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Hyperparathyroidism: an overview of information
Last reviewed: 23.04.2024
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Hyperparathyroidism - fibro-cystic osteodystrophy, Recklinghausen's disease - a disease associated with the pathological hyperproduction of parathyroid hormone by hyperplastic or tumor-altered parathyroid glands.
According to most authors, hyperparathyroidism occurs at a frequency of 1: 1000 people, women are sick 2-3 times more often than men. Hyperparathyroidism usually occurs in people aged 20-50 years. Children, young men and old people rarely get sick. However, there are cases of congenital primary hyperparathyroidism.
For the purpose of screening for hyperparathyroidism, the serum calcium level was studied in 50,000 people; a few dozen serums with a high calcium content were detected. More recently, it became known that there is a primary hyperparathyroidism and with normocalcemia.
The cause and pathogenesis of hyperparathyroidism. There are primary, secondary and tertiary hyperparathyroidism.
In the case of primary hyperparathyroidism (I GPT), the hyperproduction of parathyroid hormone is usually associated with the development of autonomic-functioning adenoma of parathyroid glands (parathyroidoidomas), less often - with two or more adenomas, with diffuse hyperplasia or with OCJD cancer.
Secondary hyperparathyroidism (II GPT) is the reactive hyperproduction of parathyroid hormone by hyperfunctioning and / or hyperplastic OGDZH in conditions of prolonged hyperphosphatemia and insufficiency of 1,25 (OH) 2 D 3 in chronic renal failure; chronic hypocalcemia in diseases of the gastrointestinal tract with impaired absorption (malabsorption syndrome).
The causes and pathogenesis of hyperparathyroidism
Symptoms of hyperparathyroidism. Hyperparathyroidism develops, as a rule, slowly and gradually. Symptoms of hyperparathyroidism are manifold. Early symptoms (depending on the predominant nature of the lesion). There may be changes in the therapeutic (mainly gastrointestinal), urological, traumatic, rheumatological, dental, neuro-psychic. The uncertainty of complaints in the initial period of hyperparathyroidism leads in the absolute majority of patients to an incorrect or belated diagnosis.
The first manifestations of the disease are usually general and muscle weakness, rapid fatigue. There are weakness and pain in certain muscle groups, especially the lower extremities. It becomes difficult to walk (the patients stumble, fall), get up from the chair (need to rely on the hands), enter the tram, the bus develops a duck walk and looseness in the joints, pains in the feet (flat feet) are felt due to muscle relaxation. All these manifestations are associated with hypercalcemia, which causes a decrease in neuromuscular excitability and muscle hypotension. Patients because of severe weakness are confined to bed sometimes even before the appearance of fractures. Skin of earthy shade, dry.
Symptoms of hyperparathyroidism
Diagnosis and differential diagnosis of hyperparathyroidism. Diagnosis of hyperparathyroidism, especially in the early stages of the disease, is difficult. It is based on an assessment of anamnesis, clinical, radiologic, biochemical and hormonal parameters. Pathognomonic clinical signs are changes in the organs of vision - calcification in the eyelids, keratopathy, ECG - shortening of the ST interval.
Important information for the diagnosis of hyperparathyroidism is provided by the X-ray method of investigation. To characterize the state of the skeleton in the dynamics, repeated radiography of bones with standard density radiocontrasts, scanning of the skeleton with 131 1-diphosphonates, and also γ-photon absorption spectrometry is used.
The basis of hyperparathyroidism is the violation of phosphorus-calcium metabolism. The study of biochemical indicators reveals an increase in the content of calcium in the blood serum; this is the most important sign for hyperparathyroidism. The normal level is calcium 2.25-2.75 mmol / l (9-11.5 mg%). In hyperparathyroidism, it is increased to 3-4 mmol / l, and under hyperparathyroid crisis conditions - up to 5 mmol / l and more.
Diagnosis of hyperparathyroidism
Treatment of hyperparathyroidism. The main type of treatment for primary and tertiary hyperparathyroidism is surgical intervention - removal of parathyroidism or several adenomas. Especially necessary surgery (for emergency indications) with the development of a hyperparathyroid crisis. In secondary hyperparathyroidism, surgical intervention is indicated by the combination of a persistent increase in parathyroid hormone and blood calcium, a violation of the calcium and phosphorus ratio, the presence of metabolic disorders in the bone tissue, the appearance of calcification of soft tissues. When surgical treatment of primary hyperparathyroidism due to cancer of the parathyroid glands (4,5-5% of cases), it is necessary to remove the tumor together with the adjacent thyroid gland. In hyperparathyroidism, associated with hyperplasia of the parathyroid glands, subtotal or complete removal is indicated (in the latter case, their intramuscular implantation is desirable). A typical postoperative complication is persistent hypoparathyroidism (2-3% of observations) and transient hypoparathyroidism.
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