General characteristics of the disease
Hyperparathyroidism (aka giperparatiroz) - endocrinological is a disease in which the body of man is an increased secretion of parathyroid hormone. As a result, in the skeletal system increases the amount of calcium and develops hypercalcemia syndrome. Because of this decreased bone strength, and there is an increased likelihood of bone fractures.
For a long time hyperparathyroidism was considered a rare disease. However, due to the current level of medical technology we found out that a rare disease is in fact the only hyperparathyroidism with a significant excess of parathyroid hormone glands.
The disease occurs in low severity average of one out of 500 people. Diagnosis of hyperparathyroidism often occurs during routine medical examination.
The disease can be a primary or secondary forms.
The cause of primary hyperparathyroidism in 85% of cases is parathyroid adenoma. A single form of tumor called solitary paratiromoy. Much less to primary hyperparathyroidism cause multiple benign tumors or malignant tumors of the parathyroid glands. Another possible cause of primary hyperparathyroidism - hyperplasia of the parathyroid glands.
Hyperproduction PTH causes excessive renal excretion of phosphate accelerates the absorption of calcium in the intestine and disrupts metabolic processes in bone tissue. In primary hyperparathyroidism the rate of resorption (destruction) of bone exceeds the rate of bone formation.
As a result, a patient with hyperparathyroidism develops generalized osteoporosis (thinning and deformation of the bones), osteodystrophy (accelerated bone loss).
Among the complications of primary hyperparathyroidism is called tissue damage and nephrocalcinosis renal tubules (kidney stones). Large amounts of calcium in urine significantly reduced renal function of the patient.
Other common complications of primary hyperparathyroidism:
- calcification of blood vessels,
- high blood pressure,
- ulcerative lesions of the bowel,
- left ventricular hypertrophy,
- valve and coronary calcification (deposition of salts in the heart).
To the development of secondary hyperparathyroidism causes the body's attempt to compensate for hypocalcemia (calcium deficiency in the body) or hyperphosphatemia (a surplus of phosphates).
The main reasons are considered to be of secondary hyperparathyroidism kidney disease and gastrointestinal tract. For Example:
- renal rickets,
- chronic renal failure,
- primary tubulopathy (disturbance transporting substances in the membranes of renal channels);
- malabsorption (poor absorption of the small intestine).
Secondary hyperparathyroidism and bone disease can lead and fermentopathy when genetic or systemic autoimmune diseases.
Another possible provocateur secondary hyperparathyroidism - malignant tumors in the bone marrow (multiple myeloma).
Symptoms of hyperparathyroidism
The disease is characterized by the complete absence of symptoms at an early stage of development. Diagnosis hyperparathyroidism at this stage is possible only on the basis of the detected hypercalcemia.
Renal symptoms of hyperparathyroidism include:
- polyuria (excessive secretion of urine)
- polydipsia (severe thirst syndrome)
- nephrolithiasis (kidney stones)
- frequent cases of pyelonephritis (inflammation of the kidneys).
Symptom hyperparathyroidism heavy degree - the development of renal failure.
Bone symptoms of hyperparathyroidism are:
- frequent fractures,
- chondrocalcinosis (destruction of the cartilage of the joints).
Gastrointestinal symptoms of hyperparathyroidism:
- anorexia (lack of appetite)
- duodenal ulcer and stomach,
- pancreatitis (inflammation of the pancreas),
- pankreakalkulez (stones in the pancreas).
With long-term course of the disease manifest symptoms of hyperparathyroidism cardiovascular and central nervous system disorders:
- arterial hypertension,
- irritability or drowsiness,
When the secondary form of the disease predominant symptoms of hyperparathyroidism, and of the underlying disease is usually renal or gastrointestinal etiology.
The most severe complication of a primary or secondary hyperparathyroidism - hypercalcemic crisis. The patient with the indicators of calcium in the blood plasma than 4 mmol / L increases sharply weakness, drowsiness, dehydration, fever, and then develops a coma.
Diagnosis of hyperparathyroidism
Hypercalcemia, hyperparathyroidism as the main symptom, diagnosed by routine biochemical analysis of blood. In the diagnosis of hyperparathyroidism it is also important in the simultaneous detection of the patient's blood deficiency phosphates and the high rate of phosphates, alkaline phosphatase, amino acids hydroxyproline and cyclic AMP (cAMP).
To evaluate the function of the parathyroid glands in the diagnosis of hyperparathyroidism check the level of parathyroid hormone in the blood.
By instrumental methods of diagnosis of hyperparathyroidism include ultrasound, MRI and CT scan of the mediastinum and neck X-ray of the bones. Osteodensitometry procedure allows you to measure bone density. Through the use of ECG in the diagnosis of hyperparathyroidism determined cardiac complications of the disease.
Genetic diagnosis of hyperparathyroidism is used in familial forms of hypercalcemia.
The treatment of hyperparathyroidism
Primary hyperparathyroidism - a slowly progressive disease. When hypercalcemia below 3 mmol / L treatment of hyperparathyroidism, usually not available. The patient needs only a dynamic observation.
Conservative treatment of hyperparathyroidism is limited to the elimination of the state of hypercalcemia. For this patient in uncomplicated cases, we recommend drinking plenty. In the emergency situation in the conservative treatment of hyperparathyroidism used diuretics and intravenous administration of sodium chloride to increase blood volume.
Additionally, patients with symptoms of primary or secondary hyperparathyroidism may prescribe a course of bisphosphonate. These drugs slow the bone loss and normalize the level of calcium in the body. However, when the reception may be some side effects: muscle pain, fever, and high levels of blood creatinine.
The effect of the treatment of hyperparathyroidism calcimimetics still poorly understood.
Radical treatment of hyperparathyroidism - surgery for tumors of the parathyroid glands. After removing paratiromy held a course of conservative therapy to eliminate the condition of hypercalcemia.
Absolute indications for surgical treatment of hyperparathyroidism include:
- single tumor of the parathyroid glands,
- the young age of the patient,
- high degree of hypercalcemia
- renal dysfunction,
- a significant decrease in bone mass.
Possible methods of surgical treatment of hyperparathyroidism - subtotal or total parathyroidectomy. In the first case, not only removed 50-70g least altered tissue of the parathyroid glands.
The effectiveness of surgical treatment of hyperparathyroidism more than 97%. Recurrence of the disease is possible only with genetic forms of hypercalcemia syndrome.