Text Box: HYPOPARATHYROIDISM AS A RARE MANIFESTATION OF WILSON’S DISEASE: A CASE REPORT Ahmadi A University Hospital No. 1, Kerman, Iran A 13 year–old girl was admitted to the pediatric ward of Hospital No 1 of Kerman University because of crampy pains, numbness, and history of seizure. Her problem started one week prior to admission. On physical examination, the prominent finding included mild hepatomegaly, exaggeration of deep tendon reflexes, and positive Chvostek and Trousseau signs. Laboratory test values on admission were as follows: Ca++ 2 mg/dL, phosphorus (P) 8 mg/dL, and undetectable serum PTH level. Urinalysis indicated 2+ glycosuria and a mild proteinuria. Radiologic studies revealed only mild generalized osteoporosis. The patient was treated with calcitriol and calcium with the impression of hypoparathyroidism. One week later, serum Ca++ and P were normal and the patient was discharged in good condition. One and a half months later, the patient experienced ecchymotic lesions on her thigh and calf. PT and PTT were prolonged and therapy with supplementary vitamin K was started. In regard to hypoparathyroidism, hepatomegaly and coagulopathy, Wilson’s disease was considered as the etiology; this was confirmed with low serum ceruloplasmin level, 24﷓h high urinary excretion of copper and existence of corneal Kayser–Fleischer ring. It was concluded that parathyroid insufficiency was due to Wilson’s disease, secondary to copper deposition in parathyroid glands. The exact prevalence of hypoparathyroidism in Wilson’s disease is not known, though it seems to be a rare finding. There is no report of hypoparathyroidism as the first manifestation of Wilson’s disease in literature, hence this patient is most probably the first case of Wilson’s disease presenting with hypoparathyroidism as the first manifestation. 1202