Idiopathic hypoparathyroidism presenting as fatigue

Fatigue is a common symptom encountered in clinical practice, often posing a diagnostic challenge due to its myriad underlying causes. A comprehensive clinical history can serve as a valuable guide in such diagnostic dilemmas. A man in his 30s presented with a history of intermittent fatigue. The history of premature cataract surgery prompted an investigation for hypocalcaemia. Subsequent evaluation revealed hypocalcaemia, hyperphosphatemia and low serum parathyroid hormone. Additionally, elevated creatine kinase and lactate dehydrogenase levels were noted. Treatment with calcium and alfacalcidol yielded a favourable response. This case underscores the significance of revisiting clinical history and considering hypocalcaemia as a potential aetiology in cases of unexplained fatigue. It also emphasises the potential for overlooking the diagnosis due to the inconspicuous nature of hypocalcaemic myopathy in idiopathic hypoparathyroidism.