Paratyrene

Paratirenoma is a hormone-producing tumor, usually benign, which is characterized by an increase in the level of calcium in the blood and the corresponding clinical signs. This diagnosis is very difficult to establish, because the location of the tumor is often ectopic, which requires additional sophisticated diagnostic methods.

Causes of the paratyrenoma

Parathyrene is a tumor from cells that have a similarity to the cells of the parathyroid glands. Therefore, such a tumor have the same functions and is characterized by increased production of parathyroid hormone. Under normal conditions, the parathyroid glands are located on the posterior surface of the thyroid glands and have a capsule common to them. Their number is four, and the shape is no more than a bean. But with parathyrene, their dimensions increase and their number can be much larger. Also, there are cells with an ectopic location, that is, parathyrene with an ectopic source of hormone production.

The exact cause of paratyrene formation, as well as of all tumors, is very difficult to determine. The etiological factor that induces an excessive division of cells of the parathyroid glands may be external and internal factors. Among the internal causes can be identified the following:

• gene and chromosomal mutations of cells on a certain cycle of development, which lead to a violation of cell division;
• influence of biologically active substances and growth factors on the processes of cellular differentiation;
• congenital ectopia of the parathyroid glands;

Among the environmental factors that can cause parathyroidism can be identified:

• ionizing radiation or the action of radio waves with a certain frequency on the human body can cause a violation of the regulation of cell division;
• postoperative trauma of the parathyroid gland tissue in the case of thyroidectomy can cause ectopic metastasis of cells with subsequent activation of the function of these cells;
• the influence of viruses, bacteria, fungi and other living organisms is often associated with the theory of oncogenesis, in this case these factors can not be excluded from causal factors;
• disorders of hormonal regulation with an elevated level of certain hormones that are associated with the level of calcium in the blood;
• disturbance of the bone system under the influence of exogenous factors.

These reasons can act at any time in human life, so it is impossible to predict the development of paratyrene.

Pathogenesis

The pathogenesis of parathyrene formation is the induction of excessive cell division, which stimulates their function and the corresponding clinical signs. Thus, when a certain etiologic factor begins to act, the cells of the parathyroid gland begin to be intensively uncontrolled, which is accompanied by an increase in the normal size of the gland. At the same time, their functional activity also increases and a huge amount of parathyroid hormone is synthesized. When the tumor mass increases in volume, it becomes necessary to spread it. So there are ectopic foci from the cells of the parathyroid gland, which are called extraendocrine parathyrene. These foci can spread into the thoracic cavity, abdominal cavity, intestine. No local changes in parathyrene in this case does not cause, because it is not malignant and does not violate the normal topic of other organs. But its function increases in proportion to the mass of cellular structures. And, thus, the amount of parathyroid hormone increases.

The pathogenesis of the development of clinical symptoms in parathyrene depends on the level of this hormone. Under normal conditions, the parathyroid hormone increases the amount of calcium in the human blood, being a calcitonin antagonist. In this case, the parathyroid hormone acts on the osteoclasts of the bone tissue and this is accompanied by the intensification of their function with the release of free calcium from the bones and ingress of it into the blood. Also, the parathyroid hormone acts on the intestine by the enhanced absorption of calcium and the synthesis of proteins, which are transport forms of the calcium molecule.

Thus, the amount of calcium in the blood increases significantly, and the function of calcitonin is not enough to regulate the normal level of calcium, especially in the presence of ectopic foci of parathyrene. This also contributes to the manifestation of a specific clinical picture.

Symptoms of the paratyrenoma

Hypercalcemia as a leading sign of endocrine tumors of the pancreas is a rare phenomenon. Ectopic secretion of parathyroid hormone in these tumors has not been fully proved, because it is difficult to decide whether manifestations of hyperparathyroidism result from a pancreatic tumor or are part of multiple endocrine neoplasia of type I, which is often observed in islet-cell neoplasms in general.

It should be borne in mind that hypercalcemia can be the result of a metastatic process in the bone.

The clinical course of parathyrene is not malignant, as this tumor does not reveal any local manifestations. Symptoms are caused mainly by the level of calcium in the blood, which affects many human organs. Calcium is a microelement that provides cardiac activity, the work of muscle and nerve fibers, as well as the structure of bone tissue. Calcium also takes part in the normal conductivity of the impulse and the contraction of muscle fibers. He is the main initiator of muscle contraction at the moment when he enters through the calcium channels inside the cell. With parathyrene, the amount of calcium in the blood increases and, accordingly, its passage through the canals increases.

