Description hyperparathyroidism
The prefix hyper- medicine indicates whether it is some kind of authority or function of the structure, it is always magnified than normal. Hyperparathyroidism is thus elevated parathyroid function.
Parathyroids are four small glands, which are normally located at the rear of the thyroid. Though they are small, their function is very important because it is the level control for our body super important element – calcium. Along with controlling calcium levels also affects the levels of phosphates. For this purpose consists of a hormone called parathyroid hormone.
Parathyroid hormone raises blood calcium by several mechanisms. One is the release from bones,then increases its absorption in the gut and ultimately increases in renal calcium reabsorption back into the bloodstream.
Thus, if the body becomes depressed levels of calcium, parathyroid gland releases PTH and circulation then the method described above, equals the level back to normal.
But may be situations where the body consists of parathyroid hormone excess. This leads to an excessive increase in calcium levels in the blood, called hypercalcemia. Also, the reduced level of phosphate – hypophosphatemia.
According to the cause that this increased release of PTH evokes hyperparathyroidism are divided into several groups.
primary hyperparathyroidism
The first is called. Primary hyperparathyroidism, which in this case means that the increased production of parathyroid hormone is given alone parathyroid disorder.
Primary hyperparathyroidism can occur at any age, but more commonly affects women around 40 to 60 years. The disease incidence is 1 in 1000, and after diabetes and thyroid disorder is the third most common endocrine disease.
The most common reason is a benign tumor of the gland – adenoma (about 80% of cases), another possible cause is known. Hyperplasia (enlargement) of one or more of the parathyroid glands, rarely can cause primary hyperparathyroidism cancer – cancer.
secondary hyperparathyroidism
The second group is called. Secondary hyperparathyroidism. Its cause is outside parathyroid,therefore is actually a consequence of some other diseases, which reduces the blood calcium level, on which the parathyroid glands release parathyroid hormone responsive increased, so that a low calcium concentration adjusted. This condition can cause diseases such as chronic renal failure and reduced intake of vitamin D (hypovitaminosis D).
Risk factors of hyperparathyroidism
Why does the creation of states. which lead to primary hyperparathyroidism, we can say very difficult, and therefore no specific risk factors, which needs to be avoided not known.
Secondary hyperparathyroidism can be caused by low vitamin D intake.
Another risk factor secondary hyperparatreózy are all diseases which lead to chronic renal failure.The most common of these include diabetes (diabetes).
symptoms of hyperparathyroidism
Hyperparathyroidism often occurs after long periods without symptoms or problems are very mild. To think of disease until the moment when the detected high level of calcium in the blood.
Primary hyperparathyroidism classically affects mainly two systems, and the bones and kidneys.
The kidneys are formed stones (nephrolithiasis), the excess calcium is also stored in the tissue of the kidney (nephrocalcinosis). Because of the concentration impaired renal function leads to increased formation of urine, also emerges thirst. The presence of stones leads to more frequent urinary infections.
Bone disease is highly variable, collectively called as called. Hyperparatyreózní osteodystrophy.Increased amount of parathyroid hormone acts on the bone so that it dissolves. Furthermore, in forming bone cysts, bone erosion is a form in it so. Erosion. All these processes lead to bone pain, especially in the back, hips and legs. If the disease continues, it can lead to bone fractures and deformities such as. Shortening the torso, bending and bowing thoracic spine sternum. The position of the lower extremities changes to “O”.
In patients with primary hyperparathyroidism is more common ulcer of the stomach and duodenum, pancreatitis, gallstones.
Patients have elevated blood pressure, heart rhythm disturbances, due to higher levels of calcium them to form a cornea stripes calcification. For the same reason, the calcium stores into the joints.
High levels of calcium also affects the nervous system and muscles. Appears weakness of the upper extremities, increased fatigue. Nervous system, collectively known as so-called. Endocrine brain syndrome – the patient is lethargic, apathetic, disoriented, hallucinating, appearing in his state of paranoia.
Secondary hyperparathyroidism in chronic renal failure often causes so-called. Renal osteodystrophy, which may be expressed as the above hyperparatyreózní osteodystrophy and osteomalacia ( “soft bones” the lack of vitamin D and calcium).
In secondary hyperparathyroidism, vitamin D deficiency occurs muscle weakness, osteomalacia, bone pain and gait disorders – ie. Duck walk.
treatment hyperparathyroidism
Treatment of primary hyperparathyroidism involves surgical removal of the affected gland – parathyroidectomy. This must be done by an experienced surgeon. Often it is necessary to remove also the thyroid lobe, where it is in parathyroid gland ingrown.
If the patient can not undergo the operation is generally followed by an endocrinologist. Treatment here is the regime measures. It requires plenty of fluids, must not lead to dehydration or the lack of movement. Of the drugs are administered bisphosphonates that inhibit bone resorption.
Treatment of secondary hyperparathyroidism in chronic renal failure lies in adjusting the levels of calcium and phosphate in the blood. It is necessary to follow a strict diet, which consists of a controlled dietary intake of phosphorus (max. 800 mg / day) are given drugs that inhibit the absorption of phosphorus, as well as vitamin D.
In the therapy of secondary hyperparathyroidism of vitamin D deficiency, this administered by intramuscular injection.
How to help treat of hyperparathyroidism
In primary and indeed in secondary hyperparathyroidism your greatest contribution to the treatment based on adherence to medical recommendations and Prescribing therapy. Hyperparathyroidism is a creeping disease and inconspicuous, but the more insidious because it underestimated.
complications of hyperparathyroidism
Even after successful surgery can sometimes appear hoarseness. This is caused by damage to the recurrent nerve. Reversible nerve provides innervation of the vocal cords, and if it becomes damaged during surgery (which can happen even to its strong surgeon), reflected the paralysis of the vocal cords, on one or both sides. This paralysis may be temporary, but unfortunately sometimes even permanent.
After the operation also leads to a sharp decrease of parathyroid hormone, resulting in a decrease in blood calcium, this condition is actually the antithesis of hyperparathyroidism. It is therefore a hypoparathyroidism, which is manifested by increased neuromuscular excitability called. Tetany,which the patient feels like tingling or even cramps muscles of the face, tongue, hands and feet.
Other Names: Increased parathyroid function, hyperfunction parathyroid, hyperparathyroidism, increased production of parathyroid hormone, hyperparathyroidism
