels: CT appearance and differential considerations. Radiology. 1985; 155(3): 745-9.
[9]  Demondion X, Delfaut EM, Drizenko A, Boutry N, Francke JP, Cotten A. Radio-anatomic demonstration of the vertebral lumbar venous plexuses: an MRI experimental study. Surg Radiol Anat. 2000; 22(3-4): 151-6.
[10]  Rubin MR, Bilezikian JP. Hypoparathyroidism: clinical features, skeletal microstructure and parathyroid hormone replacement. Arq Bras Endocrinol Metabol. 2010; 54(2): 220-6.
[11]  Mishaela R. Skeletal Manifestations of Hypoparathyroidism. Endocrinol Metab Clin North Am. 2018; 47(4): 825-837.
[12]  Funato N, Nakamura M, Richardson JA, Srivastava D, Yanagisawa H. Loss of Tbx1 induces bone phenotypes similar to cleidocranial dysplasia. Hum Mol Genet. 2015; 24(2): 424-35.
[13]  Li D, Gordon CT, Oufadem M, Amiel J, Kanwar HS, Bakay M, Wang T, Hakonarson H, Levine MA. Heterozygous Mutations in TBX1 as a Cause of Isolated Hypoparathyroidism. J Clin Endocrinol Metab. 2018; 103(11): 4023-4032.
[14]  Bell DJ, Gaillard F. Hyperostosis of the skull (differential). Radiopaedia.
[15]  Woo CC. Radiological features and diagnosis of acromegaly. J Manipulative Physiol Ther. 1988; 11(3): 206-13.