Primary and secondary hyperparathyroidism: symptoms and treatment. Primary and secondary hyperparathyroidism in women, treatment with folk remedies

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Hyperparathyroidism - endocrine pathology, the third most common after thyroid diseases and diabetes mellitus. Lately hyperparathyroidism receives close attention: endocrinopathy of the parathyroid glands is common cause hypertension, gastric ulcers, urinary and cholelithiasis, as well as serious illness- osteoporosis.

In addition, there is evidence that hyperparathyroidism can provoke the development of breast and prostate cancer. So serious consequences disorders of the parathyroid glands, of which there are four in the body, require each person to know the first symptoms of hyperparathyroidism.

What it is?

Hyperparathyroidism is pathological condition parathyroid glands, leading to increased production of parathyroid hormone. This hormone regulates the exchange of phosphorus and calcium: the concentration of the latter in the blood increases due to its leaching from bone tissue. All consequences of pathology concern organs and systems that are sensitive to changes in the level of these substances in the body.

Primarily affected are the kidneys, vascular (atherosclerosis) and musculoskeletal systems, gastrointestinal tract, mental condition(especially in older people).

Hyperparathyroidism is most often diagnosed in people 20-50 years old. Moreover, in women (especially during menopause) this syndrome found 2-3 times more often than men. The disease may initially occur latently or with minimum set nonspecific signs (fatigue, decreased appetite, etc.). The diagnosis is established on the basis of a blood test - the level of calcium (ionized and total), parathyroid hormone, phosphorus, vit. D - and urine analysis for daily calcium levels.

Important! Hyperparathyroidism is often combined with diffuse nodular goiter(thyroid disease). Therefore, all patients with this diagnosis mandatory should be examined for parathyroid hormone, calcium and phosphorus levels.

Causes and types of hyperparathyroidism

Depending on the cause of the increase in the concentration of parathyroid hormone in the blood, endocrinologists distinguish several types of hyperparathyroidism. Subsequent treatment tactics depend on the form of the disease.

• Primary hyperparathyroidism

Primary damage to the parathyroid glands, called Recklinghausen's disease, is characterized by an initial increase in parathyroid hormone due to benign (adenoma) or malignant (adenocarcinoma) proliferation of the parathyroid glands. Often hyperparathyroidism is a component of multiple endocrine neoplasias. With this genetic disorder Along with hyperparathyroidism, oncopathology of the thyroid gland, pheochromocytoma (tumor formation in the adrenal glands), cancer of the pancreas and pituitary gland are diagnosed.

With primary hyperparathyroidism, a high level of calcium is detected in the blood (its normal concentration is also possible), parathyroid hormone, 25-OH vit. D. Clinically, the disease manifests itself when total calcium is from 3 mmol/l (normal is 2.15 - 2.50 mmol/l) and ionized calcium is from 2 mmol/l (normal is 1.03-1.37 mmol/l). Phosphorus concentration is reduced (below 0.7 mmol/l). The daily amount of calcium in urine is most often normal, sometimes increased. The ratio of chlorine and phosphorus ranges from 32.

• Secondary hyperparathyroidism

Increased parathyroid hormone in the secondary form is a consequence long-term deficiency calcium. Most often, secondary hyperparathyroidism is diagnosed in children due to vitamin deficiency. D (rickets in children under 1 year of age). Chronic failure vit. D in adults - a level of less than 14 ng/ml - leads to osteomalacia (decreased bone mineralization and decreased strength). Also, a secondary increase in parathyroid hormone results from impaired absorption of calcium into the blood from small intestine(malsorption) and sluggish renal failure. This happens hyperplastic growth parathyroid glands and increasing the production of their hormone to compensate for calcium deficiency.

At the biochemical level, secondary hyperparathyroidism is manifested by an increase in parathyroid hormone, 25-OH vit. D and phosphorus in the blood, while calcium levels are reduced. Daily calcium in the urine is increased - above 400 mg/day (10 mmol/day).

• Tertiary hyperparathyroidism

This form of the disease is a consequence of long-term untreated secondary hyperparathyroidism. In this case, hyperplasia passes into the stage of parathyroid adenoma, and renal decompensation requires hemodialysis.

Important! You should be aware that some ectopic neoplasms - breast cancer, bronchial cancer - can produce parathyroid hormone, while the parathyroid glands are unchanged. In such cases, pseudohyperparathyroidism is diagnosed.

