Hypoparathyroidism
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms
- Features of the course of hypoparathyroidism in children
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Hypoparathyroidism is a disease resulting from insufficient secretion of parathyroid glands of parathyroid hormone or impaired susceptibility to it of target organs, which is manifested by impaired metabolism of phosphorus and calcium.
The disease is observed in 0.3-0.4% of the population, affects people of any age and gender.
Tetanic syndrome - the main clinical sign of hypoparathyroidism
Causes and risk factors
In the human body, the exchange of calcium and phosphorus is regulated by the combined action of parathyroid hormone, vitamin D and calcitonin (thyroid hormone). The lack of parathyroid hormone leads to an increase in the concentration of phosphates in the blood and a simultaneous decrease in calcium. This imbalance becomes the cause of further disturbance of mineral metabolism, primarily of magnesium, sodium and potassium ions. As a result, there is an increase in neuromuscular excitability, manifested by convulsions. In addition, the excess content of calcium salts in the blood contributes to their deposition on the inner walls of blood vessels and in internal organs.
Causes of hypoparathyroidism:
- iatrogenic damage to the parathyroid glands (during surgical interventions on the neck organs, primarily on the thyroid gland);
- neck injuries, accompanied by hemorrhage in the parathyroid glands;
- inflammatory diseases of the parathyroid glands;
- metastases in the neck tissue and parathyroid glands;
- Di Giorgi syndrome - a genetic pathology characterized by abnormal development of the parathyroid glands (as well as congenital heart defects and aplasia of the thymus gland);
- exposure to ionizing radiation;
- various hormonal imbalances (chronic adrenal insufficiency, primary hypothyroidism);
- some autoimmune and systemic diseases (amyloidosis, hemochromatosis).
Hypoparathyroidism is associated with a malfunction of the parathyroid glands
Forms of the disease
According to the clinical course, the following forms of hypoparathyroidism are distinguished:
- Sharp. It is characterized by frequent seizures, and compensation is difficult.
- Chronic. Seizures are relatively rare, usually provoked by psychological trauma, menstruation, nervous or physical fatigue, infectious diseases, changing seasons (exacerbations more often occur in autumn and spring). The therapy ensures the achievement of long-term remission.
- Latent (latent). It proceeds without any clinical signs and is diagnosed only according to the results of laboratory and instrumental examination.
Depending on the cause, hypoparathyroidism is distinguished:
- postoperative - it develops as a complication after surgery on the parathyroid and thyroid glands;
- post-traumatic - due to damage to the tissue of the parathyroid glands by trauma, hemorrhage, the action of ionizing radiation;
- congenital - caused by hypoplasia or aplasia of the parathyroid glands;
- autoimmune - the result of the formation of antibodies to the tissues of the parathyroid glands;
- idiopathic - the cause cannot be established.
Symptoms
The main clinical manifestation of hypoparathyroidism is the development of tetanic (convulsive) syndrome. An attack of seizures is often preceded by precursor symptoms:
- coldness of the limbs;
- tingling sensation in the legs or hands;
- feeling creepy over the upper lip;
- stiffness, muscle numbness.
Seizures usually involve symmetrically located muscles of the upper and lower extremities. Less commonly, the muscles of the face, trunk and internal organs are involved in an attack.
Seizures are the main symptom of hypoprathyroidism
Features of muscle spasms in hypoparathyroidism:
- with convulsions of the upper extremities, the hands are pressed against the body, bent at the wrist and elbow joints;
- convulsions of facial muscles are accompanied by drooping of the eyelids, shifting of eyebrows, characteristic compression of the jaws and lowering of the corners of the mouth;
- convulsive spasm of the coronary vessels is manifested by an attack of angina pectoris;
- cramps of the muscles of the body lead to its sharp extension back;
- cramps of the abdominal muscles, diaphragm, intercostal muscles and neck muscles cause difficulty breathing, shortness of breath;
- cramps of smooth muscles of the gastrointestinal tract are clinically manifested by intestinal colic, dysphagia;
- muscle cramps in the bladder lead to anuria.
Unlike seizures caused by other causes, seizures with hypoparathyroidism are severely painful. With a mild form of the disease, they last several minutes and occur 1-2 times a day. A severe form of hypoparathyroidism is manifested by prolonged convulsive attacks, sometimes accompanied by loss of consciousness, several times a day.
For hypoparathyroidism, disorders of the autonomic nervous system are also characteristic:
- excessive sweating;
- dizziness;
- hearing impairment (ear popping, ringing in the ears);
- violation of twilight vision (night blindness);
- heart rhythm disturbances;
- violation of temperature sensitivity.
With hypoparathyroidism, there is a violation of the autonomic nervous system
A long-term low level of calcium in the blood leads to changes in higher mental activity (emotional lability, sleep disorders, decreased intelligence).
