Symptoms of hypoparathyroidism

Patients with hypoparathyroidism are concerned about paresthesia, cold snap and a feeling of creeping crawling all over the body, especially in the limbs, convulsive twitching in the muscles, bouts of painful tonic convulsions, nervousness. In the late stages of the disease there are skin changes, cataracts, calcifications in various organs and in the subcutaneous tissue.

In the course and nature of the clinical features of hypoparathyroidism, two of its forms are distinguished: manifest (manifest), with acute and chronic manifestations, and latent (latent).

Clinical symptoms of hypoparathyroidism are composed of several groups of symptoms: increased neuromuscular conduction and convulsive readiness, visceral-vegetative and neuropsychic disorders.

The relative frequency of major neurological and psychiatric disorders in hypoparathyroidism is as follows: tetany occurs in 90% of patients, convulsions in 50.7%, extrapyramidal symptoms in 11%, mental disorders in 16.9% of patients. The most typical of hypoparathyroidism is tetanus attacks, beginning with paresthesia, fibrillar muscle twitches, turning into tonic convulsions, involving predominantly symmetrical groups of limb flexors (often the upper ones), and in severe forms also facial muscles. During an attack, the arms are bent in the joints, the wrist is in the form of the "hand of an obstetrician"; legs stretched, compressed together, the foot is in a state of sharp plantar flexion with bent fingers (pedal spasm, "horse foot"). Convulsions of the facial musculature cause a "sardonic" peculiar form of the mouth ("fish mouth"), a spasm of chewing musculature (trism), cramps of the eyelids. Less often there is a convulsive extension of the trunk to the back (opisthotonus). Cramps of the respiratory muscles and diaphragm can cause breathing difficulties. Especially dangerous is often observed in children laryngospasm and bronchospasm (possibly the development of asphyxia). Because of spasms of the smooth musculature of the esophagus, swallowing is disturbed. In connection with pylorospasm, vomiting occurs. Due to changes in the tone of the musculature of the intestine and bladder - diarrhea or constipation, dysuria, abdominal pain.

Convulsions with hypoparathyroidism are very painful. Consciousness in tetany is usually preserved and rarely disturbed, only with especially severe attacks. Attacks can be of different lengths: from several minutes to several hours, they occur at different frequencies. When the tone of the sympathetic nervous system prevails during an attack, the attack proceeds with pallor due to spasm of peripheral vessels, with tachycardia, and an increase in blood pressure. With the predominance of the tone of the parasympathetic autonomic nervous system, vomiting, diarrhea, polyuria, bradycardia, hypotension are typical. Outside tetanus attacks, vegetative disorders in patients are manifested by a feeling of cold or heat, sweating, persistent dermographism, dizziness, fainting, visual accommodation, strabismus, diplopia, migraine, ringing in the ears, a feeling of "pawning" the ears, unpleasant sensations in the heart with a picture of coronarospasm and rhythm disturbances. On the ECG, the lengthening of the QT and ST intervals is observed without changing the T wave. The extension of these segments is due to the fact that the repolarization of myocardial cells is disturbed during hypocalcemia. ECG changes are reversible when normocalcemia is achieved. During severe attacks of tetany, it is possible to develop cerebral edema with stem and extrapyramidal symptoms. Brain disorders in hypoparathyroidism can be manifested and epileptiform attacks, clinically and electroencephalographically similar to genoein epilepsy; The difference is the rapid favorable dynamics of the EEG in achieving stable normocalcemia, which is not the case with classical epilepsy. With prolonged hypocalcemia, changes in the psyche, neuroses, emotional disturbances (depression, bouts of longing), insomnia develop.

The most severe neurologic changes are observed in patients with intracranial calcification, particularly in the basal ganglia, as well as over the Turkish saddle, and sometimes in the cerebellum. The manifestations associated with intracranial calcification are polymorphic and depend on their location and the degree of increase in intracranial pressure. More often than others, phenomena of epileptiform type and parkinsonism are observed. These changes are also typical for pseudohypoparathyroidism.

With a prolonged course of hypoparathyroidism, cataracts can occur, usually subcapsular, bilateral, and sometimes there is edema of the nipple of the optic nerve. There are changes in the dentoalveolar system: in children - dental abnormalities; in patients of all age groups - caries, defects of enamel. Characteristic violations of hair growth, early graying and hair thinning, brittle nails, skin changes: dryness, peeling, eczema, exfoliative dermatitis. Very often develop candidiasis. The acute form of the disease occurs with frequent and severe attacks of tetany and is difficult to compensate. The chronic form flows milder, with adequate therapy it is possible to achieve long (perennial) unapproachable periods. Latent hypoparathyroidism proceeds without visible external symptoms and is detected only on the background of provoking factors or during a special examination. Provoking factors for latent hypoparathyroidism can be agitation, a decrease in calcium intake and an increase in phosphate intake, physical activity, premenstrual periods, infections, intoxications, hypothermia or overheating, pregnancy, lactation. As a rule, convulsive phenomena and a detailed picture of the hypoparathyroid crisis arise when the calcium content in the blood drops to 1.9-2.0 mmol / l.

X-ray semeniotics of hypoparathyroidism consists of the phenomena of osteosclerosis, periosteasis of long tubular bones, ribbon-shaped metaphyses, premature calcification of the rib cartilage. Sclerosis of the skeleton is usually combined with pathological calcifications in soft tissues: in the brain (trunk, basal ganglia, vessels and membranes of the brain), in the walls of peripheral arteries, in the subcutaneous tissue, in ligaments and tendons.

With the development of the disease in childhood, there are violations of growth and development of the skeleton: short stature, brachodactyly, changes in the dentoalveolar system.

[1], [2], [3], [4], [5], [6]