This disease occurs in most cases in women, more than two to three times than that of the male population. Hyperparathyroidism often affects women from twenty-five to fifty years. The disease may be subclinical or mixed, vistseropaticheskuyu, bone shape, and an acute shape of a hypercalcemic crisis.
What it is?
Hyperparathyroidism - a disease of the endocrine system caused by excessive production of parathyroid hormone due to hyperplasia parathyroid (parathyroid) glands or a tumoral lesion and characterized by marked disturbance of calcium metabolism and phosphorus.
Pathogenesis
The mechanism of formation Hyperparathyroidism is excessive production of parathyroid hormone, calcium violation fosofornogo homeostasis.
Excess PTH increases bone resorption and mobilization of calcium and phosphorus which reduces the reabsorption of phosphate in the kidney that leads to hypercalcemia (increased blood calcium concentration above 2.57 mmoles / l), hypophosphatemia, hypercalciuria and phosphaturia. Excessive secretion of PTH causes the release of calcium into the blood from the depot, resulting in hypercalcemia.
These variations contribute to renal dysfunction, stone formation and calcification in renal parenchyma. Hyperparathyroidism stimulates increased production of 1, 25 (OH) 2D3, which increases the absorption of calcium in the lumen bowel, exacerbating hypercalcemia, is conducive to the development of gastric ulcers and 12 duodenal ulcer, pancreatitis.
Statistics
Currently, primary hyperparathyroidism - one of the most common endocrinopathies, which occupies the third place after diabetes mellitus and thyroid disease. Primary hyperparathyroidism affects about 1% of the adult population. The risk of its occurrence is more than 2% over the age of 55 years, women suffer from this disease is 2-3 times more often than men (men 1: 2000, postmenopausal women 1: 500). The incidence of primary hyperparathyroidism is new observations 20-200 per 100 000 population.
In the United States recorded a year about 100 000 cases, it is 15.4 per 100 000, and in older people - 150 cases per 100 000 people. In Europe, this figure is higher, an average of 300 cases per 100 000 people. According to the report of the United Nations Population Division from 2001, population aging is almost irreversible. The proportion of older people in 1950 It was 8% in 2000 - 10% and is projected to 2050 reaches 21%. Thus, as the population ages frequency primary hyperparathyroidism will steadily increase.
primary hyperparathyroidism
This disease polietiologic (has several different causes).
The most common cause (80-85% of cases) is the development of tissue solitary parathyroid adenoma. Adenoma - a benign tumor of glandular epithelium and can occur in any body's iron. Its appearance often no way associated with external factors, but rather is associated with a variety of internal states of an organism (such as stress, medication intake, reduced pressure, and others).
Other causes of primary hyperparathyroidism adenoma secrete multiple (2-4%), hyperplasia (an increase in cell size - 7.12%) and cancer of the parathyroid gland (1-2%).
Secondary hyperparathyroidism
By the development of secondary hyperparathyroidism lead body attempt to compensate hypocalcemia (calcium deficiency in the body) or hyperphosphatemia (overabundance phosphates).
The main reasons are considered secondary hyperparathyroidism of renal and gastrointestinal disease. For example:
- renal rickets,
- chronic renal failure,
- primary tubulopathy (violations transporting substances in the membranes of renal channels);
- malabsorption syndrome (malabsorption small intestine).
By secondary hyperparathyroidism can also result in bone pathology and fermentopathy with genetic or systemic autoimmune diseases. Another possible provocateur secondary hyperparathyroidism - malignant tumors in the bone marrow (multiple myeloma).
tertiary hyperparathyroidism
For a given type of disease characterized by an increase in blood PTH 10-25 times with normal calcium. This diagnosis is made when the resistance to secondary hyperparathyroidism of conservative treatment, and the appearance of hypercalcemia.
Classification
Since the increase in the concentration in blood paratgomona leads to malfunction of the various organs and systems are isolated The following forms of primary hyperparathyroidism in which dominated by the existence of one of the systems, and exactly:
- Bone form (hypercalcemia and hypophosphatemia leads to a decrease in bone mass);
- Renal form (prevail renal disorders due hypercalciuria);
- Gastrointestinal (most rare form; increase of calcium in the blood stimulates the glandular cells of the stomach to produce more gastrin and its excess can lead to the appearance of ulcers and the development of gastric ulcer and duodenal ulcer; also calcium can be deposited in pancreatic tissue, thereby reducing the amount of hormones produced by it - pankreokaltsinoz).
The symptoms of hyperparathyroidism, photos
The clinical picture of primary hyperparathyroidism is usually bright. Women are particularly pronounced symptoms in severe its course, which is also characterized by the appearance of a number of signs of hypercalcemia. The main manifestations - disorders of the bones and kidneys, but there are signs of pathology of other organs and systems.