Symptoms of hyperparathyroidism by stages and forms

The severity of symptoms in hyperparathyroidism increases gradually. Sometimes, against the background of imaginary health, a hypercalcemic crisis suddenly occurs. With a slight increase in parathyroid hormone in a patient with varying intensity, the following are noted:

• fatigue after physical activity, no cramps;
• pain in bones and muscles, caused by leaching of calcium from bone tissue;
• constant thirst and headache;
• frequent urination (usually painless, which excludes genitourinary tract infections);
• frequent nausea, constipation, rarely vomiting;
• itchy skin, in severe cases the skin takes on an earthy-gray tint;
• memory loss due to depression, increased anxiety and mood swings;
• “duck walk” - the patient shifts from one foot to the other;
• weight loss, fever;
• pathological loosening and loss of teeth.

At the late stage of hyperparathyroidism of the parathyroid glands, a large lump is palpated on the front of the neck. In this case, the disease affects one or more target systems.

Bone form

A radical decrease in bone density leads to the development of osteoporosis and pathological fractures, often occurring even without the slightest physical exertion (in bed). Debilitating pain occurs either in the limbs or in the spine.

Skeletal deformation gradually occurs: the patient becomes shorter, dense calcifications form near the joints of the arms and legs, long bones limbs are twisted.

Fractures, although they do not cause severe pain, heal much longer than usual.

Visceral form

Defeat internal organs develops gradually. Symptoms of hyperparathyroidism correspond to the body system most susceptible to pathological effects:

• Gastrointestinal tract - peptic ulcers in the stomach with repeated bleeding, pancreatitis, stones in gallbladder And frequent attacks biliary colic;
• kidneys - nephrocalcinosis leads to the formation of kidney stones, renal failure worsens, leading to uremia;
• heart, blood vessels - atherosclerosis, hypertension develops, angina attacks and arrhythmia are common, the QT interval is shortened;
• eyes - calcification of the blood vessels of the eye leads to the appearance of “red eye” syndrome, visual acuity steadily decreases, “spots” often appear in the eyes;
• neuropsychic sphere - in severe cases, intellect is suppressed, psychosis is common, stupor and coma are possible.

Mixed form

For mixed type hyperparathyroidism is characterized by symptoms of damage to bone tissue and internal organs, expressed to the same degree.

Complications - hyperparathyroid crisis

Serious condition life-threatening patient, occurs when there is a critical increase in calcium in the blood - the total is above 3.5-5.0 mmol/l. Factors contributing to the development of hypercalcemic (hyperparathyroid) crisis are:

• uncontrolled intake of calcium, vit. D, hypothiazide (diuretic);
• long bed rest during severe infections or for fractures;
• pregnancy.

A rise in pressure and an increase in temperature to 40ºC are accompanied by severe weakness, drowsiness, increased muscle pain, and uncontrollable vomiting. Initial mental agitation and resulting convulsions due to dehydration lead to impaired consciousness, a further decrease in tendon reflexes and a coma. Maybe stomach bleeding, thrombosis, pulmonary edema.

If a hyperparathyroid crisis occurs, immediate hospitalization and intensive therapy, aimed at replenishing fluid volume (intravenous infusion of saline) and removing excess calcium in the urine.

Treatment of hyperparathyroidism - surgery or medications?

Modern treatment of hyperparathyroidism depends on the intensity of the symptoms of the disease, the severity of biochemical changes in the blood and the form of the disease. In primary and tertiary hyperparathyroidism, surgical intervention is clearly used - removal of hyperplastic or adenomatous areas of the parathyroid glands. The operation of parathyroidectomy in most cases is performed through endoscopic access (through punctures), but requires the surgeon to have sufficient experience in performing such interventions.

Also, indications for surgical excision of the parathyroid glands for hyperparathyroidism are:

• at least one case of hypercalcemic crisis;
• ionized calcium in the blood is above 3.0 mmol/l;
• progressive renal failure - creatinine clearance is one third lower than age levels;
• an increase in the daily norm of calcium excreted in the urine by 2-3 times (more than 400 mg/day);
• severe stage of osteoporosis - T criterion above 2.5.

Conservative treatment is advisable only for mild forms of hyperparathyroidism (for example, in menopausal women) and in the presence of chronic renal failure(contraindication to radical surgery). Minor secondary hyperparathyroidism, provoked by a lack of calcium and vit. D, accordingly, is corrected by a course of Vit. D in large doses and calcium.

