Primary hypoparathyroidism (HPT) is rarely seen in the clinic, and it can be combined with rhabdomyolysis. There are few reports about this phenomenon. Therefore, it is significant to explore the etiology that is conducive to early diagnosis, timely treatment, and preventing the recurrence.

A 63-year-old man was admitted to our hospital with a severe upper respiratory tract infection and progressing decreased myodynamia of the lower limbs. Blood tests showed creatine kinase > 32000 U/L, creatinine 207.8 µmol/L, calcium 1.28 mmol/L, myoglobin 558.7 ng/mL, and parathyroid hormone 0 pg/mL. He was diagnosed with primary HPT with rhabdomyolysis, and severe upper respiratory tract infection was considered to be the initial trigger. He responded well to supplementation of intravenous calcium gluconate and oral calcium as well as bedside hemodialysis, fluid hydration, infection control, protecting the liver, etc. Creatine kinase, myoglobin, and serum calcium returned to normal, and muscle strength improved significantly. Symptoms improved after symptomatic treatment.

Severe infection should be prevented, which is the key cause of rhabdomyolysis in patients with HPT.

• Primary hypoparathyroidism
• Rhabdomyolysis
• Hypocalcemia
• Decreased myodynamia
• Respiratory tract infection
• Case report

Rhabdomyolysis presenting with severe hypokalemia as the first manifestation of primary hyperaldosteronism is extremely rare.

Two middle-aged Chinese females were admitted to our emergency department for muscular weakness and limb pain, and both have the history of early onset hypertension. Laboratory test showed elevated creatinine phosphokinase (4, 907 and 8, 531 IU/L) and extremely low serum potassium (1.38 mmol/L and 1.98 mmol/L). Rhabdomyolysis and severe hypokalemia were established as first diagnosis. Hypokalemic rhabdomyolysis was confirmed after nervous system disorders, autoimmune diseases and trauma were excluded. Adrenal computerized tomography scan and postural stimulation test revealed aldosterone-producing adenomas. They both received laparoscopic adrenalectomy and were stable at the 2-year follow-up visit.

The two cases remind physicians to bear in mind the risk of hypokalemia-induced rhabdomyolysis among patients with primary hyperaldosteronism.