Hypoparathyroidism (tetany)

Hypoparathyroidism (tetany) - a disease characterized by a decrease in the function of the parathyroid glands, increased neuromuscular excitability and convulsive syndrome.

Etiology. Removal or damage of the parathyroid glands during surgery, their defeat in infections, intoxications, autoimmune disorders, decreased sensitivity of tissues to the action of parathyroid hormone.

Pathogenesis. Insufficient allocation of parathyroid hormone, leading to violations of calcium-phosphorus homeostasis (hypocalcemia and hyperphosphataemia). Increased neuromuscular excitability, there is a tendency to develop convulsive syndrome.

Symptoms, course. The seizure is usually preceded by a feeling of numbness, crawling in the upper lip, fingers and toes, coldness of the limbs, a feeling of stiffness. Then painful tonic and clonic convulsions of separate muscle groups develop: limbs, face, trunk. Seizures are observed mainly in the flexor muscles, therefore the hand takes the characteristic position of the "hand of an obstetrician".

When the tetanus flexion muscles of the lower limbs, the foot bends inward, the fingers are bent to the sole ("horse foot"). Convulsions of the facial musculature are accompanied by trismus, the formation of a "fish mouth".

The spread of cramps to the muscles of the neck can cause laryngospasm, accompanied by shortness of breath, cyanosis, and sometimes asphyxiation. There may develop pylorospasm with vomiting, nausea, acidosis; Spasms of the musculature of the intestine, bladder. Spasm of the coronary vessels of the heart is accompanied by sharp pains in the region of the heart. Attacks of tetany are provoked by various stimuli: painful, mechanical, thermal, hyperventilation.

Tapping along the trunk of the facial nerve near the external auditory meatus causes contraction of the muscles of the forehead, upper eyelid, mouth (the Chvostek symptom), tapping along the upper branch of the facial nerve at the outer edge of the orbit leads to a reduction in the circular muscle of the eyelid; Pulling the shoulder with a tourniquet - to the characteristic position of the hand - "hand of an obstetrician" (a symptom of Tissaur).

With a long course of the disease during the interictal period, patients are concerned about sweating, impaired vision due to disruption of accommodation, ringing in the ears, hearing loss. Develop hypocalcemic cataract, brittle nails, brittle and tooth decay. There are changes in the psyche: decreased intelligence, memory impairment, neuroses.

The calcium content in the blood is reduced, especially its ionized fraction; A relationship between the severity of tetany and the degree of decrease in the level of calcium in the blood. The phosphorus content in the blood is higher than normal, the excretion of calcium and phosphorus in the urine is reduced. The level of parathyroid hormone in the blood is reduced.

Treatment. To stop an attack of tetany, IV infusion of 10-20 ml of a 10% solution of chloride or calcium gluconate, parathyroidine - 2 ml IM.

To prevent attacks, appoint inward calcium preparations (gluconate, lactate, glycerophosphate) for 4-6 g / day; Parathyroidine - 2 ml 2-3 times a week with courses of 1.5-2 months; Preparations that improve absorption of calcium in the intestine (dihydrotachysterol) 10-25 drops 2-3 times a day, anabolic steroids (methandrostenolone, nebrolil, retabolil, silabolin), a diet rich in calcium (milk, cheese, cabbage, lettuce, radish, apricots , Strawberries, lemons).