Symptoms of hypoparathyroidism

A patient with hypoparathyroidism is bothered by paresthesia, coldness and a crawling sensation throughout the body, especially in the extremities, convulsive twitching in the muscles, attacks of painful tonic convulsions, nervousness. In the late stages of the disease, skin changes, cataracts, calcifications in various organs and in the subcutaneous tissue appear.

Based on the course and nature of clinical features of hypoparathyroidism, two forms are distinguished: obvious (manifest), with acute and chronic manifestations, and hidden (latent).

The clinical symptoms of hypoparathyroidism consist of several groups of symptoms: increased neuromuscular conductivity and seizure readiness, visceral-vegetative and neuropsychiatric disorders.

The relative frequency of the main neurological and mental disorders in hypoparathyroidism is as follows: tetany occurs in 90% of patients, seizures - in 50.7%, extrapyramidal symptoms - in 11%, mental disorders - in 16.9% of patients. The most typical attacks of hypoparathyroidism are tetany, beginning with paresthesia, fibrillary twitching of muscles, turning into tonic convulsions, involving mainly symmetrical groups of flexors of the limbs (usually the upper ones), in severe forms - also the muscles of the face. During an attack, the arms are bent at the joints, the hand is in the form of an "obstetrician's hand"; the legs are extended, compressed together, the foot is in a state of sharp plantar flexion with bent toes (pedal spasm, "equine foot"). Spasms of the facial muscles cause a "sardonic" peculiar shape of the mouth ("fish" mouth), spasm of the masticatory muscles (trismus), spasms of the eyelids. Less often, there is a spasm of the trunk backwards (opisthotonus). Spasms of the respiratory muscles and diaphragm can cause breathing difficulties. Laryngospasm and bronchospasm, which are often observed in children, are especially dangerous (asphyxia may develop). Swallowing is impaired due to spasms of the smooth muscles of the esophagus. Vomiting occurs due to pylorospasm. Due to changes in the tone of the muscles of the intestine and bladder - diarrhea or constipation, dysuria, abdominal pain.

Convulsions in hypoparathyroidism are very painful. Consciousness in tetany is usually preserved and is rarely impaired, only in particularly severe attacks. Attacks can have different durations: from several minutes to several hours, and occur with different frequencies. If sympathetic nervous system tone predominates during an attack, the attack occurs with pallor due to spasm of peripheral vessels, with tachycardia, and increased blood pressure. If parasympathetic autonomic nervous system tone predominates, vomiting, diarrhea, polyuria, bradycardia, and hypotension are typical. Outside of tetany attacks, autonomic dysfunction in patients manifests itself as a feeling of coldness or heat, sweating, persistent dermographism, dizziness, fainting, visual accommodation disorders, strabismus, diplopia, migraine, tinnitus, a feeling of "clogged" ears, unpleasant sensations in the heart with a picture of coronary spasm and rhythm disorders. In this case, the ECG reveals an extension of the QT and ST intervals without changing the T wave. The extension of these segments is due to the fact that hypocalcemia disrupts the repolarization of myocardial cells. ECG changes are reversible when normocalcemia is achieved. During severe tetany attacks, cerebral edema with stem and extrapyramidal symptoms may develop. Brain disorders in hypoparathyroidism can also manifest themselves as epileptiform seizures, clinically and electroencephalographically similar to genuine epilepsy; the difference is the rapid favorable dynamics of the EEG upon achieving stable normocalcemia, which does not occur in classical epilepsy. With prolonged hypocalcemia, mental changes, neuroses, emotional disorders (depression, melancholy attacks), and insomnia develop.

The most severe neurological changes are observed in patients with intracranial calcification, particularly in the basal ganglia area, as well as above the sella turcica, and sometimes in the cerebellum area. Manifestations associated with intracranial calcification are polymorphic and depend on their localization and the degree of increase in intracranial pressure. Epileptiform-type phenomena and parkinsonism are observed most often. These changes are also typical of pseudohypoparathyroidism.

With prolonged hypoparathyroidism, cataracts may develop, usually subcapsular, bilateral, sometimes swelling of the optic nerve papilla is observed. Changes in the dental system occur: in children - disturbances in the formation of teeth; in patients of all age groups - caries, enamel defects. Characteristic are disturbances in hair growth, early graying and thinning of hair, brittle nails, skin changes: dryness, peeling, eczema, exfoliative dermatitis. Candidiasis develops very often. The acute form of the disease occurs with frequent and severe attacks of tetany and is difficult to compensate. The chronic form is milder, with adequate therapy it is possible to achieve long (many years) attack-free periods. Latent hypoparathyroidism occurs without visible external symptoms and is detected only against the background of provoking factors or during a special examination. Provoking factors in latent hypoparathyroidism may be anxiety, decreased calcium intake with food and increased phosphate intake, physical activity, premenstrual period, infections, intoxications, hypothermia or overheating, pregnancy, lactation. As a rule, convulsive phenomena and a full-blown picture of hypoparathyroid crisis occur when the calcium content in the blood decreases to 1.9-2.0 mmol/l.

The X-ray semiotics of hypoparathyroidism consists of osteosclerosis, periostosis of long tubular bones, band-like compactions of metaphyses, and premature calcification of costal cartilages. Skeletal sclerosis is usually combined with pathological calcifications in soft tissues: in the brain (stem, basal ganglia, vessels, and membranes of the brain), in the walls of peripheral arteries, in subcutaneous tissue, in ligaments and tendons.

When the disease develops in childhood, growth and skeletal development disorders are observed: short stature, brachydactyly, and changes in the dental system.

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