HYPOPARATHYROIDISM – complete or partial insufficiency of the parathyroid glands of various nature.
Etiology .
- In the recent past cause hypoparathyroidism often it has been the case Noe removal of parathyroid same climb at subtotal thyroidectomy .
- Less commonly, hypoparathyroidism develops due to thyroiditis and paratireoiditov with by following atrophy of the parathyroid glands. Often a result of infections – measles, angas us, influenza or from dystrophic Menenius, amyloidosis and others.
- May develop after the removal of Gorm tionally-active parathyroid glands adenomas, as a result of hyperfunction one adenomatous gland atrophy others.
- Finally, there are autoimmune, idiopathic, and congenital (phage syndrome) forms.
- Nursing mothers may disrupt the compensation function of the parathyroid same climb. One of the reasons – the loss of organisms of calcium and vitamin D PTO
Pathogenesis.
Mechanism of development of the disease is to lower the filtration procedure and increases the reabsorption of phosphate in renal nephrons and tubules with increasing contains Zhaniya phosphate in blood and hypocalcemia . In this case, excess phosphorus is removed with feces in the form of phosphorus-calcium insoluble salts.
Reduction of calcium content in the blood is due to its ionization ized, biochemically active fraction and an extreme degree before walking to 5 mg% (below this urs nya calcium metabolism is regulated without PTH ) in blood phosphorus level reaches 12-15. mg% (at a rate of 2-4 mg%).
Note that hyperphosphatemia is not a direct cause of the clinical manifestations of hypoparathyroidism and theta SRI. Violation calcium equal equilibrium entails violation from attitude Ca – Na , Ca – Mg and Ca -K, in the blood. All this leads to povy sheniyu neuromuscular excite the bridge. Such a state can usu gublyatsya violation of activity of the higher parts of the central nerve Noah system under the influence of emotions tional factors and the other the adverse pleasant situation for the organism. Pathological anatomy. Often marked atrophy and distro graphical instruments changes in parathyroid same Lesach and sometimes no variation. These cases are referred to as idiopathic hypoparathyroidism . In younger children, died of tetany, not rarely found hemorrhaging of the parathyroid in the Lesach deposition of hemosiderin , cystic degeneration, scarring due to the inflammatory -negative processes. Detected atom rofiya cardiac muscle, erosion and hemorrhage in the gastric mucosa, muscular dystrophy and Sun -inflammatory renal processes.
Clinic.
Severity Zabolev Nia and clinical course Various chayut the following forms:
- Latent (hidden)
- Chronic
- Sharp
- Super sharp
Latent Hypoparathyroidism .
Complaints of patients with latent (hidden) hypoparathyroidism numerous us, but not pathognomonic. At the heart of Mr. they are expressed in weakness, feeling of pins and needles, absence Corollary appetite, numbness of fingers to the extremities, pain in the stomach, commandments rah, heartburn. Conventional objective research methods specific patho logical abnormalities often do not show. To identify latent hypoparathyroidism, a number of samples (symptoms) have been proposed , often bearing the names of the authors. These samples are not complicated and available. They are based on higher NII nervous excitability. Symptoms of Trousseau , Erb , Hoffmann , Hofi , Schlesinger , Got General Recognition . Schultz, a symptom malobertso Vågå nerve . The above symptoms for their better identified Nia can be improved by shifting the “acid-base balance of the body in the direction of alkalosis that before attained by giperpnoe . The patient is lying on his back, offering to those chenie 3 minutes. take a deep ‘breath with enhanced exhalation, with a rhythm of about 15 breaths per minute. The experiment cannot be continued for a long time, since an attack of tetany can be caused. Along with an increase in tendon reflexes, a shortening of the time of chronaxia is noted.
It has been observed that women in the pre menstrual period, those bouts Britain are exacerbated due to increased secretion of estrogen. Accordingly, Borbiev and Klotz proposed diagnostic test with estrogens: patient vnutrimyshech but administered 20 mg of estradiol benzoate and determine the calcium content in the blood. Normally, after the administration of estrogen, the level of calcium in the blood does not decrease, and with latent hypoparathyroidism , its marked decrease.
Laboratory methods .
- The most valuable is the definition contains calcium Zhaniya Therefore, it is better when ionized, non-protein bound calcium is detected. It is the biologists cally more active, more mobile nym and better reflects the true picture kaltsiemii . Normally, with the holding of ionized calcium in blood is 4-5 mg% and at hypoparathyroidism respectively Zabolev gravity of Nia – decreases.
- Urinary calcium : normally in 1 liter of urine contains an average of 120 mg% kal tion. When hypoparathyroidism urinary calcium reduces Xia. About kaltsiemii and urinary calcium indicative information can be obtained from the sample Sulkovicha . Phosphaturia is also determined. Per day normally allocated 2.8g phos handicap (P2O5) at hypoparathyroidism phosphaturia decreases.