Increased calcium content inside the cell causes a huge inflow of water, which in turn promotes intracellular hyperhydration. The edema of the muscle fibers causes compression of the nervous ganglia and nerve endings, which is a factor in the development of the clinical picture caused by parathyrene. This is accompanied by a violation of the innervation of the muscles and their contraction, which at the initial stages is manifested as numbness and paresthesia of the distal muscles of the upper and lower extremities. Therefore, the first signs of parathyroidism can be manifested by such nonspecific symptoms as numbness of the hands, paresthesia, increased fatigue of the muscles.

Further, when the level of calcium in the blood increases to such a level that the amount in the cell and outside the cell is leveled, then more serious clinical signs of the disease appear. The muscle cell is not able to relax, because the calcium channels do not work, then the cell starts to fall and the muscle spasm lasts more than usual, which causes manifestations in the form of convulsions. Thus, convulsions are another clinical symptom of parathyroidism. Seizures can be localized in the distal muscles with the clinic of the spasm of part of the arm or leg as a "midwifery hand" or "horse foot". Also, with a pronounced clinical picture, there may be convulsions of the respiratory muscles, which can be fatal. Prolonged and recurring convulsions are a serious symptom, as they can lead to tetany, spasm of the glottis and this is also dangerous complications. It is this clinical picture that can lead to the thought of a possible elevated level of calcium in the blood, which in the future will make it possible to suspect parathyroidism.

Also a symptom of parathyroidism can be considered osteoporosis, which develops against the background of an increased amount of parathyroid hormone. In this case, there are symptoms in the form of frequent fractures, violations of the axis of bones and their curvature. There are complaints of pain in the legs, joints, fatigue sensation of the legs. This important clinical symptom is often the main symptom that causes patients to consult a doctor.

With a prolonged progressive course of the disease, calcium salts form conglomerates that can be deposited as kidney stones with the provocation of a renal colic clinic. But this is by no means a specific feature and is not the main thing in the paratyrenoma clinic.

The nonspecific clinical picture of such a benign tumor allows not to give any serious signs for a long time, therefore it is important not to forget about the probable symptoms of parathyrene and to check the level of electrolytes of blood in time.

Complications and consequences

The most serious complication of parathyroidism can be considered the development of tetany of muscles against the background of prolonged hypercalcemia. In this case, there may be a contraction of the diaphragm, the glottis and other respiratory muscles, which can lead to death. Therefore, it is necessary to clearly monitor the level of calcium in the blood with the possible rapid introduction of the necessary drugs.

Diagnostics of the paratyrenoma

The diagnosis of paratyrene is difficult to establish and confirm, especially if it has ectopic localization. In this case, there may be normal sizes of the parathyroid glands and their function, whereas the main role in the development of the symptomatology is played by ectopic foci of parathyrene. Then the diagnosis can be established only clinically without an accurate confirmation.

Often patients with parathyroidism come with complaints of pain in the legs, a feeling of aching in the bones, as well as twitching or frequent muscle cramps. Then it is necessary to accurately study the history and to identify possible provoking factors. It is important to find out when the symptomatology first began and how it progressed. It is necessary to clarify the state of the thyroid gland, to find out whether any surgical interventions were performed on the thyroid gland. This is an important diagnostic sign, since trauma or removal of the parathyroid glands is possible, which subsequently provoked their ectopia and increased function.

When examined, no specific symptoms can not be determined. It is very important to carry out additional diagnostic methods in case of suspicion, to any education of a similar nature.

Analyzes, which must be carried out first and which help determine the severity of the disease, is the determination of the level of blood electrolytes. This is also necessary for the differential diagnosis of various pathologies with similar symptoms. Therefore, a biochemical blood test is performed to determine the level of calcium, magnesium and potassium in the blood. The normal level of blood calcium is 2.25 - 2.75 mmol / l. If this figure is significantly higher than the norm, then another analysis is needed - the determination of the level of parathyroid hormone in the blood and calcitonin. The level of these hormones will allow talking about a possible paratyrene, if the level of parathyroid hormone is significantly increased, like calcium.

Instrumental diagnostics of parathyrene is carried out as the final stage of diagnosis for the specification of tumor size and localization. The most informative method is computed tomography or magnetic resonance imaging. These methods of investigation make it possible to see the state of the parathyroid glands, their size and structure due to numerous transverse sections with the help of X-rays. Thus, one can see a tumor of the parathyroid glands, establish its size and confirm the diagnosis. In the absence of the possibility of carrying out such methods of research, one can use ultrasound examination of the thyroid gland and parathyroid glands. On ultrasound, you can also see pockets of parathyroid glands in the form of a tumor that have an increased echogenicity against the background of the normal structure of other glands.

Confirm the diagnosis of a benign process is necessary with the help of a thin-needle biopsy. This should also be done for the purpose of differential diagnosis, since the parathyroidal node may resemble tumor metastasis. Therefore, under the supervision of ultrasound, biopsy of parathyrene is performed and after the cytological examination it is possible to establish the diagnosis accurately and to exclude malignant growth.

