Version May 2024
| Low PTH (hypoparathyroidism) |
| Genetic disorders |
| Abnormal parathyroid gland development |
| Abnormal PTH synthesis |
| Activating mutations of calcium-sensing receptor (autosomal dominant hypocalcemia or sporadic isolated hypoparathyroidism) |
| Postsurgical (thyroidectomy, parathyroidectomy, radical neck dissection) |
| Autoimmune |
| Autoimmune polyglandular syndrome (associated with chronic mucocutaneous candidiasis and primary adrenal insufficiency) |
| Isolated hypoparathyroidism due to activating antibodies to calcium-sensing receptor |
| Infiltration of the parathyroid gland (granulomatous, iron overload, metastases) |
| Radiation-induced destruction parathyroid glands |
| Hungry bone syndrome (post-parathyroidectomy) |
| HIV infection |
| High PTH (secondary hyperparathyroidism in response to hypocalcemia) |
| Vitamin D deficiency or resistance |
| Multiple causes |
| PTH resistance |
| Missense mutation in PTH |
| Pseudohypoparathyroidism |
| Hypomagnesemia |
| Kidney disease |
| Loss of calcium from the circulation |
| Hyperphosphatemia |
| Tumor lysis |
| Acute pancreatitis |
| Osteoblastic metastases |
| Acute respiratory alkalosis |
| Sepsis or acute severe illness |
| Drugs |
| Inhibitors of bone resorption (bisphosphonates, calcitonin, denosumab), especially in vitamin D deficiency |
| Cinacalcet |
| Calcium chelators (EDTA, citrate, phosphate) |
| Foscarnet (due to intravascular complexing with calcium) |
| Selected gadolinium-based contrast agents (gadodiamide, gadoversetamide) may cause spurious hypocalcemia by interfering with laboratory measurement of total calcium |
| Phenytoin (due to conversion of vitamin D to inactive metabolites) |
| Fluoride poisoning |
| Disorders of magnesium metabolism |
| Hypomagnesemia can reduce PTH secretion or cause PTH resistance and is therefore associated with normal, low, or high PTH levels |
Data from: Thakker RV. Hypocalcemia: Pathogenesis, differential diagnosis, and management. In: Primer on the metabolic bone diseases and disorders of mineral metabolism, sixth edition, American Society of Bone and Mineral Research 2006; 35:213.
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