Hyperparathyroidism

Hyperparathyroidism (generalized fibrous osteodystrophy, Recklinghausen's disease) is a disease caused by hyperfunction of the parathyroid glands.

Pathogenesis. Excess parathyroid hormone, caused by adenoma or glandular hyperplasia, leads to violations of phosphoric-calcium metabolism, strengthening of osteoclastic processes, excretion of calcium and phosphorus from the skeleton and excesses in the blood. Simultaneously, due to a decrease in tubular reabsorption and an increase in the release of phosphorus, hypophosphatemia and hyperphosphaturia develop. In bone tissue, there are phenomena of osteoporosis and osteomalacia. There are also secondary hyperparathyroidism, which develops against the background of long-existing hypocalcemia (with damage to the kidneys or gastrointestinal tract), and tertiary hyperparathyroidism in the background of long-existing secondary hyperparathyroidism or progressive renal failure.

Symptoms, course. The disease occurs at the age of 20-50 years, more often in women. Developing general muscle weakness, fatigue, hypotension of the muscles of the upper and lower extremities, pain in the feet, thirst, loosening and loss of teeth, weight loss, stones are formed in the urinary tract. As the disease develops, the primary lesion of a particular system is revealed. With bone and mixed forms, the main symptoms are: bone pain, worse with movement; Long-healed, painless fractures (often femoral, pelvic, humerus, ribs), formation of false joints, deformation of the skeleton, reduction in growth. Typical slow, swinging "duck" gait. A thoracic cage barrel-shaped, palpation of the skeleton can reveal clavate swelling in place of cysts, zones of former fractures. There are two forms of hyperparathyroid osteodystrophy - fibrocystic osteitis and pagetoid and two stages - osteoporotic and cystic. On the radiographs revealed systemic osteoporosis (primarily in the tubular bones, skull and less often the spine), subperiosteal resorption in the main and middle phalanges of the fingers. End phalanxes have a scalloped appearance. In the cystic stage, cysts develop, more often in the femur, pelvic bones, forearms, shoulders, shins.

In renal form the main symptoms: polydipsia, polyuria, hypoisostenuria, alkaline urine reaction. Two-way nephrocalcinosis develops, sometimes hydronephrosis, which can lead to azotemia and uremia with prolonged course. Patients are concerned about dyspeptic disorders, frequent attacks of renal colic, increased blood pressure. When the visceropathic form often develop peptic ulcers of the duodenum, stomach, intestines, ulcers recur, lead to bleeding, perforation of the wall of the stomach and intestines. Chronic pancreatitis, pancreoccalcinosis develop, and gallstones form in the gall bladder. There is a decrease in tendon reflexes, radicular symptoms, increased excitability, tearfulness, irritability, sleep disturbance, memory loss.

When ophthalmological examination, the deposition of calcium salts in the anterior chamber of the eye is detected, which is manifested by a decrease in visual acuity, the appearance of "flies" in front of the eyes. In the blood - hypercalcemia (increased levels of total and ionized calcium), hypophosphatemia, increased activity of alkaline phosphatase and parathyroid hormone levels; In urine - an increase in the content of calcium, phosphorus, proline and hydroxyproline. Research should be multiple. For the purpose of topical diagnosis, parathyroid glands with selenomethionine-75 are scanned, ultrasound examination of the neck region, and arteriography.

Treatment operative.