Differential diagnosis

Differential diagnosis of parathyroidism should be carried out at the stage of symptomatology, when complaints of convulsions and paresthesia in the muscles can be caused by a simple lack of trace elements - magnesium, calcium. Then it is important to conduct a blood test, which can reveal the normal level of magnesium against the background of a significant increase in calcium. When performing ultrasound or CT, MRI should distinguish parathyrene, as a benign tumor and metastasis in the parathyroid gland or thyroid. In this case, the paratyrene has a clear contour, a homogeneous structure and even boundaries, since it does not extend to surrounding tissues and does not have malignant growth. Metastasis does not have a clear structure and boundaries, and a primary tumor is also identified.

Such diagnostic measures are necessary to establish a timely diagnosis, since with the progression of the tumor mass the clinic is strengthened, and complications may appear.

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Treatment of the paratyrenoma

Treatment of paratyrenoma is a very difficult task, because any tumor, even if it is benign, does not lend itself to conservative treatment. But in the case of parathyroidism, treatment can only be symptomatic, associated with pathogenetic features. If the tumor mass does not increase in size in dynamics, then conservative therapy is shown for a while, which will allow normalizing the level of calcium and reduce the severity of the clinic.

First you need to start with dietary recommendations. It is necessary to limit the amount of calcium that comes with food:

• to exclude cottage cheese from the diet;
• Exclude milk, butter, you can only kefir once a week;
• It is also necessary to exclude hard cheese and acidic products - sorrel, lemons.

These dietary recommendations concern only an acute period, when the level of parathyroid hormone and calcium is increased. Then the diet is expanded according to the number of trace elements in the blood.

A very important point in the treatment of paratyrenoma is the correction of hypercalcemia. For this, infusion therapy with physiological saline followed by forced diuresis is performed at the initial stages. This accelerates the excretion of calcium without the formation of stones, and also normalizes the water-electrolyte balance inside the cell and outside. To do this, use furosemide, as a loop diuretic, which effectively and quickly stimulates the work of the kidneys.

1. Furosemide is a diuretic that acts by reducing the reabsorption of sodium and chlorine in the tubules of the nephron, which facilitates the rapid elimination of metabolic products, including calcium salts. The method of application of the drug consists in its introduction at the end of the infusion therapy intravenously drip, which makes it possible to achieve the so-called forced diuresis. Dosage of the drug - from 20 to 60 milligrams per day, which is administered one or two times. Side effects are possible in the form of allergic skin reactions with severe itching, dizziness, decreased pressure, drowsiness, sleep disturbance and increased blood sugar. Precautions - if there is a history of renal colic, the drug should be used with extreme caution.
2. Preparations that inhibit the action of parathyroid hormone in parathyrene should also be aimed at restoring bone resorption, since in this case the work of osteoclasts and calcium that comes from the bones decreases in the blood. Therefore, the use of drugs that prevent the resorption of bones is considered effective in treating parathyroidism - such drugs include bisphosphonates.

Pamidronate is a remedy from a group of drugs that inhibit the resorption of bone tissue. The active substance of the drug is pamidronic acid. The method of application of the drug depends on the outgoing level of calcium in the patient's blood, but on average the dosage is from 15 to 90 milligrams. The drug is administered intravenously drip, slowly, for two hours. The interval between administration of the drug is four weeks. Side effects are possible in the form of frequent headaches, initiatory pains in bones, muscles, abdominal pain, vomiting, dizziness are also possible.

1. Tevabon is an effective tool for the treatment of parathirenoma due to the pathogenetic action of the drug due to its combined composition. The active substance of the drug is alendronic acid and alfacalcidiol. Alendronic acid is a bisphosphonate, therefore it interferes with the resorption of bone tissue, and calcidiol is one of the forms of vitamin D and ensures the normalization of calcium-phosphorus metabolism due to various mechanisms. One of such mechanisms is a decrease in calcium absorption in the intestine, as well as a decrease in the amount of parathyroid hormone, which is especially important with parathyrene. The method of application of the preparation has its own peculiarities - the preparation is issued in the form of tablets containing alendronic acid and in the form of capsules containing alfacalcidiol. The dosage of the drug is as follows: one tablet should be taken once a week, and capsules of alfacalcidiol one capsule daily. Side effects are possible in the form of dizziness, hypotension, muscle pain, seizures, as well as dyspepsia.

Surgical treatment of parathyroidism has its advantages, because only this method can completely rid the cause and cure the disease. To do this, it is necessary to accurately establish the localization of the tumor, its size and the topic of surrounding tissues, which will determine the amount of surgical intervention. The operation is carried out, as a rule, under general anesthesia and under the supervision of ultrasound if the tumor is small and there is the possibility of minimally invasive surgery. Otherwise, the surgery is open. The volume of the operation consists in the complete removal of the tumor and parathyroid gland from which it was formed and the preservation of unchanged glands for normal functioning in the future.

