Sisters came to our hospital complaining of short fingers and toes in 1984. The elder was 8 years old and the younger was 7 years old. They exhibited short metacarpal and metatarsal bones due to early epiphyseal closure on physical examination, and normal serum calcium, phosphorus and parathyroid hormone on laboratory findings, we diagnosed pseudopseudohypoparathyroidism. But they developed hypocalcemia and hyperphosphatemia with the growth spurt. Ellsworth-Howard test recently performed using human PTH showed positive urinary cyclic AMP response and negative phosphauric response, so we diagnosed them pseudohypoparathyroidism Type II by Drezner's classification.
We thought their serum calcium level had been barely within normal range with the normal level of circulating 1, 25-dihydroxyvitamin D because of a mild form of pseudohypoparathyroidism, but increased calcium requirement with the growth spurt caused hypocalcemia and hyperphosphatemia.
