Two years ago, Dr Alexander K. C. Leung reported on a case of pseudopseudohypoparathyroidism (CONSULTANT, April 1999, page 1296). The patient was a 13-year-old girl with short stature, short fourth metacarpals and metatarsals, mild mental retardation, and no identifiable biochemical abnormalities (A).
Drs Leung and Justine H. S. Fong of Calgary, Alberta, report that this patient, now 15 years old, presented with pain and swelling of the right fourth finger of 3 months' duration. Restriction of movement was noted in the digit's distal interphalangeal joint. A radiograph of the right hand showed a short fourth metacarpal and extensive metastatic calcification on the posterolateral margin of the distal and middle phalanges of the middle finger (B). The area of calcification measured approximately 1 × 3.5 cm.
Metastatic calcification in patients with pseudopseudohypoparathyroidism commonly affects the subcutaneous tissues and basal ganglia.