Against the background of chronic hypoparathyroidism, trophic disorders develop:
- dryness and flaking of the skin;
- hyperpigmentation;
- increased fragility of nails;
- eczema;
- fungal dermatitis;
- baldness;
- cataract.
Features of the course of hypoparathyroidism in children
In childhood, in most cases, an autoimmune form of hypoparathyroidism is diagnosed.
The seizures are observed at different intervals. The child develops abdominal pains, and then develops tonic cramps with the head thrown back. Breathing is impaired, which leads to cyanosis of the skin.
Frequent seizures contribute to increased intracranial pressure, persistent headaches in the child and swelling of the optic nerve discs.
Teething is delayed, while the dental crowns have an irregular shape, the enamel layer is underdeveloped.
Hypoparathyroidism in children is often accompanied by the following pathologies:
- cataract;
- autoimmune keratoconjunctivitis;
- primary insufficiency of the sex glands;
- total or alopecia areata;
- chronic lymphocytic thyroiditis;
- chronic adrenal insufficiency;
- Addison-Birmer disease.
If hypoparathyroidism is not treated, the child begins to irreversibly lag behind in physical and mental development.
Diagnostics
Diagnosis of hypoparathyroidism, with the exception of latent forms of the disease, is usually not difficult. It is carried out on the basis of a characteristic clinical picture, anamnesis data (radiotherapy, surgery and neck injuries), signs of increased neuromuscular conduction.
To diagnose hypoparateriosis, the level of parathyroid hormone in the blood and urine is determined
Laboratory diagnostics of hypoparathyroidism includes the determination of the content of parathyroid hormone in the blood and urine, the concentration of phosphorus and calcium in the blood. Hypoparathyroidism is characterized by:
- hyperphosphatemia;
- hypocalcemia;
- hypophosphaturia;
- hypercalciuria;
- a decrease in the amount of parathyroid hormone both in the blood and in the urine.
Hardware diagnostics:
- X-ray examination - calcification of the cartilage of the ribs and signs of osteosclerosis are revealed;
- densitometry - increased bone density is detected;
- magnetic resonance imaging - there are deposits of calcium salts in the tissues of the brain, subcutaneous tissue and internal organs.
To determine the increased neuromuscular conductivity, a test with hyperventilation is performed.
Treatment
An important role in the treatment of hypoparathyroidism is played by diet therapy. The diet should be dominated by foods with a low phosphorus content, rich in magnesium, calcium. Patients are advised to consume more vegetables, fruits and dairy products. The menu should include fish oil, liver, egg yolks, that is, foods rich in ergocalciferol (vitamin D 2). During periods of exacerbation, meat dishes are excluded from the diet.
Diet therapy is an important part of the treatment of hypoparathyroidism
Drug therapy for hypoparathyroidism is carried out with calcium preparations (gluconate or calcium carbonate), which are taken with diluted hydrochloric acid, gastric juice or ammonium chloride - this improves the absorption of calcium from the intestine.
Monotherapy of hypoparathyroidism in most cases does not allow the normalization of serum calcium levels. Therefore, vitamin D preparations are additionally prescribed (colecalciferol, alfacalcidol, ergocalciferol). Sunbathing or mild UV exposure is also indicated.
For the prevention of seizures, anticonvulsants are prescribed, for example, Phenobarbital (Luminal).
With the development of a hypocalcemic crisis, an urgent intravenous administration of calcium gluconate is necessary.
Possible complications and consequences
One of the most common complications of hypoparathyroidism is a hypocalcemic crisis. It develops due to a rapid drop in serum calcium concentration. A patient under the influence of external irritation (sound, mechanical, hyperventilation) or spontaneously develops a convulsive seizure, which without medical assistance can last for a long time - up to several hours. Convulsions can spread to the vocal cords, smooth muscles of the bronchi, which leads to the formation of laryngospasm, bronchospasm, the appearance and growth of acute respiratory failure.
Against the background of a long course of hypoparathyroidism, patients develop calcification of internal organs, including the brain, cataracts.
Forecast
The prognosis is favorable for life, subject to systematic treatment and dispensary observation. An examination by an endocrinologist is carried out at least 1 time in 3 months - this allows a timely assessment of the compensation of pathology and, if necessary, adjust the therapy scheme. The patient needs to undergo an ophthalmological examination 2 times a year, since the risk of cataract formation is high.
Prevention
In order to prevent the development of hypoparathyroidism in the surgical treatment of thyroid diseases, preference should be given to sparing surgical techniques. In case of recurrent toxic goiter, it is desirable to carry out treatment with radioactive iodine, and not a second operation, since the risk of damage to the parathyroid glands in this case is very high.
After surgical intervention on the thyroid gland and other organs of the neck, active prevention of postoperative complications (infiltrates, adhesions), which can cause a deterioration in the blood supply to the parathyroid glands, should be carried out.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
