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Case report
Pulmonary alveolar proteinosis (PAP) in idiopathic hypoparathyroidism
  1. Soma Saha1,
  2. Karan Madan2,
  3. Deepali Jain3 and
  4. Ravinder Goswami1
  1. 1 Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, Delhi, India
  2. 2 Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, Delhi, India
  3. 3 Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Professor Ravinder Goswami; gosravinder{at}


Idiopathic hypoparathyroidism (IH) and autoimmune pulmonary alveolar proteinosis (PAP) are rare disorders. A patient with IH and optimal calcaemic control on calcium and alfacalcidol was detected to have PAP after 8 years of follow-up. Patient had no respiratory complaints. Routine abdominal imaging for renal calcification showed patchy ground glass opacities in the lower lung fields leading to incidental diagnosis of PAP. Pulmonary function tests showed impaired diffusion capacity of the lung. Anti-granulocyte macrophage-colony stimulating factor autoantibodies were positive. Patient regularly attended the pulmonary clinic and showed progressive improvement in diffusion capacity of the lung during 2 years of follow-up. The calcaemic control in IH remained stable despite its presence with PAP. The autoimmune PAP in the presented case suggests a possible autoimmune basis of IH.

  • endocrine system
  • respiratory medicine

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  • Contributors RG and SS managed the patient in the endocrine clinic and KM managed the patient in the pulmonary clinic. SS, KM and RG equally contributed in the planning, conduct, reporting, acquisition of data, analysis and interpretation of the data. DJ reported the histopathology slides. All authors have approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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