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The hyperparathyreosis is an endocrine disease, in a basis which the excess producing parathormone epithelial bodies lies. The increased production of hormone is a consequence of a hyperplasia of glands that in turn leads to disturbance of a phosphorus-calcium exchange. So there is a strengthened removal of phosphorus and calcium from a skeleton, increase of osteo klastichesky processes and excess receipt them in large numbers in blood.
The simultaneous increased release of phosphorus, and also decrease in a canalicular reabsorption leads to emergence of a hypophosphatemia and hyperphosphaturia, at the same time, in a bone tissue symptoms of osteoporosis and osteomalacy appear. More often everything, is 2-3 times more, than men, the illness affects women aged from 25 and till 50 flyings.
Are an origin of a hyperparathyreosis a tumor of epithelial bodies.
Depending on an origin the hyperparathyreosis is divided into the following types:
- Primary appears as a result of formation of adenoma of epithelial bodies in most cases of a disease. And only in one of ten cases of diseases of the reason emergence of a carcinoma or a hyperplasia, growth and increase in normal cells of gland is.
- The secondary hyperparathyreosis — occurs function strengthening, pathological growth and increase in glands, the long lowered content of calcium at the simultaneous increased content of phosphates in blood. Increase in production of parathormone at a chronic renal failure is observed.
- Tertiary — is observed development of benign tumors of epithelial bodies, and also the increased production of parathormone because of a long secondary hyperparathyreosis.
- The pseudo-hyperparathyreosis – is observed production of parathormone by tumors which arose not from cells of epithelial bodies.
The illness is divided by degree of manifestation on
- manifest form.
- oligosymptomatic (soft) form.
- asymptomatic form.
Besides, on disease degree the illness is divided into the bone, renal, visceral and mixed forms.
Danger of a disease is that it can proceed without symptoms and detection or diagnosis of a hyperparathyreosis happens accidentally, at inspection. At early stages of a disease the patient has a fast fatigue even at small loadings, a headache, muscular weakness, difficulties when walking, and especially, at rise up a ladder, the characteristic rolling-over "duck" gait.
Patients test emotional disbalance, sensitivity and uneasiness, memory worsens, the depression develops. Skin gains earthy-gray color. At advanced age various mental disorders can develop.
The late stage of a bone hyperparathyreosis is characterized by a softening and a curvature of bones, emergence of scattered ostealgias of hands or legs, in a backbone. The usual movements can lead to bone changes which low-painful, but slowly grow together, at the same time, is sometimes formed nearthroses.
Because of the deformed skeleton, the patient can even become lower growth. At osteoporosis of jaws at the patient healthy teeth are loosened or drop out. On a neck at a palpation big adenoma in the field of epithelial bodies is probed. On extremities visible periartikulyarny kaltsinata appear.
At a vistseropatichesky hyperparathyreosis nausea, vomiting, sharp weight reduction is observed. Patients complain of appetite loss, gastric pains, a meteorism. At inspection emergence of round ulcers with bleedings, and also various signs of damage of a pancreas and gall bladder is found, the polyuria and symptoms of a renal failure develops. Food of bodies and fabrics is broken, high concentration of calcium in blood causes damage to vessels of heart, increase of arterial pressure, stenocardia. At calcification of an eye conjunctiva it is observed, so-called, a syndrome of "a red eye".
At a renal form main symptoms of a hyperparathyreosis: polyuria and alkali reaction of urine. Development of a bilateral nefrokaptsinoz is possible that, in turn, can lead to an azotemia and uraemia. The patient is disturbed by supertension, attacks of renal colic, dispepsichesky frustration. There is an ulcer of a duodenum or stomach, perforation of a wall of a stomach and intestines is possible. Chronic pancreatitis, formation of stones in a gall bladder is often possible.
Diagnosis of a hyperparathyreosis
Diagnosis of a disease is carried out on the basis of blood tests, the defining calcium and phosphorus in an organism and the analysis of urine.
At detection of high level of calcium it is carried out other analyses and researches: ultrasonic research, X-ray inspection, KT and MPT which allow to reveal osteoporosis, pathological ulcers of a digestive tract, cystous changes of bones and other changes. Stsintigrafiya of epithelial bodies reveals localization of an arrangement of glands and their anomaly.
At a secondary hyperparathyreosis diagnosing of the defining disease is carried out.
Treatment of a hyperparathyreosis
Treatment of an illness is carried out in a complex in a combination of conservative therapy by medicamentous drugs and operational surgery. Before operation conservative treatment which purpose puts decrease in level of Sa in blood is carried out.
In the operational way malignant tumors of epithelial bodies are removed, then radiation therapy is carried out.
The forecast of a hyperparathyreosis is favorable at timely carried out diagnosis of a hyperparathyreosis and adequate surgical treatment. The complete recovery of working capacity depends on degree of a prevalence of a bone tissue. If treatment of a hyperparathyreosis is begun at an early stage, the patient is recovered within, at most, half a year. In medium-weight cases recovery lasts for 2 years. In the started cases disability is probable.
Less favorable forecast at renal forms of a hyperparathyreosis and completely depends on degree of kidneys before an operative measure. Without operation — disability and a lethal outcome because of the progressing cachexia and a chronic renal failure.
At giperkaltsiyemichesky crisis the forecast depends on timeliness of treatment, the lethality makes 32%.
Complications of a hyperparathyreosis
Dangerous complication is giperkaltsiyemichesky crisis, life-threatening the patient. Crisis arises always suddenly owing to an acute hypercalcemia. As risk factors serve the long bed rest, uncontrolled administration of drugs of calcium and vitamin D and thiazide diuretics. Vomiting, acute pains in epigastriums, drowsiness, disturbance of consciousness are characteristic of crisis the high temperature of a body rising to 40 C, the coma is frequent. Also there are such complications of a hyperparathyreosis as a fluid lungs, fibrinferments, perforation of round ulcers, bleeding.