Advanced Cataracts and Pseudotumor Cerebri as the First Presentations of Hypoparathyroidism

Purpose: To report a rare case of a patient with hypoparathyroidism presenting with bilateral disc swelling and near mature cataract as her first clinical manifestation Case report: A 23-year-old woman presented with complaint of worsening vision since one year ago and a history of refractory seizures and headache for several years, being under treatment with Lamotrigine 50 mg/daily. Slit-lamp examination revealed significant cataracts on both sides. Red reflex was dull in the right eye and absent in the left side. The intraocular pressure (IOP) measurement was normal in both eyes (16 mmHg). Her fundus examination revealed disc swelling in her right eye and hazy media that obscured fundus examination due to dense cataract in the left eye. The combination of bilateral disc swelling and dense cataracts raised suspicion to hypoparathyroidism. Subsequently, neuroimaging and intracranial pressure (ICP) monitoring was requested along with neuro-ophthalmalogy consultation. The diagnosis was Psedotumor Cerebri. Due to increased ICP, she underwent multiple lumber punctures. Computed tomography (CT) scan showed abnormal signal density in basal ganglia suggestive for presence of calcium depositions, making the diagnosis of hypoparathyroidism more probable. Ensuing laboratory result made the definite diagnosis of hypoparathyroidism. Meanwhile the cataract progressed and the visual acuity (VA) decreased to HM in her both eyes. She underwent cataract extraction and PCIOL implantation. Papilledema resolved and the vision restored to 20/20. Conclusion: Ocular complaints happens very rare in the course of hypoparathyroidism but still it seems rational that this occasionally fatal condition be ruled out by hormonal evaluation for cases of unexplained cataracts, particularly if it is accompanied by disc swelling.