CONVULSIONS AND HYPOPARATHYROIDISM IN A N EONATE DUE TO MATERNAL HYPERPARATHYROIDISM

Background. - Severe prolonged hypocalcemia may occur in neonate whose parathyroid hormone production has been blocked by maternal hyperpara thyroidism. This report describes such a case. Case report. - A 7 day- old girl was admitted suffering from dyspnea and repeated convulsions that had continued for 2 days. Her birthweight was 3,500 g and her hei ght 50 cm. Her mother had been given an iron preparation and calcium d uring pregnancy. Clinical examination of the newborn or birth revealed a cleft palate and micrognathia. The baby had been given milk-formula plus ergocalciferol, 1,200 IU/day. At admission, the baby was hypoton ic. Her serum total calcium was 1.27 nmol/l; total proteins 61 g/l; io nized calcium 1.1 mmol/l; phosphorus 2.14 mmol/l; intact PTH 21 pg/ml (N = 10-65) and 25(OH)D 8 ng/ml (N = 8-30). She was given intravenous phenytoin was needed to stop clinical and electrical seizures. Her blo od calcium was normalized 5 days later. Her mother, who was clinically normal, had; total serum calcium: 2.72 and 2.77 mmol/l; total protein s: 71 g/l; phosphorus: 0.85 mmol/l; intact PTH: 73 pg/ml; 25(OH)D: 6 n g/ml; Ultrasonography showed an adenoma fo the right parathyroid. Furt her studies on the baby showed no signs of Di George syndrome. Conclus ion. - Neonatal hypocalcemia always requires investigation of both the infant and mother. Measurements of vitamin D metabolites and intact P TH are required to recognize maternal hyperparathyroidsm.