Hyperparathyroidism

Introduction to hyperparathyroidism Hyperparathyroidism is the secretion of excess parathyroid hormone (PTH) from the nail parasite. Parathyroid gland itself has lesions, such as hyperproliferation, neoplastic or even cancerous, due to other physical conditions, such as long-term vitamin D deficiency, may lead to hyperparathyroidism. The disease is more common in people aged 20 to 50, and more women than men. The onset is slow, and there are those who have discovered kidney stones repeatedly. There are bone pain as the main manifestation. Those with neurological symptoms are high in blood calcium, and those who have multiple endocrine neoplasia are also found. There are always asymptomatic people. Hyperparathyroidism can lead to bone pain, fractures, hypercalcemia, etc. It can also harm other systems of the body and requires active diagnosis and treatment. The phenomenon of misdiagnosis and mistreatment is not uncommon because of insufficient understanding of hyperparathyroidism. It not only wastes the patient's energy and financial resources, but also seriously affects the quality of life of patients, and can lead to irreversible organ damage and even death. basic knowledge The proportion of illness: 0.03% Susceptible people: more common in people aged 20 to 50 Mode of infection: non-infectious Complications: Osteoporosis, fracture, uremia, bloating, constipation, abdominal pain, hypercalcemia

Cause of hyperparathyroidism

The most important function of the parathyroid glands is to maintain the relative stability of human blood calcium levels by increasing or decreasing the amount of parathyroid hormone secreted. The causes of hyperparathyroidism can be divided into three types:

Glandular carcinogenesis (60%):

Such as hyperproliferation, neoplastic or even cancerous, medically known as primary hyperparathyroidism, which is commonly referred to as "hyperthyroidism", is due to excessive release of thyroid hormone synthesis by the thyroid gland, causing hypermetabolism and sympathetic Nervous excitement, a condition that causes palpitations, sweating, eating and increased stools and weight loss.

Endocrine factors (20%):

Such as long-term vitamin D deficiency, intestinal function absorption disorder or renal insufficiency, etc., blood calcium is lower than normal, the parathyroid gland needs to increase the secretion of parathyroid hormone to increase blood calcium levels, therefore, it can be considered compensatory hyperactivity, It is called secondary hyperparathyroidism.

Other (5%):

On the basis of long-term secondary hyperplasia, the parathyroid gland has undergone neoplastic changes, which is called triple hyperparathyroidism. In another case, the parathyroid itself does not have the above-mentioned lesions, but because other organs of the body secrete substances similar to parathyroid hormone, its performance is largely the same as excessive secretion of parathyroid hormone, medically called For pseudohypoparathyroidism, it is not a true hyperparathyroidism.

Hyperparathyroidism prevention

The prognosis of hyperparathyroidism is related to the etiology, extent, and intrinsic factors of patients with combined diseases, and also whether the treatment is scientific. The vast majority of primary hyperparathyroidism can be cured. The earlier the treatment, the more thorough the recovery. Myasthenia gravis and psychiatric symptoms can disappear after successful surgery, and osteoporosis can be improved, but renal dysfunction or fibrous cystic osteitis that has already occurred is difficult to recover. It is worth pointing out that whether the first operation of parathyroid cancer is scientifically standardized is the most important factor in determining whether or not to cure. However, the challenge for doctors is that they are often unable to effectively identify parathyroid adenomas and parathyroid carcinomas before surgery. It is also necessary to combine the findings in the surgery to further judge the benign and malignant tumors.

Parathyroid hyperfunction Complications Osteoporotic fractures, uremia, bloating, constipation, abdominal pain, hypercalcemia

Bone pain: When hyperparathyroidism is hyperactive, bone resorption is intensified, making osteoporosis occur earlier, faster, and more severely. Basically, there are different degrees of bone pain symptoms, especially in the lower back and leg. Tired, heavy people are difficult to walk, and can't even stand. X-ray examination or CT examination often shows obvious osteoporosis, and even obvious bone destruction, which is similar to bone tumor. Some patients are even mistaken for surgery.