Glucocorticosteroids (Prednisolone), calcimimetics (Mimpara, Calcitonin), bisphosphonates (pamidronic acid, Zoledro-Denk, Clodronate), forced diuretics (iv infusions of saline solution in combination with the diuretics Furosemide, Torazemide) are used in a complex, individually dosed manner.

Forecast

The patient’s condition directly depends on the severity of blood changes and symptoms of hyperparathyroidism, the timeliness of seeking medical care. In 98% of cases, surgical intervention guarantees full recovery. Due to the curvature of bones and post-fracture joints, the quality of life is significantly reduced, and some patients are at risk of disability.

Hyperparathyroid crisis is the most life-threatening.

Quite often, after diagnosis, patients discover disturbances in the functioning of the parathyroid glands. Symptoms of hyperparathyroidism may often not cause any concern. Lethargy, weakness, decreased performance, constipation - people often attribute all these disorders to general fatigue and poor nutrition. Therefore, they consult a doctor already in the later stages of the development of the disease.

In this regard, many people today are interested in the question of what hyperparathyroidism is. Symptoms and treatment, causes and exacerbation are important points, which are worth dealing with. So what does this disease threaten the patient with and what treatment can modern medicine offer?

Brief information about and their functions

Hyperparathyroidism, symptoms and treatment in women, secondary hyperparathyroidism, hypercalcemic crisis are terms that patients often encounter. But before we deal with the reasons, it is worth considering some anatomical features human body.

Most people have two pairs of parathyroid glands, which are usually located on the back surface of the thyroid gland (sometimes they are even embedded in its tissue). By the way, 15-20% of the population has from 3 to 12 glands. Their number and location may vary. The glands are small, a few millimeters in size, weighing from 20 to 70 mg.

Parathyroid glands secrete active biological substance, namely parathyroid hormone, which regulates the metabolism of phosphorus and calcium in the body. If there is insufficient amount of calcium in the blood, the hormone triggers the process of its release from the bones, improves the absorption of this mineral by intestinal tissues, and also reduces the amount that is usually excreted in the urine. Parathyroid hormone also increases the release of phosphorus from the body.

What is hyperparathyroidism? Epidemiology

Hyperparathyroidism is a disease in which there is an increase in the secretion of parathyroid hormone by the parathyroid glands. This is a chronic disease endocrine system, which is often associated with hyperplasia of the glands themselves or the formation of tumors in their tissues.

It is worth saying that symptoms of hyperparathyroidism in women are recorded three times more often than in the stronger sex. Today, the pathology is considered very common. If we talk about endocrine diseases, hyperparathyroidism ranks third in prevalence (after hyperthyroidism and diabetes mellitus).

Pathological changes due to illness

As already mentioned, when the level of parathyroid hormone in the blood increases, a violation occurs calcium metabolism in the body - this mineral begins to be washed out of the bones. At the same time, the level of calcium in the blood increases. The bone tissues of the skeleton are replaced by fibrous ones, which naturally leads to deformation of the supporting apparatus.

Symptoms of hyperparathyroidism are associated not only with impaired bone structure. An increase in calcium levels in the blood often leads to the formation of calcifications in the tissues of internal organs. First of all, the vascular walls and kidneys suffer from the appearance of such neoplasms. In addition, against the background of calcemia, there is an increase blood pressure, increased secretion in the stomach (often leading to the formation of ulcers) and conduction disturbances in nerve tissues, which is accompanied by memory impairment, muscle weakness and depressive states.

Hyperparathyroidism: symptoms and causes of the primary form

IN modern classification There are several groups of this pathology. Patients are often diagnosed with its symptoms associated with primary damage to the glands, and in 85% of cases the cause of the disease is an adenoma (benign tumor).

Much less often, multiple tumors are discovered during diagnosis. Rarely, the cause of impaired secretion is cancer, which in most cases develops after irradiation of the neck and head area. The initial stages of the disease are accompanied by nonspecific symptoms - weakness, fatigue, drowsiness, irritability. This is why patients rarely seek help. The disease can develop over years. According to statistics, the primary form of the disease in most cases develops in women during menopause, as well as in older people.

Secondary form of the disease and its features

Secondary hyperparathyroidism is a disease that develops in initially healthy glands. Increased secretion of parathyroid hormone occurs against the background of a decrease in calcium levels in the blood, which is usually associated with other pathologies.

