Seizure and Profound Hypokalemia: Unusual Presentation of Primary Hyperparathyroidism

  • Yasuto Nakasone Diabetes Center, Aizawa Hospital, Matsumoto
  • Shinya Uchino Noguchi Thyroid Clinic and Hospital Foundation, Beppu
  • Yuka Sato Diabetes Center, Aizawa Hospital, Matsumoto
  • Keishi Yamauchi Diabetes Center, Aizawa Hospital, Matsumoto
  • Toru Aizawa Diabetes Center, Aizawa Hospital, Matsumoto

Keywords

Seizure, hypokalaemia, hyperparathyroidism, itraconazole

Abstract

Abstract:

A 68-year-old man was admitted because of tonic–clonic convulsion. He had been receiving 200 mg itraconazole for 10 days. He had hypokalaemia (2.2 mEq/l), hypercalcaemia (Cacorr 11.0 mg/dl) and elevated serum parathyroid hormone (PTH, 95 pg/ml). Ultrasound examination of the neck revealed a low echoic tumour. Cessation of itraconazole and fluid supplementation eradicated clinical symptoms and profound hypokalaemia, but serum potassium remained low normal (3.4 mEq/l) and the mild hypercalcaemia and elevated PTH were unchanged. To conclude, a small amount of itraconazole (200 mg) precipitated profound hypokalaemia and seizure in a patient with mild hyperparathyroidism and low normal serum potassium.

Author Biographies

Toru Aizawa,
Diabetes Center, Aizawa Hospital, Matsumoto Senior Consultant

References

  • Amichai B, Grunwald MH. Adverse drug reactions of the new oral antifungal agents--terbinafine, fluconazole, and itraconazole. Int J Dermatol 1998;37:410–415.

  • Aldinger KA, Samaan NA. Hypokalemia with hypercalcemia: Prevalence and significance in treatment. Ann Intern Med 1977;87:571–573.

  • Bayat-Mokhtari F, Palmieri GM, Moinuddin M, Pourmand R. Parathyroid storm. Arch Intern Med 1980;140:1092–1095.

  • Amin AL, Wang TS, Wade TJ, Yen TW. Normal PTH levels in primary hyperparathyroidism: still the same disease? Ann Surg Oncol 2011;18:3437–3442.

  • Kim DD, Que L, Raizis AM, Florkowski CM. Novel inactivating mutation of the calcium-sensing receptor in a young woman with mild hypercalcaemia. Intern Med J 2014;44:413–416.
  • Published: 2015-06-30

    Issue: Vol 2 No 3 (2015) (view)

    Section: Articles

    How to cite:
    Nakasone, Y., Uchino, S., Sato, Y., Yamauchi, K., & Aizawa, T. (2015). Seizure and Profound Hypokalemia: Unusual Presentation of Primary Hyperparathyroidism. European Journal of Case Reports in Internal Medicine, 2(3). https://doi.org/https://doi.org/10.12890/2015_000196