Hyperparathyroidism - a disease of the parathyroid (parathyroid) gland, which develops due to the increased secretion of PTH.
Elevated levels of PTH in the blood leads to acceleration of its managed metabolic processes, namely, acceleration of exchange of calcium and phosphorus.
Hyperparathyroidism is of three types: primary, secondary and tertiary. They differ among themselves for the reasons and mechanisms of occurrence, but also the strength of clinical manifestations.
Causes
The primary form
Primary hyperparathyroidism - a 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 form
- chronic lack of calcium in the diet
- malabsorption syndrome, such as Crohn's disease, pancreatitis, and others. (Impaired bowel function in which it ceases to absorb one of the nutrients)
- chronic renal failure (Due to its phosphate content is increased in the blood, which leads to a decrease of calcium concentration in it)
The main mechanism of hyperparathyroidism associated with increased phosphorus excretion in the kidney under the action of PTH. Immediate consequences of such processes include:
- hypercalcemia (increased blood calcium concentration, which can lead to its deposition in other organs, thereby disrupting their functions; since paratgomon takes calcium from the bones, their density is reduced, they become brittle, increasing the likelihood of fractures)
- hypercalciuria (increased excretion of calcium in the urine can contribute to kidney damage)
- hypophosphatemia (reducing the phosphorus concentration in the blood supply leads to deterioration of bone phosphorus, thereby even further increasing their fragility).
Hyperparathyroidism is 2-3 times more common in women than in men. The majority of patients - people over 30 years.
Kinds
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:
- Renal form (prevail renal disorders due hypercalciuria)
- Bone form (hypercalcemia and hypophosphatemia leads to a decrease in bone mass)
- 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
The clinical picture and symptoms of both primary and secondary hyperparathyroidism depends on the form of the disease. The clinical picture of secondary shape different from the primary hyperparathyroidism sheer force manifestations.
kidney-shaped (40-50% incidence)
In renal form of hyperparathyroidism, patients usually complain of:
- renal colic (The result of the increased load on the kidneys)
- blood in the urine (a consequence of the increased load on the kidneys)
- an increase in the frequency of the urge to urinate
When the duration of the current disease, the infection can join these symptoms, which cause pyelonephritis (Inflammation of the renal pelvis accompanied by lower back pain, fever). Hypercalcemia may also promote calcium deposition in the kidneys (nephrocalcinosis).
bone shape (Frequency - 50-60%)
Patients with bone shape hyperparathyroidism often complain about:
- joint pain, back, wrists (reduced bone mass leads to pathological processes in cartilaginous tissue that generates the working surfaces of the joints, and also reduces resistance to bone loads)
- frequent fractures (bone thinning contributes directly to their fragility)
- the curvature of the bone, rickets in children, the appearance scoliosis (More rarely occur because sometimes instead of pathological bone fragility, hypercalcemia leads to increase their flexibility)
Gastrointestinal (Frequency of occurrence - 15-20%)
Since in the gastro-intestinal form of patients is formed gastric ulcer or duodenum, the complaint will be connected with the manifestations of these diseases.
- pain in the upper stomach (gastric juice irritates the defect in the mucosa, causing pain)
- acid regurgitation or heartburn (irritation of the stomach wall leads to their reflex contraction and release of the esophagus gastric juice)
- body weight reduction (directly connected with deterioration of digestion of food in the stomach)
- vomiting and nausea after eating (also due to stomach irritation)
Primary hyperparathyroidism can lead to a state of hypercalcemic crisis, which threatens the life of the patient, and requires urgent resuscitation.
Diagnostics
Diagnosis of hyperparathyroidism may engage experts in various fields of medicine. This is due to a variety of clinical forms of the disease. The diagnosis of primary hyperparathyroidism placed using:
- anamnesis (poll, study the patient card, inspection)
- presence of characteristic symptoms of
- X-ray examination of bones of hands, feet, skull and spine
- study blood tests (total and specific, such as the level of analysis paratgomona, calcium, phosphorus) and urine
- Study of gastric juice, and the state of the stomach wall and duodenum (using EGD - fibrogastroduodenoscopy)
- possible bone biopsy (for accurate determination processes inside the bone, in the event that other methods of study have not shown significant deviations)
- ultrasound, computed or magnetic resonance imaging (to determine the precise localization of disease outbreak in the parathyroid glands)
hyperparathyroidism treatment
Currently, the only reliable method for the treatment of primary hyperparathyroidism - surgical removal of adenomas or other tumors of the parathyroid glands.
Treatment of secondary hyperparathyroidism limited to treatment of underlying disease that caused.
Often, when late diagnosis developed hyperplasia of the parathyroid gland, which is not amenable to conservative therapy. Such patients also shows operation.
Treatment of hyperparathyroidism has been a surgeon.
Also, during treatment is the treatment of hyperparathyroidism accompanying (caused by, or independent diseases).
The preoperative patient prep prescribed therapy aimed at reducing the the level of calcium in the blood (a high concentration which can create considerable difficulties during surgery).
Apply the following drugs: pamidronate, etidronate or other phosphates, with intravenous administration of saline with the addition of sodium sulfate, furosemide.
The choice of anesthesia method depends on the patient's condition.
During surgery the surgeon to inspect the entire complex of the parathyroid glands to detect hearth that caused the disease. If the cause was prostate hyperplasia, a full removal of an organ.
The duration of the entire complex of treatment depends on the severity of hyperparathyroidism.
If hyperparathyroidism was diagnosed in time, the recovery of the patient's disability begins after 2-4 months after surgery. In more complex cases, to restore health may need more than 1-2 years.
Forecast
The prognosis of the treatment depends on the severity of hyperparathyroidism clinical manifestations.
At relatively lightweight flow and proper treatment of the main and concomitant diseases, patients recover.