In most cases, hypocalcemia is associated with either severe chronic diseases kidneys, or with impaired absorption of nutrients (including calcium) by the intestinal walls. The level of parathyroid hormone increases after gastric resection, as well as against the background of hemodialysis. Causes include rickets and severe liver damage, which are accompanied by impaired vitamin D metabolism.

Tertiary form of the disease

Tertiary hyperparathyroidism occurs in patients who have undergone successful transplantation.

As already mentioned, kidney disease is often accompanied by an increase in parathyroid hormone levels. The fact is that such pathologies are accompanied by increased excretion of calcium from the body. Prolonged hypocalcemia can lead to permanent changes in the parathyroid glands. Even after complete restoration of renal parameters, patients still experience disruption of the glands and increased secretion of parathyroid hormone.

Clinical picture of hyperparathyroidism

The symptoms of hyperparathyroidism are varied because it affects many organ systems. Moreover, clinical picture depends on the type of disease, the stage of its development, the presence accompanying pathologies, age and even gender of the patient.

The first symptoms are usually nonspecific. Patients note the appearance of lethargy and weakness, decreased appetite, and occasional nausea. There is also pain in the joints. Because increased calcium levels change the transmission of neuromuscular impulses, patients also experience muscle pain - this is how hyperparathyroidism develops. Symptoms in older patients typically include: muscle weakness. Patients find it difficult to get up from a chair, they stumble while walking, and often fall.

Due to weakness of the foot muscles, flat feet often develop and pain in the legs appears when walking. Due to damage to the renal tubules, other disorders are possible, in particular, an increase in the amount of urine. In severe cases, patients suddenly lose weight due to poor appetite and dehydration. The lack of fluid in the body affects the condition of the skin - it becomes dry and acquires an earthy color. Loss of calcium often leads to loosening and loss of healthy teeth.

Bones constantly lose calcium and phosphorus. Moreover, against the background of this disease activation of osteoclasts, cells that are capable of dissolving bones, is observed. The consequence of increased levels of parathyroid hormone is progressive osteoporosis.

Due to decreased bone density, fractures are not uncommon for patients. Moreover, even minor physical activity or impacts can injure the bone. Bones often do not fuse completely, forming so-called “ false joints" Deformations of the skeleton are also observed, in particular, the spine (kyphosis, scoliosis), chest and pelvis. This, of course, affects a person’s well-being and mobility. Hyperparathyroidism is often accompanied by crystal deposition uric acid in the joints (gout).

Affects kidney function. Often inside collecting system formation is taking place coral stones. Without treatment, kidney failure often develops, which, unfortunately, is irreversible - often the patient requires a kidney transplant.

The disease also affects the digestive tract. Patients complain of decreased appetite, flatulence, constipation, nausea, and abdominal pain. With excess calcium in the blood, the formation of stones in the gall bladder and pancreatic ducts is possible, which leads to the development of cholecystitis and pancreatitis. By the way, the symptoms of hyperparathyroidism in women often worsen during pregnancy, which is very dangerous not only for the mother, but also for the child.

Increased calcium levels affect work nervous system and often causes mental changes. Patients may experience apathy, anxiety, and sometimes depression varying degrees expressiveness. Drowsiness, memory impairment and cognitive abilities. In the most severe cases, the disease is accompanied by confusion and acute psychosis.

Parents are often interested in questions about what hyperparathyroidism looks like in children. The symptoms, treatment and complications in this case are the same. But if we're talking about about the primary form of the disease, it is usually associated with genetic inheritance. If the disease appears in the first months or years of life, there is a delay in physical and mental development child.

Hyperparathyroidism: diagnosis

In this case, diagnosis is extremely important. Symptoms of hyperparathyroidism develop slowly and sometimes are completely absent. That is why laboratory tests of blood and urine are performed first. During testing, blood samples may show an increase in calcium levels and a decrease in phosphate levels. A urine test reveals increased amount both elements. This study carried out twice - if they give the same results, a blood test for parathyroid hormone is performed.

An increase in hormone levels indicates the presence of hyperparathyroidism, but it is important not only to establish the presence of the disease, but also to determine its cause. To begin with ultrasonography, which helps the specialist see an increase in the size of the parathyroid gland or the presence of tumors. Additionally, magnetic resonance imaging and CT scan— these procedures provide more accurate information.

It is imperative to examine the kidneys and skeletal system to find out whether the patient has complications.

