IHP is an uncommon endocrine disorder characterized by hypocalcemia, which can lead to diverse neurological and psychiatric manifestations. Chronic hypocalcemia may also lead to basal ganglia calcifications, contributing to neuropsychiatric symptoms. Despite calcium correction, neuropsychiatric symptoms may persist, highlighting the complexity of managing IHP.

A 35-year-old female presented with status epilepticus and a history of recurrent muscle spasms, seizures, and auditory hallucinations. Clinical examination revealed positive Chvostek and Trousseau signs, suggestive of hypocalcemia, alongside moderate cognitive impairment. Imaging studies showed bilateral basal ganglia and cerebellar dentate nuclei calcifications, and laboratory investigations confirmed severe hypocalcemia, hyperphosphatemia, and significantly low PTH levels. The absence of surgical history, autoimmune disorders, or other identifiable causes led to the diagnosis of idiopathic hypoparathyroidism (IHP). While seizures were controlled with high-dose calcium and vitamin D supplementation along with antiepileptic medications, the patient's auditory hallucinations persisted, underscoring the challenges in managing neuropsychiatric symptoms in idiopathic hypoparathyroidism despite metabolic correction.

IHP should be considered in patients presenting with persistent seizures and psychiatric symptoms. Early recognition and effective management of hypocalcemia are essential to improve patient outcomes. The refractory nature of neuropsychiatric symptoms in IHP underscores the need for a multidisciplinary approach and continued research into optimal therapeutic strategies. Regular monitoring of calcium levels and patient education on treatment adherence are vital for long-term management.