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December 10, 2016 00:03

Hyperparathyroidism - Overview information

Hyperparathyroidism - fibrocystic osteodystrophy, Recklinghausen's disease - a disease associated with pathological overproduction of parathyroid hormone hyperplastic or tumor-modified parathyroid glands.

According to most authors, hyperparathyroidism occurs with a frequency of 1: 1000, women suffer 2-3 times more often than men.Hyperparathyroidism is mainly in people 20-50 years of age.Children, youths and the elderly are ill they rarely.However, there are cases of congenital primary hyperparathyroidism.

the purpose of screening for hyperparathyroidism serum calcium was investigated in 50,000 people;several tens of sera with high calcium content has been found.More recently, it became known that the common primary hyperparathyroidism and normocalcaemia.

cause and pathogenesis of hyperparathyroidism.There are primary, secondary and tertiary hyperparathyroidism.

In primary hyperparathyroidism (I ATG) overproduction of parathyroid hormone usually associated with the development of the autonomous func

tioning adenomas of the parathyroid glands (paratireoidadenomy), at least - two or more adenomas, with diffuse hyperplasia or cancer OGDZH.

Secondary hyperparathyroidism (II ATG) - a reactive overproduction of parathyroid hormone hyperfunctioning and / or hyperplastic OGDZH in conditions of prolonged failure hyperphosphatemia and 1,25 (OH) 2D3 in chronic renal failure;Chronic hypocalcemia in diseases of the gastrointestinal tract with impaired absorption (malabsorption syndrome).

causes and pathogenesis of hyperparathyroidism

symptoms of hyperparathyroidism.Hyperparathyroidism usually develops slowly and gradually.The symptoms of hyperparathyroidism diverse.Early symptoms (depending on the prevailing nature of the defeat).There may be changes in the therapeutic (mainly gastrointestinal), urology, trauma, rheumatology, dental, neuro-psychological nature.The uncertainty of the complaints in the initial period hyperparathyroidism leads the absolute majority of patients to incorrect or delayed diagnosis.

first manifestations of the disease are usually general and muscle weakness, fatigue.It appears weakness and pain in particular groups of muscles, especially the lower extremities.It becomes difficult to walk (patients stumble, fall), to get up from a chair (necessary reliance on hand), enter the tram, bus develops duck gait and looseness in the joints, pain is felt in the feet (flat feet), due to muscle relaxation.All of these symptoms are associated with hypercalcemia, which causes a decrease in neuromuscular excitability and muscle hypotonia.Patients due to severe weakness bedridden sometimes even before the fracture.Leather earthy shade, dry.

Symptoms of hyperparathyroidism

Diagnosis and differential diagnosis of hyperparathyroidism.Diagnosis of hyperparathyroidism, particularly in the early stages of the disease, is difficult.It is based on an evaluation of medical history, clinical, radiological, biochemical and hormonal parameters.Pathognomonic clinical signs are changes in the organs of sight - calcifications in the eyelids, keratopathy, by ECG - shortening of the ST interval.

Important information for the diagnosis of hyperparathyroidism gives the X-ray method of investigation.To characterize the state of the skeleton in the dynamics of re-used bone radiography with radiopaque standard density, skeletal scanning with 1311-diphosphonates as well as in-photon absorptiometry.

basis hyperparathyroidism constitute violations of calcium-phosphorus metabolism.The study of biochemical indicators reveals an increase of calcium in blood serum;It is the most important attribute for hyperparathyroidism.The normal calcium levels 2,25-2,75 mmol / l (9-11,5 mg%).When it hyperparathyroidism raised to 3.4 mmol / l, and in terms of hyperparathyroid crisis - 5 mmol / liter or more.

diagnosis of hyperparathyroidism

treatment of hyperparathyroidism.The main type of treatment for primary and tertiary hyperparathyroidism is surgery - removal paratireoadenomy or multiple adenomas.Especially needed surgery (for emergency indications) in the development of hyperparathyroid crisis.In secondary hyperparathyroidism surgery is shown at a combination of PTH and persistent increase of blood calcium, phosphorus, calcium and tackle ratio, in the presence of disturbances of bone metabolism, occurrence of soft tissue calcification.In the surgical treatment of primary hyperparathyroidism caused by parathyroid cancer (4.5-5% of cases), it is necessary to remove the tumor, together with the adjacent thyroid lobes.When hyperparathyroidism associated with hyperplasia of the parathyroid glands, shown subtotal or total removal of (in the latter case is desirable their intramuscular implantation).A common post-operative complication is persistent hypoparathyroidism (2-3% of cases) and transient hypoparathyroidism.

treatment of hyperparathyroidism