Hypercalcemic crisis and its treatment

Hypercalcemic crisis is an acute condition that develops when sharp increase blood calcium level. This pathology leads to dangerous defeats organism and in 50-60% of cases leads to death.

Fortunately, the crisis is considered rare complication hyperparathyroidism. It can be triggered by various factors, including infections, massive bone fractures, infections, and intoxication. Risk factors include pregnancy, dehydration of the body, as well as taking certain medicines, including products containing calcium and vitamin D, thiazide diuretics. Patients with hyperparathyroidism need to carefully monitor their diet, excluding foods with high content calcium and vitamin D. Lack of adequate therapy and misdiagnosis.

A hyperkalemic crisis develops quickly. First, patients develop disturbances from digestive system, including spicy sharp pains in the stomach, intense vomiting. There is an increase in body temperature. Patients complain of bone pain and muscle weakness. Disorders of the nervous system also appear, ranging from depression and depression to psychosis. The skin of a sick person becomes dry and itchy.

Due to blood clotting disorders, disseminated intravascular coagulation syndrome may develop. Possible development state of shock. The patient's death occurs as a result of cardiac arrest or paralysis of the respiratory muscles.

Treatment methods for hyperparathyroidism

We have already covered questions about what constitutes hyperparathyroidism. Symptoms and treatment in this case are closely related. If we are talking about the primary form of the disease associated with the formation of a tumor, then surgical removal of the tumor is possible. The operation is not always performed. The fact is that the disease can develop over decades without causing any particular inconvenience to the patient. And it mainly affects older people, which creates additional difficulties.

The decision about the need for surgical intervention is made by the doctor. It is believed that surgery is necessary if there is a strong increase in the level of calcium in the blood (more than 3 mmol/l) and severe disturbances in the functioning of the kidneys. Indications for the procedure are stones in excretory system, significant loss of calcium in the urine, a history of hypercalcemic crises, as well as severe osteoporosis.

If the doctor decides not to remove the tumor or gland (if it is hypertrophied), then patients still need to undergo regular examinations - it is important to conduct examinations of the kidneys and bone apparatus at least 1-2 times a year. Constant monitoring of blood calcium levels and blood pressure is important.

As for the secondary form, treatment of hyperparathyroidism comes down to eliminating primary diseases. Calcium deficiency in the blood can be eliminated with medication - patients are prescribed medications containing this mineral, as well as vitamin D. If taking the drugs does not give the expected effect, surgical excision of parts of the gland can be performed.

Pseudohyperparathyroidism and its features

Modern medicine also knows the so-called pseudohyperparathyroidism. It's pretty rare disease, which is accompanied by the same symptoms. However, the pathology is not associated with the work of the parathyroid glands themselves.

The patient is found to have malignant neoplasms, which can be localized in the kidneys, lungs, mammary glands and other organs. These tumors contain cells that are capable of producing active substances, the mechanism of action is similar to parathyroid hormone. With this disease, an increase in the level of calcium in the blood is observed due to the dissolution of bone tissue. This is an extremely dangerous disease that can be fatal.

Prognosis for patients

Now you know how hyperparathyroidism develops. Symptoms and treatment in women, features of the course of the disease in children are important questions. But what forecasts can you count on? The results depend on the stage of development at which the disease was detected.

If we are talking about early primary hyperparathyroidism, then with timely treatment the prognosis is favorable. Symptoms from the internal organs and nervous system disappear after a few weeks. Bone structure can be restored within a few years. In advanced cases, patients may retain skeletal deformities, which affect the quality of life, but are not dangerous.

If there is kidney damage, even after surgery, kidney failure may progress. In any case, you should carefully monitor your health and undergo preventive medical examinations.

The term “hyperparathyroidism” refers to a symptom complex that occurs as a result increased activity parathyroid glands - by their production of excess amounts of parathyroid hormone. There are 3 forms of this pathology, but any of them affects predominantly women (in a ratio of 2-3:1 to men) of mature age - 25-50 years. About the types of hyperparathyroidism, the causes and mechanism of its development, clinical manifestations, principles of diagnosis and therapeutic tactics in this condition, you will find out by reading the text of our article. But first of all, we will talk about what kind of hormone it is - parathyroid hormone, and what functions it performs in the human body.

Parathyroid hormone: basic physiology

Parathyroid hormone is produced by the cells of the parathyroid (otherwise known as parathyroid) glands when the level decreases ionized calcium blood below normal values. These cells have special receptors that determine how much calcium is in the blood, and based on this data they produce more or less parathyroid hormone.

