Hyperparathyreosis

General characteristic of a disease

The hyperparathyreosis (it гиперпаратироз) is an endocrinological disease at which in a human body there is hypersecretion of hormones of epithelial bodies. As a result of it in bone system the amount of calcium increases, and the hypercalcemia syndrome develops. Because of it durability of bones decreases and there is an increased probability of bone changes.

Long time the hyperparathyreosis was considered as quite rare disease. However thanks to the modern level of medical technologies it was succeeded to find out that rare pathology actually is only the hyperparathyreosis with a considerable surplus of hormones of epithelial bodies.

The disease of small expressiveness occurs on average at one of 500 people. Diagnosis of a hyperparathyreosis quite often happens during planned medical examination.

The disease can be primary or secondary form.

Primary hyperparathyreosis

As the reason of development of primary hyperparathyreosis in 85% of cases serves epithelial body adenoma. It is accepted to call a single form of a tumor solitary paratiromy. Lead multiple benign tumors or malignant new growths of epithelial bodies to primary hyperparathyreosis much less often. Other possible reason of primary hyperparathyreosis – a hyperplasia of epithelial bodies.

Hyperproduction of parathormones causes excess removal by kidneys of phosphates, accelerates absorption of calcium in intestines and breaks exchange processes in a bone tissue. At primary hyperparathyreosis the speed of a resorption (destruction) of a bone tissue exceeds osteogenesis speed.

As a result at the patient with a hyperparathyreosis generalized osteoporosis (thinning and deformation of bones), an osteodystrophy (the accelerated destruction of bones) develops.

Among complications of primary hyperparathyreosis call damages of fabrics of renal tubules and a nephrocalcinosis (formation of stones in kidneys). Large amounts of calcium in urine significantly reduce function of kidneys of the patient.

Other widespread complications of primary hyperparathyreosis:

• calcification of blood vessels,
• increase in arterial pressure,
• intestines cankers,
• hypertrophy of a left ventricle of heart,
• valve and coronary kaltsinata (deposits of salts in heart).

Secondary hyperparathyreosis

The attempt of an organism to compensate a hypocalcemia (deficit of calcium in an organism) or a hyperphosphatemia (a surplus of phosphates) leads to development of a secondary hyperparathyreosis.

Diseases of kidneys and GIT are considered as the main reasons for a secondary hyperparathyreosis. For example:

• renal rickets,
• chronic renal failure,
• primary tubulopatiya (disturbances of transportation of substances in membranes of renal channels),
• sprue (bad absorbability of a small intestine).

Also can lead bone pathologies and fermentopatiya at genetic or general autoimmune diseases to a secondary hyperparathyreosis.

One more possible provoker of a secondary hyperparathyreosis – malignant new growths in marrow (multiple myeloma).

Hyperparathyreosis symptoms

The disease is characterized by total absence of symptoms at an initial stage of development. Diagnosis of a hyperparathyreosis at this stage is possible only on the basis of the found hypercalcemia.

Carry to renal symptoms of a hyperparathyreosis:

• polyuria (urine hypersecretion),
• polydipsia, (syndrome of strong thirst),
• nephrolithiasis (stones in kidneys),
• frequent cases of pyelonephritis (inflammation of kidneys).

Symptom of a hyperparathyreosis of heavy degree – development of a renal failure.

Bone symptoms of a hyperparathyreosis it:

• frequent changes,
• osteoporosis,
• chondrocalcinosis (destruction of cartilaginous tissue of joints).

Gastrointestinal symptoms of a hyperparathyreosis:

• anorexia (lack of appetite),
• meteorism,
• nausea,
• peptic ulcer of a duodenum and stomach,
• pancreatitis (pancreas inflammation),
• панкреакалькулез (stones in a pancreas).

At the long course of a disease cardiovascular symptoms of a hyperparathyreosis and frustration of TsNS are shown:

• arterial hypertension,
• depression,
• hypererethism or drowsiness,
• confusion of consciousness.

At a secondary form of a disease symptoms not of a hyperparathyreosis, and the main disease, as a rule, of a renal or gastrointestinal etiology prevail.

The heaviest complication of primary or secondary hyperparathyreosis - giperkaltsiyemichesky crisis. At the patient with calcium indicators in a blood plasma higher than 4 mmol/l sharply accrue weakness, drowsiness, dehydration, fever, and then coma develops.

Diagnosis of a hyperparathyreosis

The hypercalcemia as the main symptom of a hyperparathyreosis, is diagnosed by means of routine biochemical analysis of blood. In diagnosis of a hyperparathyreosis simultaneous identification in blood of sick deficit of phosphates and the raised indicators of phosphate salts, an alkaline phosphatase, hydroxyproline amino acid, and also TsAMF (cyclic adenosinemonophosphate) is also important.

For assessment of function of epithelial bodies in diagnosis of a hyperparathyreosis the level of parathormones in blood is checked.

Refer to tool diagnostic methods of a hyperparathyreosis ultrasonography, MPT and KT of area of a mediastinum and a neck, the roentgenogram of bones. The procedure of osteodensitometry allows to measure density of bones. Thanks to use of an ECG in diagnosis of a hyperparathyreosis cardial complications of a disease are defined.

Genetic diagnosis of a hyperparathyreosis is applied at family forms of a hypercalcemia.

Treatment of a hyperparathyreosis

Primary hyperparathyreosis – slowly progressing disease. At a hypercalcemia lower than 3 mmol/l treatment of a hyperparathyreosis, as a rule, is not carried out. The patient needs only dynamic observation.

Conservative treatment of a hyperparathyreosis is limited to elimination of a condition of a hypercalcemia. For this purpose plentiful drink is recommended to the patient in uncomplicated cases. In an urgent situation in conservative treatment of a hyperparathyreosis diuretic drugs and intravenous administration of Sodium chloride for increase in volume of the circulating blood are used.

In addition sick with symptoms of primary or secondary hyperparathyreosis rates of biphosphonates can be appointed. These drugs slow down destruction of bones and normalize calcium level in an organism. However at their reception some side effects are possible: muscle pain, fervescence and high level of creatinine in blood.

The effect of use of kaltsimimetik in treatment of a hyperparathyreosis is still insufficiently studied.

Radical method of treatment of a hyperparathyreosis - surgery at tumors of epithelial bodies. After removal of a paratiroma a course of conservative therapy is conducted to eliminate a condition of a hypercalcemia.

Absolute indications for surgical treatment of a hyperparathyreosis are:

• single tumor of epithelial bodies,
• young age of the patient,
• high degree of a hypercalcemia,
• renal failures,
• considerable reduction of bone weight.

Possible methods of surgical treatment of a hyperparathyreosis – a subtotal or total parathyroidectomy. In the first case are not removed only 50-70g the least changed fabrics of epithelial bodies.

Efficiency of surgical treatment of a hyperparathyreosis more than 97%. The recurrence of a disease is possible only at genetic forms of a syndrome of a hypercalcemia.