Hyperparathyroidism

October 12, 2011

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Hyperparathyroidism   - Is endocrine disease, based on which lies an excessive production parathyroid glands PTH . Increased hormone production is a consequence of gland hyperplasia , Which in turn leads to disruption of calcium and phosphorus metabolism. This happens enhanced removal of phosphorus and calcium from the skeleton, increase osteo clastic processes and excessive transport them in large amounts in the blood.

The simultaneous increase in the allocation of phosphorus, as well as reducing tubular reabsorption   leads to hypophosphatemia   and hyperphosphaturia While, in the bone there are signs of osteoporosis and osteomalacia . Most everyone is 2-3 times more than men, the disease affects women between the ages of 25 and 50 years.

The cause of hyperparathyroidism is a tumor of the parathyroid glands.

Depending on the cause of hyperparathyroidism are divided into the following types:

• Initial   Education appears as a consequence of parathyroid adenomas in the vast majority of cases. And only one out of ten cases of the reason is the emergence of Carcinoma   or hyperplasia, proliferation of normal cells and an increase in cancer.
• Secondary hyperparathyroidism   - There is a strengthening function, abnormal proliferation and swollen glands, prolonged low calcium content, while elevated levels of phosphate in the blood. There has been an increase in generation PTH   in chronic renal failure.
• Tertiary   - Observed the development of benign tumors of the parathyroid glands, as well as increased production of parathyroid hormone due to prolonged secondary hyperparathyroidism.
• Psevdogiperparatireoz   - Observed production of parathyroid tumors that did not arise from cells of the parathyroid glands.

According to the severity of the disease is divided into

• symptomatic   form.
• malosimptomno   (soft) form.
• asymptomatic   form.

Furthermore, the degree of the disease disease is divided into bone . kidney . visceral   and mixed   form.

Symptoms of hyperparathyroidism

Risk of disease is that it can occur without symptoms and detection or diagnosis of hyperparathyroidism occurs accidentally during examination. In the early stages of the disease the patient has a fatigue even at low loads, headache . muscular weakness , Difficulty walking, and especially when climbing up the ladder, characteristic waddle "duck" gait.

Patients experiencing emotional instability, resentment and anxiety, deteriorating memory, becomes depressed. The skin becomes sallow gray. In old age may appear different mental disorders .

To further develop signs of various internal organs - urolithiasis disease , Gallstones, stomach ulcers, osteoporosis and others.

Late stage bone hyperparathyroidism is characterized by softening of bones and curvature, the appearance of scattered bone pain of hands or feet, in the spine. Normal movement can lead to bone fractures that maloboleznennye, but slowly grow together, and the sometimes false joints is formed.

Because of deformable skeleton The patient may be even shorter. In osteoporosis patient jaw become loose or fall out healthy teeth. On the neck palpation palpable large adenoma   in the parathyroid glands. On the limbs appear visible periarticular calcification .

With vistseropaticheskom hyperparathyroidism   there is nausea, vomiting, sudden weight loss. Patients complain of loss of appetite, stomach pain, bloating. The examination revealed the appearance of peptic ulcers with bleeding And various signs of the pancreas and gall bladder, and polyuria develops symptoms of renal insufficiency. Disturbed nutrition of organs and tissues, a high concentration of calcium in the blood causes damage to blood vessels of the heart, high blood pressure, angina . When calcification ocular conjunctiva observed the so-called syndrome of "red eye."

When kidney shaped main symptoms of hyperparathyroidism:   polyuria   and alkaline reaction of urine. Perhaps the development of bilateral nefrokaptsinoza , Which in turn may lead to azotemia   and uremia . Patients concerned about high blood pressure, seizures, renal colic, dyspepsia. It appears duodenal ulcer or gastric perforation of the wall of possible stomach and intestines. Often possible chronic pancreatitis , The formation of gallstones.

Diagnosis of hyperparathyroidism

Diagnosis of the disease is carried out on the basis of blood samples, determining calcium and phosphorus in the body and urine.

If you find a high level of calcium is carried out other analyzes and studies: ultrasound, x-ray, CT and MRI scans that can detect osteoporosis, ulcers, abnormal gastrointestinal tract, cystic bone changes and other changes. Scintigraphy   parathyroid localization identifies the location of glands and their anomaly.

In secondary hyperparathyroidism performed diagnosis determines the disease.

The treatment of hyperparathyroidism

Treatment of the disease is carried out in a complex combination of conservative therapy medical drugs and operating surgery. Before the operation is conducted conservative treatment, the purpose of which is placed decline Ca level in blood .

Surgically removed malignant tumors of the parathyroid glands, and then radiation therapy.

Forecast favorable hyperparathyroidism held at a timely diagnosis of hyperparathyroidism and adequate surgical treatment. Full rehabilitation depends on the extent of the bone tissue. If the treatment of hyperparathyroidism initiated at an early stage, the patient recovers within a maximum of six months. In mid-severe cases, recovery lasts for 2 years. In advanced cases, the disability is likely.

Less favorable prognosis in renal hyperparathyroidism forms and is totally dependent on the degree of kidney before surgery. Without surgery - disability and death due to progressive cachexia   and chronic renal failure.

With hypercalcemic Stroke   The prognosis depends on the timeliness of treatment, mortality was 32%.

Complications of hyperparathyroidism

Dangerous complication is hypercalcemic crisis, threatening the patient's life. Crisis always occurs suddenly due to acute hypercalcemia. The risk factors are prolonged bed rest, the uncontrolled use of calcium and vitamin D, and thiazide diuretics. For the crisis is characterized by high body temperature rises to 40 C, vomiting, acute epigastric pain, drowsiness , Impaired consciousness, coma often. Also, there are complications such as a pulmonary edema, hyperparathyroidism, thrombosis , Peptic ulcer perforation, bleeding.