Consequently, the main function of this hormone in the human body is to increase the concentration of ionized calcium in the blood. This goal is achieved in three ways:

1. Gain
   activation of vitamin D in the kidneys. This stimulates the formation of a special substance from the vitamin - calcitriol, which, in turn, accelerates the absorption of calcium in the intestines, which means that more of this macroelement enters the blood from food. This path is possible only if the vitamin D content in the body is within normal limits and not reduced.
2. Activation of the process of reabsorption (reabsorption) of calcium from urine in renal tubules, back into the bloodstream.
3. Stimulation of cell activity, main function which is the destruction of bone tissue. They are called osteoclasts. So, under the influence of parathyroid hormone, these cells destroy bone, and the calcium that is formed is sent into the bloodstream. The result of such processes is fragile bones that are susceptible to fractures and high levels of calcium in the blood.

It is worth noting that the negative effect of parathyroid hormone on bone tissue occurs only with a stable, prolonged increase in its concentration in the blood. If the level of the hormone exceeds the norm only periodically and for a short time, this, on the contrary, stimulates the activity of osteoblasts - the cells responsible for bone formation, that is, it strengthens the bones. There is even a synthetic analogue of parathyroid hormone - teriparatide, which is used to treat osteoporosis.

Types, causes, mechanism of development of hyperparathyroidism

Depending on the cause of this syndrome, there are 3 forms. Let's look at each of them in more detail.

1. Primary hyperparathyroidism (Albright's syndrome, Recklinghausen's disease, parathyroid osteodystrophy). Its cause is, as a rule, hyperplasia of the parathyroid glands or tumor formation in the area of ​​these organs. These can be single or multiple adenomas, carcinoma, multiple endocrine deficiency syndromes (one of their manifestations is hyperplasia of the parathyroid glands). With any of these diseases, the function of receptors sensitive to calcium levels is disrupted - the threshold of their sensitivity is either significantly reduced or completely absent. As a result, the cells of the parathyroid glands produce a large amount of parathyroid hormone - hyperparathyroidism occurs.
2. Secondary hyperparathyroidism. It is regarded as a compensatory reaction of the body in response to a decrease in the concentration of calcium in the blood. Occurs in the following pathologies:

• illnesses digestive tract(liver pathology, malabsorption syndrome and others), which are accompanied by hypovitaminosis D and a decrease in the absorption of calcium from the intestines into the blood;
• (a decrease in the level of calcium in the blood develops due to a decrease in the number of functioning nephrons (structural unit, kidney cell) and a decrease in the production of calcitriol by the kidneys);
• hypovitaminosis D of any nature;
• bone diseases (in particular, osteomalacia).

All of the diseases listed above lead to (due to which both the number of calcium-sensitive receptors of the parathyroid gland cells and the degree of sensitivity of the remaining “living” receptors) decrease), a decrease in the level of calcitriol (this also helps to reduce the number of calcium-sensitive receptors), and a decrease in calcium absorption from food into blood. The parathyroid glands react to this by increasing the production of parathyroid hormone, which activates the processes of bone destruction in order to increase the concentration of calcium ions in the blood, and if similar violations last a long time, hyperplasia of these glands develops.

3. Tertiary hyperparathyroidism. It transforms from secondary when an adenoma develops against the background of hyperplastic parathyroid glands. This is naturally accompanied by increased production of parathyroid hormone.

There is another classification of hyperparathyroidism, based on the severity and nature of the symptoms of this pathology. The following forms are distinguished:

• manifest (visceral, bone, mixed forms and hypercalcemic crisis); characterized by a clear clinical picture;
• asymptomatic ( clinical manifestations absent, increased parathyroid hormone levels are detected by chance; subsequent targeted examination reveals a tumor or hyperplasia of the parathyroid glands, as well as a slight decrease in bone mineral density);
• low-symptomatic (accounts for 30 to 40% of cases of this pathology; symptoms are moderate, calcium and parathyroid hormone levels are slightly increased, bone mineral density is moderately reduced, there are no pathological fractures, but there are some sluggish disorders of the internal organs).

Symptoms

The clinical picture of primary hyperparathyroidism is usually clear. Symptoms are especially pronounced in severe cases, which are also characterized by the appearance of a number of signs of hypercalcemia. The main manifestations are disorders of the bones and kidneys, but there are also signs of pathology in other organs and systems.