- The level of alkaline phosphatase on lowers the. Normally, in adults s is 3-5 units. in children 5-15 units.
- Blood picture: the nature of the mind renny lymphocytosis and eosinophilia .
- There are a number of dynamic tests for determining calcium-phosphorus equilibrium. Some of them are not It is of great value and gives dubious results. Nai more reliable test with a parathyroidin (Albright probe). Its essence lies in the fact that with the introduction of parathyroidin in patients, phosphaturia is significantly increased. When latent hypoparathyroidism daily phosphate dence from 2 mg may reach up to 60 mg (from sample PTH ). ECG – for hypoparathyroidism , as with hypocalcemia , a prolongation of the QRST interval is characteristic.
Severe hypoparathyroidism .
With long-term existence of the expressed hypoparathyroidism develops a number of trophic changes: actinic skin, brittle nails, premature hair graying and hair loss, Cataraqui one tooth decay, sexually delay of development in children, decrease if Bidault adults, amenorrhea and hypo- menorrhea women. Violations psi hicheskie more frequently observed in juvenile idiopathic hypoparathyroidism , and you rage as dementia, change Niya personality.
For Pronounced Hypoparathyroidism is characterized by:
- Early development of calcification and ate vessels roskleroza that leads to coronary insufficiency and Ishe mission brain.
- Increasing sensitivity Nosta neuromuscular system often leads to spastic phenomena from the vegetative organs: coronary spasm , duodenospazmu , spasms of the bladder with symptoms of dysuria and others.
- The most severe manifestation of hypoparathyroidism is tetany, which may, in a fatal outcome. Nered to the clinic it reminds Jacksonian epilepsy, and are determined lennye difficulties in differential cial diagnosis. The first manifestations of tetany begin with a person: a feeling of numbness, a feeling of crawling Nia tingling in the lips, bound Nosta muscles of the mouth, tonic spasm of the facial muscles gives the kind of ” Risus sardonicus ” or “fish mouth”, later followed by tonic and clonic seizures konechnrstey . The fingers are compressed in metacarpophalngeal joints, brush extends toward the ulna, the thumb is in the middle and brush prini maet peculiar kind of “hands Akusha ra”. It becomes vague, but thrust receiving position outsole hydrochloric flexion. Reducing abdominal muscles and abdominal organs newly causes abdominal pain, for the made difficult swallowing. In the case of laryngospasm breathing becomes noisy, there is cyanosis , and the presence and bronchospasm will build etsya impression bronchial ast us. Children up to three months vozra hundred tetany appears exceptional but rarely. Often there is WHO Raste 6-12 months and less frequently after the age of three. The disease becomes more frequent in puberty and after the age of 25 back on is observed less frequently. A tetany, like spasmophilia, is often observed in females. In this variation plays a role they Gorm tional products, which is complicated by pregnancy and lactation.
TREATMENT.
A diet containing pain Chez calcium, phosphorus and less bo gataya vitamin D. Outside attacks patients should be protected from infection and the factors causing the WHO excitation of the nervous system.
- Assigning dissolved sedatives, Barbie Turati, bromides, seduksen.
- It is necessary to carry out the treatment of chronic gastroenteritis, particular but hypoacid states obst vuyuschih calcium absorption. To preserve acidity c. stomach for significant natural gastric juice or betatsid hydrochloric acid with pepsin.
- Calcium preparations are prescribed in 30 minutes. do.edy in media therein of 1-2 grams per day, in the form molochnokislotnogo , calcium chloride or gluconate calcium.
- For the purpose of suction pressure .nazna phosphorus chayut aluminum hydroxide 1.5-3 g a day before meals.
- To enhance the absorption of calcium in the intestine to significant digidrotahisterol ( tahistin -Fort) 10-20 drops per day, vitamin D, fish oil.
- In acute cases, tetany immediately administered intravenously 10% solution of calcium chloride, 10-30 ml honey ately. The effect comes immediately. The action lasts 2 hours.
- Calcium gluconate is effective for 8 hours. Introduce 10 ml of 5.10% solution intravenously or inside musculo. Injection preparations kal tion repeated 3-4 times a day; simultaneously assigned and inside.
- Parathyroidin (for injection) —2 ml, 1-2 times a day subcutaneously; the action Wier it occurs after 2-4 hours and lasts for 12-24 hours. The drug is best used for pre warnings related attacks than for their relief. His long Execu mations can result in refractory against drug and ana prophylactically reactions.
- When expressed laryngospasm, nepod a groundbreaking treatment resorting to yn tubatsii or tracheotomy .
- In the treatment of tetany is recommended etsya frequent determination of blood calcium