THE clinical syndrome of idiopathic hypoparathyroidism has recently been reviewed by Steinberg and Waldron (1). They accept the criteria previously established by Drake and associates (2)—low serum calcium level, high serum phosphate level, normal renal function, normal bones by x-ray examination, and chronic tetany—but make several minor modifications. These include the requirement that the serum phosphorus level be above 5 mg. per 100 ml. in adults and above 7 mg. per 100 ml. in persons under the age of 16, and that the clinical course be not characterized by chronic diarrhea. The coincidence of idiopathic hypoparathyroidism and chronic adrenal insufficiency (Addison's disease) has been reported in 3 previous cases to our knowledge. Only 1 of these;, however, (that reported by Leonard (3) in 1946) would seem to have been sufficiently documented to make both diagnoses certain. The foregoing criteria for the diagnosis of idiopathic hypoparathyroidism were met in this case, and autopsy revealed complete fibrosis of the adrenal cortices (“primary atrophy”) and total absence of the parathyroid glands. The 2 other cases which probably represented combined parathyroid and adrenal insufficiency, cannot be accepted unequivocally. The first (Case #3 of Sutphin, Albright, and McCune (4)) was a 12-year-old boy with hypocalcemia and tetany, who subsequently showed pigmentation, hypotension, and weight loss which terminated fatally; but there was no documented hyperphosphatemia (above 5 mg. per 100 ml.), adrenal function studies could not be made, and there was no autopsy. The second, (an 8-year-old girl reported by Talbot, Butler and MacLachlan (5)) had well demonstrated hypoadrenalism as well as hypoparathyroidism, but the details of the latter were not reported and, therefore, cannot be evaluated.
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Leifer et al. (1953) studied this question.