The symptoms of the musculoskeletal system:
- bone deformities, pain in them, frequent fractures, gout and pseudogout;
- muscle weakness, atrophy of them;
- cysts in the bones;
- in severe forms - a feeling of pins and needles, burning, numbness, certain parts of the body (signs of radiculopathy), paralysis of the muscles of the pelvis;
- hyperparathyroidism formed if at a young age - pigeon breast, small long bones, spine and ribs deformation, loosening of teeth.
2. From the observed disruption of their kidney function, recurrent nephrolithiasis (kidney stones), calcinosis nephrons.
3. Vascular lesion (calcification of the heart valves, coronary vessels, eyes, blood vessels and brain).
4. On the part of the psyche: depressive disorders, irritability, drowsiness, memory impairment.
5. On the part of the digestive tract may occur such violations:
- symptoms of a peptic ulcer of the stomach and duodenum, frequent relapses them;
- chronic pancreatitis;
- calcinosis pancreatic cells;
- forming in the ducts of the pancreas stones;
- dyspepsia symptoms (nausea, vomiting, loss of appetite, stool disorders (constipation)), as well as weight loss.
6. Hypertension, cardiac arrhythmias.
7. On the side of the joints - the symptoms of gout, calcium deposition in articular cartilage.
8. Expressed thirst, large urine volume excretion, frequent nocturnal urination.
Symptoms of secondary hyperparathyroidism in women vary depending on how they are caused by disease. Tertiary hyperparathyroidism corresponds in terms of clinical manifestations of secondary hyperparathyroidism preceding it - this severe pathology. The difference is that the parathyroid hormone concentration in the blood at the same time far beyond the normal range - exceeds 10 or even 20 times.
Diagnostics
hyperparathyroidism diagnosis is established by:
- the presence of symptoms characteristic of the disease;
- parathyroid roentgen - to detect the presence of tumor in the gland;
- According to the blood test: will be detected by an increase in calcium concentration in blood (normal 2,25-2,75 mmol / l), increasing its isolation from urine (normal 200-400 mg. per day). The content of phosphorus in the blood compared with the norm reduced in urine - increased.
- Thyroid ultrasound revealed an increase in parathyroid glands.
hyperparathyroidism treatment
When hyperparathyroidism need to be treated urgently. The main is surgery, with hypercalcemic Stroke intervention is conducted on an emergency basis. Most of the time is spent trying to find the tumor, when the operation takes place. If found vistseropaticheskaya form of the disease, which is confirmed by the survey (high PTH concentration), then the operation is carried out even without a topical diagnostics.
Operation - one of the main methods to save the patient, if the diagnosis of hyperparathyroidism or its primary form.
If the patient's age above fifty years, the operation is carried out:
- if creatinine rate from age norm is less than thirty per cent;
- when it detects a progressive osteoporosis;
- if there are complications due to primary hyperparathyroidism;
- if the composition above Ca 3 mmol / l if there acute symptoms of hypercalcemia.
When deciding not to carry out the operation, patients must consume liquid rate that they need to move more, that there was no lack of exercise. Contraindicated in the treatment of cardiac glycosides and thiazide diuretics. You also need to monitor your blood pressure if patients postmenopause, estrogen prescribed. Six months later need to be screened. Namely, it will determine the composition of the plasma creatinine, calcium, creatinine clearance. Every year a part of the abdominal examination using the ultrasonic method.
hypercalcemic crisis
If not treated and not to hold a constant level of calcium and parathyroid hormone controls the body, it is rare hypercalcemic crisis. Completely disrupted neural activity, increases blood clotting, which is a deadly blood clots may form or stop the heart. The general condition of the person is deteriorating.
Hypercalcemic crisis is often confused with pancreatitis due to similar symptoms:
- develop ulcers and bleeding intracavitary;
- there is fever;
- worried itching;
- body temperature rises above 40 degrees.
The patient is a lack of understanding of what is happening, he begins psychosis, further shock. Fatality occurs in paralysis of the respiratory system or stopping the main body - the heart.
Forecast
With timely diagnosis of primary hyperparathyroidism and the successful removal of the tumor, producing parathyroid hormone - the forecast is favorable. Restoring bone structure usually occurs during the first two years after surgery. Hyperparathyroidism pathological symptoms of the nervous system and internal organs disappear within a few weeks.
In advanced cases may remain bone deformation at the fracture site, complicating further career. Prediction significantly deteriorates kidney disease because nephrocalcinosis is irreversible state and develop renal failure after surgery can progress.
With regard to the prognosis of secondary hyperparathyroidism, it depends on the underlying disease, as well as timely prevention of organ changes.