Physiotherapeutic treatment can be used in the postoperative period for better recovery of damaged tissues. Vitamins in the future should be selected without the calcium content in them, and calcium should be taken in a separate form at the need and under the control of the level of electrolytes of blood.

Alternative treatment of paratyrenoma

Alternative treatment of parathyrene can be used as a complex measure and is mainly aimed at reducing the amount of calcium in the blood due to its binding and the formation of insoluble elements. The main alternatives are:

1. Comfrey is a plant that helps normalize the function of bone cells and restore the normal structure of the beams, which reduces the severity of osteoporosis and bone pain. For medical infusion it is necessary to take three tablespoons of herbs, pour boiling water and boil over low heat for another five minutes, this infusion should be covered and insisted for three hours. Take in warm form five times a day for two tablespoons. The course of treatment is not less than three months.
2. Use of massage oil from medical products helps to normalize blood circulation in bone tissue and symptoms decrease. To do this, take three tablespoons of olive oil, add a tablespoon of aloe juice, a teaspoon of honey and vitamin E one ampoule. All this is to mix and massage the limbs every evening.
3. Wiping with cold water in the morning helps to normalize the level of calcium by regulating hormonal balance and affecting the thyroid gland. Therefore it is recommended to do such wiping every morning with the subsequent easy gymnastics.

Herbal treatment also has its advantages:

1. The licorice root has a very high tropism to the bone tissue and the muscular system, so it helps very well with limb spasms. To prepare the medicine you need to take the root of licorice, pour it with alcohol and insist for at least three days. Take this solution should be a teaspoon in the morning and in the evening two weeks.
2. Walnut is widely used for the treatment of bone pathology, therefore, as a symptomatic remedy, the drug can also be used. For medical infusion it is necessary to take three tablespoons of shell from walnut, pour boiling water and boil over low heat for another ten minutes, this infusion should be covered and insisted. Take in warm form in the morning and evening for one teaspoon. The course of treatment is one month.
3. Valerian root and nettle leaves have a good effect on phosphorus-calcium metabolism, so it is recommended for this disease. To do this, take the leaves of nettle and the root of valerian pour them with water and insist for ten minutes. Such a solution should be drunk in a glass twice a day.

Homeopathic remedies can also be used in the complex treatment of paratyrenoma:

1. Ferrum iodate is a one-component homeopathic preparation, the main active ingredient of which is the inorganic iron substance. The drug is recommended for the treatment of osteoporotic phenomena as a drug of the substitution mechanism of action. The drug is released in the form of standard homeopathic granules and dosage of it - ten pellets three times a day. The way of application - under the tongue after eating after half an hour. Precautions - do not use for allergies to conifers. Side effects are in the form of a disorder of the menstrual cycle that passes after the correction of the dose.
2. Fucus vesiclesus is a homoeopathic one-component agent that is used to correct the hormonal background and electrolyte metabolism in the pathology of the thyroid and parathyroid glands. The preparation is available in the form of drops and granules. Method of application and dosage - seven granules three times a day or ten drops per glass of warm water. Side effects are rare, dyspeptic disorders are possible.
3. Adonis vernalis is a homeopathic remedy of natural origin. The drug is released in the pharmacological form of the homeopathic solution in ampoules and is dispensed on the third part of the ampoule once a week with possible oral use. Side effects are not common, but there may be stool disruption, dyspeptic phenomena and allergic reactions. Precautions - it is impossible to use the drug for acute inflammatory process of any localization.
4. Spongia is a drug that is well suited to patients in the postoperative period for the treatment of thyroid hormone deficiency, as well as induced parathyrene. The drug is available in the form of drops and a dosage of five drops once a day.

These are the main alternative drugs and homeopathic medicines that are used most often.

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Prevention

Prevention of paratyrene formation can only be nonspecific and consists in general measures of proper nutrition, healthy lifestyle and avoidance of potential mutagens.

Forecast

Surgical intervention can be considered the "gold standard" of paratyrene management, but if this is not possible, then the result can be metastasis of the tumor and the formation of ectopic foci of these cells, and then there will be no opportunity to conduct a complete audit and eradication of the tumor.

The prognosis for life is favorable for life, since it is a benign tumor and with symptomatic measures of treatment the general condition of the patients is satisfactory, and they can live a long time. If an operation is performed to remove paratyrenoma, then the prognosis for complete recovery is also favorable.

Parathirenoma is a benign hormone-producing tumor of the parathyroid gland, which is characterized by an increase in the level of parathyroid hormone and calcium in the blood. The main clinical symptoms develop with significant changes and are not specific, so it is important to diagnose the pathology correctly and on time.