Hyperparathyreosis

Description:

Primary hyperparathyreosis - the disease of epithelial bodies which is shown excess products of parathormone with development of a syndrome of a hypercalcemia.

Hyperparathyreosis symptoms:

At most of patients primary hyperparathyreosis proceeds asymptomatically and the diagnosis is established at inspection concerning a hypercalcemia.

  1. Renal symptoms include a polyuria, a polydipsia, the nephrolithiasis (25%) which is often complicated by pyelonephritis; seldom - a nephrocalcinosis with development of a renal failure.
  2. Gastrointestinal symptomatology: anorexia, nausea, meteorism, weight loss. In 10% of cases stomach ulcers and/or a duodenum, develop in 10% - pancreatitis, is more rare панкреакалькулез. Twice more often than in population, cholelithiasis meets.
  3. Cardiovascular symptomatology: arterial hypertension and its complications.
  4. Bone changes: osteoporosis, chondrocalcinosis; at heavy primary hyperparathyreosis: subperiosteal resorption, acro-osteolysis of trailer phalanxes of brushes and feet, deformation of a skeleton, pathological fractures of bones, cysts, giant-cell tumors and epulises (cystous educations).
  5. Central nervous system: depression, drowsiness, confusion of consciousness, excitement, skin itch.
  6. Giperkaltsiyemichesky crisis - a rare heavy complication of primary hyperparathyreosis. Drowsiness, a stupor, a coma, psychosis, after the accruing anorexia, vomiting, vepigastriya pain are characteristic; quickly sharp weakness, dehydration, an anury, coma develops; a heavy complication - a myopathy with involvement of proximal departments of a trunk, intercostal muscles and diaphragms; fever to 38-39 °C is typical. Crisis develops at calcium level in plasma more than 4 mmol/l and is provoked by a long bed rest, thiazide diuretics, drugs of calcium and vitamin D.

Hyperparathyreosis reasons:

In 85% of cases solitary adenoma of epithelial body (paratirom) is the reason of primary hyperparathyreosis, is much more rare - adenomas multiple (5%), is even more rare (< 5 - a target="_blank" href="index-1312.htm" tppabs="medicalmeds.eu/onkologiya/rak/">epithelial body cancer. The hyperplasia of all epithelial bodies occurs approximately at 15% of patients.

Treatment of the Hyperparathyreosis:

Approaches to treatment are defined by expressiveness of primary hyperparathyreosis, age and a physical condition of the patient as the only radical option of treatment is surgical intervention.

Surgical treatment: at a solitary paratiroma - its removal with the subsequent therapy of a hypoparathyrosis.

Indications to surgical treatment of primary hyperparathyreosis.

Absolute indications:

  1. The expressed hypercalcemia (> 3 mmol/l)
  2. Episodes of the expressed hypercalcemia in the past
  3. Renal failure
  4. Stones in kidneys (with symptoms or without)
  5. Nephrocalcinosis
  6. The expressed hypercalcuria (> 10 mmol/days)
  7. Osteoporosis

Relative indications:

  1. The heavy accompanying pathology
  2. Complexity of dynamic observation
  3. Young age (< 50 лет)
  4. Desire of the patient

Dynamic observation is made at detection of easy expressiveness of primary hyperparathyreosis at elderly people. It is admissible in situations of lack of absolute indications to operational treatment. Dynamic observation means determination of level of calcium, function of kidneys, arterial pressure each 6-12 months, carrying out bone densitometry and ultrasonography of kidneys each 2-3 years.