Fracture: long-term hyperparathyroidism not only aggravates osteoporosis, but also causes fibrotic osteitis. These patients often have obvious short body and limb malformation. The patient may have a slight movement or collision. A fracture occurs, which is a medically pathological fracture. If it occurs in the vertebral body, there is a risk of paralysis.

Hypercalcemia-related damage: Under normal circumstances, the amount of calcium absorbed by the human body from the outside is basically equal to the amount of calcium excreted from the body, but in the case of primary hyperparathyroidism, due to the excessive release of bone calcium, The absorption of the intestine also increases, and the amount of calcium entering the blood is much larger than the amount of calcium excluding the body. Therefore, the blood calcium concentration is higher than normal, which is called hypercalcemia. A similar situation occurs in the case of triple or pseudohypoparathyroidism.

Due to the presence of hypercalcemia, coupled with bone matrix release and changes in urine pH, etc., it is easy to cause repeated urinary calculi. The continuous deposition of calcium salts in the renal parenchyma also gradually reduces renal function, even renal failure and uremia. .

Hypercalcemia can also jeopardize many other systems of the body, such as the heart circulatory system, the neuromuscular motor system, the digestive system, and the central nervous system. Can be manifested as heart rhythm disorder, fatigue, abdominal distension, anorexia, constipation, abdominal pain, mental and emotional abnormalities. In general, the performance of the above system is positively correlated with blood calcium levels, but also related to individual sensitivity, length of medical history, and rate of increase in blood calcium. The hazards of hypercalcemia are systemic, leading to abnormal blood sugar, abnormal lipid metabolism and blood pressure regulation disorders. Long-term hypercalcemia can also lead to the deposition of calcium salts in joints, tendons, brain tissue and cornea, causing ectopic soft tissue calcification. It is worth pointing out that even benign parotid tumors can be life-threatening, the main cause of which is hypercalcemia.

Symptoms of hyperparathyroidism Common symptoms Osteopathic endocrine function hyperthyroidism, bloating, nausea and vomiting

The disease is more common in people aged 20 to 50, and more women than men. The onset is slow, and there are those who have discovered kidney stones repeatedly. There are bone pain as the main manifestation. Those with neurological symptoms are high in blood calcium, and those who have multiple endocrine neoplasia are also found. There are always asymptomatic people. The clinical manifestations can be summarized into the following four groups:

(A) high blood calcium hypophosphatemia group: for early symptoms, often overlooked.

1. Digestive system: may have symptoms such as weak stomach, constipation, abdominal distension, nausea, vomiting and the like. Some patients with duodenal ulcer disease may be related to the secretion of gastrin from the gastric mucosa by hypercalcemia. If accompanied by islet gastrinoma, such as Zollinger Ellison syndrome, peptic ulcer is difficult to treat, some patients may be associated with multiple pancreatitis, the cause is unknown, may be due to calcium deposition in the pancreas The pancreatic duct is blocked.

2. Muscle: The muscles of the limbs are slack, the tension is reduced, and the patient is prone to fatigue and weakness. Bradycardia, sometimes arrhythmia, ECG shows a shortened QT interval.

3. Urinary system: Because of the high calcium level, there is a lot of calcium excreted from the urine. Patients often complain of polyuria, thirst, and polydipsia. The incidence of urinary stones is also high, generally between 60% and 90%. Clinically, There are renal colic, hematuria or secondary urinary tract infection, which can cause renal damage and may even lead to renal failure after repeated episodes. The characteristics of urinary stones caused by this disease are multiple, recurrent, bilateral, and stones often have increasing and increasing activity, together with renal parenchymal calcium deposition, which has diagnostic significance for this disease. Renal tubular calcium deposition and calcium deposition can cause renal failure. In general urinary stones, about 2% to 5% are caused by this disease. In addition to the above-mentioned syndromes, ectopic calcification of the renal parenchyma, cornea, cartilage or pleura may occur.

