Hyperparathyroidism-causes, symptoms, diagnosis and treatment

Hyperparathyroidism-èndokrinopatiâ, which is based on the excessive production ofparathyroid hormone parathyroid glands. Hyperparathyroidism increases blood calcium levels and pathological changes in bone and kidney. Giperparatireozom incidence among women is 2-3 times more frequent than in 

men. Giperparatireozu affects more women from25 to 50 years. Hyperparathyroidism may have a subclinical course, bone,visceropatičeskuû, a mixed form, as well as sharp for a giperkal′ciemičeskogo crisis.Diagnosis includes the definition of Ca, P, and parathyroid hormone in the blood, an x-ray study and density sensitometry.

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Hyperparathyroidism

Classification and cause of hyperparathyroidism

Symptoms of hyperparathyroidism

Complications of hyperparathyroidism

Diagnosing hyperparathyroidism

Treatment of hyperparathyroidism

Forecast for hyperparathyroidism

Prevention of hyperparathyroidism

Hyperparathyroidism-treatment in Moscow

Hyperparathyroidism-èndokrinopatiâ, which is based on the excessive production ofparathyroid hormone parathyroid glands. Hyperparathyroidism increases blood calcium levels and pathological changes in bone and kidney. Giperparatireozom incidence among women is 2-3 times more frequent than in men. Giperparatireozu affects more women from25 to 50 years.

Classification and cause of hyperparathyroidism

Hyperparathyroidism is primary, secondary and tertiary.

Clinical forms of primary hyperparathyroidism may be varied. Primary hyperparathyroidismare divided into three types:

1. Subclinical primary hyperparathyroidism

biochemical stage;

asymptomatic phase ("dumb" form).

2. Clinical primary hyperparathyroidism. Depending on the nature of the most pronouncedsymptoms are:

bone shape (paratireoidnaâ, or Rekglinghauzena disease osteodistrofia). Apparentdeformation of the limbs, leading to subsequent disability. Fractures are "on their own"without the injuries heal long and hard, reducing bone density leads to the development of osteoporosis.

visceropatičeskuû form:

Kidney-kidney stones-dominated heavy currents, with frequent attacks of renal colic, development of kidney failure;

gastrointestinal form of ulcers stomach and duodenal ulcer, cholecystitis, pancreatitis;

mixed form.

3. Severe primary hyperparathyroidism (or giperkal′ciemičeskij Kriz).

Primary hyperparathyroidism is when the parathyroid glands:

one or more adenomas (benign tumor formations);

diffuse hyperplasia (increase in the size of the gland);

hormonally-active cancer (rare, 1-1, 5% of cases).

10% of patients with hyperparathyroidism is combined with various hormonal cancers(tumors of the pituitary gland, thyroid cancer, pheochromocytoma).

Primary giperparatireozu also carry the hereditary hyperparathyroidism, which is accompanied by other hereditary èndokrinopatiâmi.

Secondary hyperparathyroidism is a compensatory response to the long-existing low bloodCa. In this case, the enhanced synthesis of parathyroid hormone is associated with impairedcalcium-phosphorus metabolism in chronic renal failure, vitamin D deficiency, malabsorbtionsyndrome (impaired absorption of Ca in the small intestine).

Tertiary hyperparathyroidism razvivetsâ if nelečenogo long-flowing the secondarygiperapartireoza and is associated with the development of autonomously functioningparatireoadenomy.

Psevdogiperparatireoz (or èktopirovannyj hyperparathyroidism) occurs when differentlocalization of malignant tumors (breast cancer bronhogennom cancer) that are able to produce paratgormonopodobnoe, a substance with multiple endocrine adenomatozah I and type II.

Hyperparathyroidism is excessive parathyroid hormone which contributes to the development of bone calcium and phosphorus. The bones become fragile, warped cansoften, increases the risk of fractures. Hypercalcemia (excess level of Ca in blood) leads to the development of muscle weakness, allocate the excess Ca with urine. Increased urination,constant thirst, is developing a kidney stone disease (stone), the deposition of calcium saltsin the parenchyma of kidney (nefrocalzinoz). Arterial hypertension in the giperparatireoze is attributable to the excess Ca on the tone of the blood vessels.

Symptoms of hyperparathyroidism

Hyperparathyroidism may be asymptomatic and detected incidentally, during the examination.

When giperparatireoze the patient simultaneously develop symptoms of various organs and systems, stomach ulcers, osteoporosis, Kidney stone, jelchnokamennaya disease, etc.

Early manifestations of hyperparathyroidism include fatigue upon exertion, muscle weakness, headache, difficulty in walking (especially when lifting, overcoming large distances), characteristic of perevalivaûŝaâsâ gait. Most patients have memory loss,emotional instability, anxiety, depression. Older people may have severe mental disorders.In the long giperparatireoze the skin is earthy-grey colour.

At a late stage of bone hyperparathyroidism is softening, curvature, pathological fractures(with normal movements in bed) are scattered bones, pain in the bones of the hands and feet, the spine. As a result of osteoporosis, JAWS drop and healthy teeth falter. Because of the deformities of the skeleton of a patient may become shorter. Pathological fractures of the maloboleznenny, but heal very slowly, often with deformities of the limbs and the formation of false joints. On the hands and feet are periartikulârnye kal′cinaty. On the neckof the parathyroid glands can palpate more adenoma.

