Nail brittleness and atrophy

Introduction The soft atrophy of the nail is a clinical manifestation of pseudohypoparathyroidism. Patients with pseudohypoparathyroidism often find rough skin, hyperpigmentation, hair loss, fingernails, soft and atrophy, and even shedding; cataracts can occur in the intraocular lens.

Cause

(1) Secondary is more common. The most common cause is the removal of the parathyroid gland or injury caused by thyroid surgery. If most or all of the glands are removed, permanent hypoparathyroidism often occurs, accounting for about 1% to 1.7% of thyroid surgery. Excessive glandular thyroid hyperplasia can also cause this disease. As for thyroid inflammation, hyperthyroidism is less common after receiving radioactive iodine or due to malignant tumor invasion of the parathyroid gland.

(2) Idiopathic is less common. It is an autoimmune disease. Can be combined with thyroid and adrenal cortical hypofunction, diabetes, such as multiple endocrine gland hypofunction; some patients can detect autoantibodies against gastric parietal cells, parathyroid glands, adrenal cortex and thyroid.

an examination

Related inspection

Determination of serum calcium serum phosphorus (Pi) by trace elements in human body

Mainly due to long-term hypocalcemia with paroxysmal aggravation caused by the following symptoms:

(1) Neuromuscular symptoms are caused by increased neuromuscular stress. Mild symptoms are only abnormal, tingling, numbness, stiff hands and feet, easy to be ignored or misdiagnosed. When the blood calcium is reduced to a certain level (80mg/L or less), there is often a seizure of the hand and foot. The bilateral symmetry wrist and the knuckle of the palm are flexed, the interphalangeal joint is straight, the thumb is adducted, and the eagle claw is formed. Both feet often have tonic stretching, knee and hip flexion; severe cases of systemic skeletal muscle and smooth muscle spasm, can occur throat and bronchospasm, asphyxia and other crises; myocardial fatigue in time tachycardia, ECG QT prolonged, mainly For the ST segment extension, with abnormal T wave; tendon tendon when there is hiccup; children with more convulsions, mostly systemic, like unexplained epileptic seizures without coma, incontinence and other performance. The above symptoms can be induced by factors such as infection, overwork and mood. Women are more likely to attack before and after menstruation. The blood calcium is about 70-80mg/L. There is no obvious sputum called recessive snoring in the clinic. If the serum free calcium is decreased or the neuromuscular stress is increased, the following test can make the recessive person show the disease. :

1, facial nerve slamming test (Chvostek sign) with the finger to hit the front of the nerve surface of the ear, can cause the same side of the mouth or nose twitching, the same side of the muscles also have convulsions.

2. The beam arm compression test (Trousseau sign) wraps the sphygmomanometer rubber bag around the upper arm, and inflates the bag to maintain blood pressure between diastolic blood pressure and systolic blood pressure, reducing or stopping the upper arm venous return for 3 minutes, which can cause partial arm twitch.

(B) mental symptoms often accompanied by anxiety, anxiety, depression, hallucinations, dysregulation, memory loss and other symptoms, but in addition to convulsions, there is little loss of consciousness. Psychiatric symptoms may be associated with cerebral basal dysfunction.

(3) ectodermal tissue vegetative degeneration and abnormal calcification group such as hypoparathyroidism is too long, often found skin rough, pigmentation, hair loss, finger (toe) nails soft and atrophy, and even shedding; intraocular lens Cataracts can occur. The disease starts from childhood, the teeth are incomplete calcification, the tooth enamel development disorder, yellow spots, horizontal stripes, small holes and other lesions. Children with multiple mental decline, EEG often have abnormal performance, epileptic waves can occur (unlike unexplained epilepsy, after the calcium supplementation, epileptic waves can disappear): stenosis of the basal ganglia can be seen on the skull X-ray film, bone It is also denser than normal, and sometimes the cerebellum can also be calcified.

diagnosis

It is easy to diagnose after thyroid surgery. Idiopathic and symptomatic submersibles are easily overlooked, and it is not uncommon for people with neurosis or epilepsy to be mistaken. However, if multiple tests of blood and urine can be performed, most of them can detect hypocalcemia in time. The above induced test can help diagnose. The main diagnostic basis is:

1 no thyroid surgery or anterior neck radiotherapy and other medical history.

2 chronic episodes of snoring.

3 blood calcium is too low, blood phosphorus is too high.

Except 4 can cause other causes of low plasma calcium, such as renal insufficiency, fatty sputum, chronic diarrhea, vitamin D deficiency and alkalosis.

5 serum iPTH was significantly lower than normal or absent.

The 6Ellsworth-Howard test has a phosphorus rejection reaction.

7 no body deformity, such as short stature, short toe and deformity of the toes or cartilage development disorders.

Idiopathic hypoparathyroidism needs to be differentiated from pseudo idiopathic hypoparathyroidism, pseudohypoparathyroidism type I and type II, pseudohypoparathyroidism, etc. Must be distinguished from other causes of hand, foot and sputum. Idiopathic constitutional dysfunction (spasmophilieconstitutionnelleid-iopathique) is a chronic constitutional neuromuscular overstressed state with insomnia, ant itching and sputum pain and other neurosis, and can present typical hand, foot and sputum, plasma Calcium and magnesium concentrations are normal, but the magnesium content in red blood cells is reduced. Although this disease is rare, it needs to be differentiated from idiopathic hypoparathyroidism.

Differential diagnosis

Clinical manifestations: The most prominent clinical features of CRPS are pain, paresthesia, vascular and motor dysfunction. Pain can occur anywhere on the body surface, such as the face and genitals, but the most common are the unilateral hands and feet. The pain can be a burning sensation, a stinging, deep dull pain and hypersensitivity to the skin. Non-painful stimuli such as breeze, bed sheets or clothing contact can cause severe pain (allodynia).

In the painful area, edema may occur, skin color and temperature change, sweating abnormalities, and limb weakness. Some patients even feel that the limb is separated from the trunk. Physical examination, in addition to the above changes, can also be found in abnormal hair growth, muscle tremors or paralysis and even limb false sputum. In the advanced stage, skin, nails, muscles and even bones may shrink. In some patients with CRPS, pain and other symptoms can slowly spread to the torso. In rare cases, the performance of the CRPS can appear in the corresponding part of the contralateral side, called the mirror (mirro). For example, if a patient's CRPS occurs in the left palm, the same CRPS may appear in the corresponding part of the right palm. The generation of mirrors is spontaneous, and the reason is still unclear. Patients with CRPS are often accompanied by symptoms such as stress, anxiety and depression.

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