1. Symptoms from the musculoskeletal system:

• bone deformities, pain in them, frequent fractures, gout and pseudogout;
• weakness in muscles, their atrophy;
• cysts in the bone area;
• at severe forms– crawling sensation, burning, numbness individual areas body (signs of radiculopathy), paralysis of the pelvic muscles;
• if hyperparathyroidism develops at a young age – keeled chest, short length tubular bones, deformations of the spine and ribs, loosening of teeth.

2. On the part of the kidneys, there is a violation of their function, recurrent nephrolithiasis (), nephron calcification.

3. The following disorders may occur in the digestive tract:

• symptoms, frequent relapses;
• pancreatic cell calcification;
• formation of stones in the pancreatic ducts;
• symptoms of dyspepsia (nausea, vomiting, loss of appetite, bowel disorders (constipation)), as well as weight loss.

4. Vascular damage (calcifications in the area of ​​heart valves, coronary vessels, vessels of the eyes and brain).

5. From the mental side: depressive disorders, irritability, drowsiness, memory impairment.

6. Severe thirst, release of large volumes of urine, frequent urination at night.

8. From the joints – signs, calcium deposition in the area of ​​articular cartilage.

The manifestations of secondary hyperparathyroidism vary depending on the disease that causes them. In terms of clinical manifestations, tertiary hyperparathyroidism corresponds to the preceding secondary hyperparathyroidism, a severe form of this pathology. The difference is that the concentration of parathyroid hormone in the blood goes far beyond normal values ​​- it exceeds them by 10 or even 20 times.

Complications

The most serious complication of hyperparathyroidism is hypercalcemic crisis. Its development is facilitated by the patient's prolonged bed rest, inadequate intake of calcium-containing medications, vitamin D and thiazide diuretics.

A crisis occurs suddenly when the blood calcium level rises to 3.5-5 mmol/l (normal is 2.15-2.5 mmol/l). Its manifestations are exacerbation of all symptoms of hyperparathyroidism, high body temperature, acute pain in the stomach, drowsiness, vomiting, impaired consciousness up to coma. Muscles atrophy. Such dangerous conditions, such as pulmonary edema, bleeding, thrombosis and perforation of ulcers of the digestive tract.

Diagnostic principles

Diagnosis is based on detecting an increased level of parathyroid hormone in the patient’s blood and further elucidating the causes of this condition.

The concentration of parathyroid hormone must be determined in the following cases:

• if any violations are detected metabolic processes in bone tissue;
• when detecting an increase or decrease in the blood serum of phosphorus and sodium ions;
• if the patient notes frequent bone fractures not associated with trauma;
• if the patient suffers from recurrent urolithiasis;
• if the patient suffers from chronic renal failure of any stage;
• if there are frequent relapses peptic ulcer stomach and duodenum;
• if the patient suffers from cardiac arrhythmias, chronic diarrhea or long-term neuropsychiatric disorders.

Algorithm for diagnosing hyperparathyroidism

Hyperparathyroidism can be suspected at any stage of diagnosis. Let's look at each in more detail.

History taking

If, while collecting anamnesis, the doctor finds out that the patient suffers from urolithiasis, which often recurs, or chronic renal failure, he should immediately think that the patient also has hyperparathyroidism. The same applies to situations when the patient describes frequent bone fractures that appear as if on their own, which are not preceded by injuries.

Objective examination

Individuals suffering from hyperparathyroidism may experience:

• muscle weakness;
• duck walk;
• deformations in the area facial skull, tubular bones and large joints;
• lethargy;
• pallor, often a gray tone of the skin (observed in persons with insufficient renal function);
• other signs of diseases that led to hyperparathyroidism.

Laboratory diagnostics

The main symptom of hyperparathyroidism is an increased concentration of parathyroid hormone in the blood.

To establish the reason for this increase, the following studies are carried out:

• general blood analysis;
• urine analysis according to Zimnitsky, determination of diuresis;
• determination of creatinine and urea levels in the blood, as well as glomerular filtration rate;
• study of the level of ionized calcium and phosphorus in the blood and urine;
• blood level test alkaline phosphatase;
• determination of blood concentrations of hydroxyproline and osteocalcin.