Visceropatičeskij hyperparathyroidism is characterized by nonspecific symptoms andgradual onset. With the development of hyperparathyroidism caused nausea, stomach pain, vomiting, flatulence, is being drastically reduced appetite, weight. In patients with bleedingpeptic ulcers are detected different localization, prone to frequent exacerbations,Cyclosporine, and signs of gallbladder and pancreas.

Is polyuria, urinary density decreases, the unquenchable thirst. In the later stages isnefrocalzinoz, razivaûtsâ symptoms of renal failure, progressing over time, uremia.

Gipercalziuria and hypercalcemia, kal′cinoza and development of vascular sclerosis leads to disruption of supply of tissues and organs. The high concentration of Ca in blood vessels of the heart failure and contributes to increased blood pressure, cause of strokes.

When calcification of the conjunctiva and cornea eye there is a syndrome of "red eyes".

Complications of hyperparathyroidism

Giperkal′ciemičeskij Kriz refers to serious complications of hyperparathyroidism, threateningthe patient's life. Risk factors include prolonged bed rest, the uncontrolled intake of Ca and vitamin D, a thiazide diuretic (reduce Ca excretion in the urine). Kriz occurs suddenly with acute hypercalcemia (Ca in blood of 3.5-5 mmol/l, with the rate of 2.15-2.50 mmol/l) and isworsening all the clinical symptoms. This condition is characterized by: high (up to 39-40° c)body temperature, acute epigastric pain, vomiting, drowsiness, impaired consciousness, coma. Dramatically increasing weakness, dehydration, a particularly serious complication is the development of myopathy (muscle atrophy) of the intercostal muscles and the diaphragm, proximal trunk. You may also experience pulmonary edema, thrombosis, bleeding, perforation of peptic ulcers.

Diagnosing hyperparathyroidism

Primary hyperparathyroidism has no specific symptoms, so diagnosis on clinical picture is quite difficult. Need to consult an endocrinologist, patient examination and interpretation ofthe results:

General urine analysis

Urine is alkaline reaction is determined by the Ca excretion in the urine (gipercalziuria) andincrease of the P (giperfosfaturiâ). Relative density is reduced to 1000, often protein in the urine (proteinuria). In the sludge are grainy and hyaline cylinders.

biochemical blood analysis (Ca, P, parathyroid hormone)

Concentrations of total and ionized Ca in blood plasma content of P below the norm,alkaline phosphatase activity increased. More revealing when giperparatireoze is to determine the concentrations of parathyroid hormone in the blood (5-8 ng/ml and above at a rate 0.15-1 ng/ml).

Ultrasound

Thyroid ULTRASOUND information only when the location of the paratireoadenom in thecommon ground in the thyroid gland.

x-rays, CT and MRI

X-rays can detect osteoporosis, cystic changes in bones, pathological fractures. To assessbone density is densitometry. With the help of x-rays with contrast medium to be diagnosedwith peptic giperparatireoze ulcer in the gastrointestinal tract. CT SCAN of the kidneys and urinary tract reveals stones. Rentgenotomografiâ zagrudinnogo space with esophagealcontrast barium suspension allows to identify the paratireoadenomu and itsmestopoložnenie. Magnetic-resonance tomography of informativeness is superior to CT and ULTRASOUND EXAMINATION, renders any parathyroid localization.

parathyroid scintigraphy

Identify localization usually and abnormally located gland.

In the case of secondary hyperparathyroidism are diagnosed defining disease.

Treatment of hyperparathyroidism

Complex treatment of hyperparathyroidism combines the operating surgery andconservative therapy medication drugs.

The main treatment for primary hyperparathyroidism is a surgical operation to removeparatireoadenomy or hyperplastic parathyroid glands. To date surgical Endocrinologyfeatures using minimally invasive methods of surgery carried out in giperparatireoze, including with application of endoscopic equipment.

If the patient has been diagnosed with giperkal′ciemičeskij Kriz, needed emergency surgery.Prior to the operation required the appointment of conservative treatment aimed at thereduction of Ca in blood: drinking plenty of fluids intravenously, isotonic NaCl solution, in the absence of renal failure-LASIX with KCl and 5% glucose, calzitrin (under the control ofthe level of Ca in blood), bifosfonata (pamidronate or Etidronate), glucocorticoids.

After surgery for malignant tumors of the parathyroid glands is radiation therapy, antitumorantibiotic also used-plikamicin.

After surgical treatment in most patients is decreasing amounts of Ca in blood, so theyprescribe Vitamin D (in more severe cases, intravenous Ca salt).

Forecast for hyperparathyroidism

Forecast for hyperparathyroidism is favourable only in the case of early diagnosis andtimely treatment.

The patient's ability to return to normal after surgical treatment of hyperparathyroidismdepends on the degree of bone hitting bone. With minor diseases recovers after surgical treatment for about 3-4 months, in the most severe cases-within the first 2 years. Inadvanced cases may be limiting the ability of bone deformities.

When kidney form of hyperparathyroidism forecast recovery less favourable and depends on the severity of kidney failure at the pre-operative phase. Without surgery, patientstypically, disabled and dying from progressive cachexia and chronic renal failure.

With the development of giperkal′ciemičeskogo kriza prognosis depends on the timeliness and adequacy of treatment, mortality and complications of hyperparathyroidism is 32%.

Prevention of hyperparathyroidism

The chronic renal insufficiency is drug prevention of secondary hyperparathyroidism.