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PARATHYROID GLANDS (Hypoparathyroidism (symptoms (muscles:
-cramps of…
PARATHYROID GLANDS
Hypoparathyroidism
- primary: low PTH activity that cause low ionised ca in extracellular fluid.
- secondary: low PTH in response to a primary process that causes hypercalcemia
- primary: low PTH, low ca. / secondary: low PTH, HIGH ca
- aetiology:
- absolute lack PTH: iatrogenic, mutation in PTH genome, autoimmune disease.
- PTH resistance: PTH receptor defect ( blomastrand's chondrodysplasy), pseudohypoparathyroidism 1a, 1c
- hyper function of ca sensing receptors: familial hypercalciuric hypocalcemia
- causes:
-acquired:
iatrogenic: excision of all parathyroid glands-surgery (common), extensive irradiation, hungry bone syndrome-after parathyroidectomy for hpyperparathyroidism; bones retail ca under influence of osteoblasts.
autoimmune: type 1 autoimmune polyglandular syndrome (APS1, APCED, HAM syndrome): at least 2 of 3 criteria: chronic mucoctaneous candidiasis, hypoparathyroidism, autoimmune adrenal insufficiency., isolated autoimmune hypoparathyroidism ( common in 7 y.o).
infiltration: hemochrombtosis, wilson disease, metastatic, amyloidosis, progressive systemic sclerosis.
metal overload: hypomagnesemia (causes primary hypoparathyroidism), hypermagnesemia (decrease PTH release).
-congenital:
branchial dysgenesis (digeorge syndrome).
HDR syndrome- barakat syndrome (primary Hypoparathyroidism, nerve Deafness, steroid resistant nephrosis (Renal dysplasia)).
PTH receptor defect ( blomastrand's chondrodysplasy)
symptoms
- muscles:
-cramps of lower half of the body.
-increased neuromuscular irritability - spasmophilia:
chvostek sign: facial twitching, induced by tapping ipsilateral facial nerve.
trousseau sign: carpal spasm induced by inflating a blood pressure cuff around the arm.
-smooth mm. cramp:
bronchospasm - wheezing
laryngospasm- hoarseness
**coronary artery-angina
peripheral artery-raynaulds syndrome
cerebral - migraine **
- neurological: parenthesis , seizures, personality disturbance
complication
cataract, calcifications in soft tissue, especially in basal ganglia (Fahr's syndrome)
treatment
- tetany onset:
ca i.v., 1-2 g/day ca orally
ACTIVE metabolites of vit.d3: calcitriol, alphacalcidol
- chronic hypoparathyroidism:
milk-free diet ,
calcium 1-2 g/d orally, vit. d.
thiazides
active metabolites of vit.d3: calcitriol, alphacalcidol
Hyperparathyroidism
Secondary
- PTH overproduction induced by hypocalcemia.
- PTH serum H, Ca serum L, P serum H-renal /L-vit.D, ALP serum H Ca urine L
- Caused by chronic renal failure (most common cause), as well as vitamin D de ciency and renal hypercalciuria.
primary
- group of sings and symptoms related to overproduction of PTH not caused by impaired mineral imbalance ( ca & p) resulting in abnormal ca & p homeostasis.
- PTH serum H, Ca serum H, P serum L, ALP serum H, Ca urine H
- classification: sporadic (90 %), hereditary (10 %).
- aetiology:
85 % - parathyroid adenoma,
15 %- parathyroid hyperplasia of all 4 glands,
< ,5 % - parathyroid carcinoma.
- symptoms:
80% asymptomatic,
20% systemic: classical ( related to hypercalcemia, urinary [ nephrolithiasis { recurrent, bilateral, calcium oxalate}, polyuria, polydipsia, chronic renal failure due to cacinosis], osseous system [subperiosteal resorption, osteoporosis, osteopenia, soul 'salt and pepper', brown bone, pathologic fracture, phalangeal tuff resorption, osteitis fibrous cystica (“brown tumors”)]), GI [peptic ulcer, pancreatitis, constipation, vomiting, loss of appetite] , CVS [tachycardia, arrhythmia, short qt interval, hypertension], CNS [ headache, sleepless, psychosis, confusion], anaemia, glucose intolerance, ca in tissue, band keratopathy- ca in horizontal band in the cornea.
diagnosis
- DD:
-neurofibromatosis type 1 (NF1);
criteria ( 2 or more): 6 or more cafe au lait spots, 2 or more neurofibromas, freckling in axilla or groin, optic glioma, 2 or are lisch nodule (iris hamartomas), bony lesion (dysplasia of the sphenoid bone or dysplasia or thinking of long bone cortex),
-osteitis deformano ( paget's disease),
-bone neoplasms
- lab: UP.
- imaging: Tc 99- gold standard, MRI, ct, hires ultrasund.mipi
treatment
non-surgical:
- observation:
ca <12 mg%,
diet should have 800-100 mg of calcium per day,
avoid thiazides
- pharmacological: sever hyperca. - Ca > 14 mg% or > 12 mg% + symptoms:
increase calciuresis: .9 nacl iv.- 2-4 l/d, furosemide 10-20 mg
decrease bone resorption: pamidronic acid, zoledronic acid, klodronic acid, calcitonin 400-8-- iu iv.
decrease vit.d activation: hydrocortisone.
surgical:
- absolute:
"classical" symptoms,
ca serum > 12, ca urne >400 mg/24h, bmd score <-2.0 sd,
pancreatitis, neuromuscular disorder.
- relative: age <50, progressive renal damage, progressive meant disturbances.
- Most common cause of hypercalcemia,
- can occur as part of MEN,
tertiary
- secondary to long standing secondary hyperparathyroidism, characterised by development autonomous hypersecretion of PTH causing hypercalcemia.
- PTH serum H, Ca serum H, P serum H, ALP serum H, Ca urine various
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