(B) skeletal symptoms : initial bone pain, can be located in the back, spine, hip, chest ribs or limbs, accompanied by tenderness. Lower limbs can not support weight, walking difficulties, often misdiagnosed as arthritis or muscle lesions; skeletal deformities gradually appear after a long time (some patients still have bone sacs such as local bulge). Shortened in length, can have pathological fractures, and even bedridden.

(C) other syndromes: a small number of patients may have psychiatric symptoms such as hallucinations, paranoid, multiple endocrine neoplasia type I (gastrin, pituitary tumor, with parathyroid adenoma sometimes associated with gastrointestinal carcinoma, said Wermer syndrome) or type II (Sipple syndrome: pheochromocytoma, medullary thyroid carcinoma with hyperparathyroidism).

Check: blood calcium often exceeds 12mg%, blood phosphorus is reduced to 2~3mg%, blood sputum phosphatase is increased; urinary calcium excretion is significantly increased, can exceed 20mg every 24 hours. Based on this, the diagnosis can be confirmed.

Psychiatric symptoms are common, mainly like depression: low mood, fatigue, lack of initiative and irritability, but also memory loss and slow thinking. If the onset is concealed, the symptoms may be ignored and missed.

"Parathyroid crisis" can occur in acute organic mental disorders, manifested as conscious turbidity, hallucinations and aggression. The patient can have repeated convulsions, drowsiness and coma.

Examination of hyperparathyroidism

1. B-mode ultrasonography of the neck has a space-occupying change in the common parts of the parathyroid gland. This test is non-invasive, economical, and easy to repeat. It is currently the preferred imaging method.

2, neck CT or MRI: for the discovery of mediastinal ectopic parathyroid glands have greater significance.

3, 99mTcMIBI parathyroid imaging: is a relatively sensitive test, especially for the detection of multiple, atopic or metastatic disease is important

However, each of the above tests has the possibility of false positives and false negatives. Its accuracy is influenced by both the examiner's experience, the location of the parathyroid glands, the pathological features of the parathyroid glands, and the presence or absence of secondary changes such as necrosis.

In addition to the above-mentioned common methods, there are veins for blood sampling, high-selective angiography, etc., but because of its invasiveness and high cost, it is generally not used as a first-line examination method.

Diagnosis and differentiation of hyperparathyroidism

Diagnostic criteria

Detection of blood parathyroid hormone is a necessary means of diagnosing hyperparathyroidism. People with the following performance should actively carry out this inspection.

1. Unexplained body aches, fatigue, or joint pain.

2. Authors of repeated urinary calculi.

3, unexplained mental activity abnormalities, such as feelings of indifference or irritability, especially with more drinking and more urine.

4, unexplained constipation, anorexia, abdominal distension, abdominal pain, or repeated digestive ulcers or pancreatitis.

5, long-term renal dysfunction.

6, elevated blood calcium.

7. Bone mineral density is significantly higher than that of the same age.

8, there are tumor history of thyroid, adrenal gland or pituitary gland.

To determine the type of hyperparathyroidism in addition to elevated levels of parathyroid hormone, combined with medical history and other findings for a comprehensive analysis.

Patients with high blood calcium, hypophosphatemia, high urinary calcium, and high urinary phosphorus are primary hyperparathyroidism.

Patients with hypocalcemia, low urinary calcium, and hyperphosphatemia are secondary hyperparathyroidism. If hypercalcemia occurs on this basis, it is triad hyperparathyroidism.

Hypercalcemia and low parathyroid hormone in the whole segment should be highly alert to the pseudohypoparathyroidism caused by the tumor, and a systemic examination must be performed to determine the source of the tumor.

It should be pointed out that the above classification method is not absolute or static. For example, renal insufficiency may be the result of primary hyperparathyroidism, or the cause of secondary hyperparathyroidism, which requires comprehensive analysis and judgment.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.