Instrumental diagnostics

The patient may be prescribed:

• Ultrasound of the parathyroid glands;
• computer or magnetic resonance imaging of them;
• scintigraphy of these organs with thallium-technetium, octreotide or other substances;
• radiography of the affected bones;
• bone tissue biopsy with determination of the morphological structure of the bone, aluminum staining and tetracycline test;
• Ultrasound of the kidneys;
• gastroscopy and other studies.

Differential diagnosis

Some diseases have a similar course to hyperparathyroidism, so careful differential diagnosis is very important here. It is carried out with:

• malignant tumors and their metastases;
• Paget's disease.

Principles of treatment

The goals of treatment are:

• normalize the level of calcium, and ideally, parathyroid hormone in the blood;
• eliminate the symptoms of hyperparathyroidism;
• prevent further aggravation of disorders of bones and other internal organs.

In secondary hyperparathyroidism, one of the goals of treatment is also the elimination of hyperphosphatemia, in other words, the normalization of previously elevated levels of phosphorus in the blood. For this purpose, patients are advised to follow a diet: limit the consumption of foods containing phosphorus (milk and products made from it, soybeans, legumes, eggs, liver, sardines, salmon, tuna, foods containing a lot of protein, chocolate, coffee, beer, nuts and others).

Drug treatment of primary hyperparathyroidism

Asymptomatic and soft shape Pathologies in older patients are subject to conservative management tactics. The patient is under observation for 1-2 years and undergoes periodic examinations. Based on its results, the doctor determines whether the process is progressing and whether the patient needs treatment.

If medication cannot be avoided, the patient is prescribed:

• group drugs (alendronic, ibandronic or pamidronic acid);
• calcitonin;
• estrogen-gestagen drugs (in postmenopausal women);
• calcimimetics (cinacalcet).

If the cause of hyperparathyroidism is cancer, and surgical treatment is impossible, patients are prescribed bisphosphonates in combination with calcimimetics, forced diuresis is organized, and chemotherapy is also administered.

Drug treatment of secondary hyperparathyroidism

Depending on what pathology led to hyperparathyroidism, the patient may be prescribed the following drugs:

• calcium carbonate (binds phosphorus, reducing its level in the blood);
• sevelamer (binds phosphorus in the digestive canal, normalizes lipid metabolism);
• vitamin D metabolites - calcitriol, paricalcitol or alfacalcidiol (promote an increase in the concentration of calcium in the blood, and therefore a decrease in the level of parathyroid hormone in it);
• calcimimetics (cinacalcet); normalize blood levels of parathyroid hormone and calcium.

Surgery

Indicated for tertiary hyperparathyroidism that has developed against the background of end-stage chronic renal failure, with the progression of its symptoms. It is also used for primary hyperparathyroidism if there are signs of target organ damage. Another indication: lack of effect from conservative treatment of a secondary form of pathology.

There are 2 intervention options: surgical and non-surgical parathyroidectomy.

The essence of non-surgical is the introduction into the area of ​​the parathyroid glands by injection of calcitriol or ethyl alcohol. The manipulation is carried out under ultrasound control. As a result, the gland cells become sclerotic and its function is consequently impaired. This technique is used for recurrent secondary hyperparathyroidism as an alternative surgical intervention, but in the primary form of pathology it is ineffective.

Surgical treatment of secondary hyperparathyroidism can be carried out in different volumes:

• removal of three glands and practically complete removal glands of the fourth, the smallest in size (only about 50 mg of its tissue are left);
• complete removal of the parathyroid glands with transplantation of one of them (the one that is the healthiest) to the forearm;
• complete removal of all parathyroid glands.

As a result of such treatment, the main clinical manifestations of the pathology, as a rule, regress. IN further patient is registered with a dispensary (is periodically examined) and receives conservative treatment(for hypocalcemia - calcium and vitamin D preparations, as well as calcium gluconate).

Hyperparathyroidism is a disease of the endocrine system that is chronic. It is caused by the fact that the secretion of hormones from the parathyroid glands begins to increase, due to tumors or hyperplasia.

Then the amount of calcium in the bone skeleton begins to increase and begins to develop. It most often occurs in women after 40 years of age and after menopause. Accompanied by low strength of bones, nails and high probability fractures with minor bruises.

Until recently, the endocrinological disease was considered rare. Hyperparathyroidism is divided into two forms: primary, secondary and tertiary. The latter is the heaviest and rarest.

Causes and development of the disease

Primary hyperparathyroidism, or also called Albright's syndrome, Recklinghausen's disease and parathyroid osteodystrophy, develops due to or the presence of a tumor.

With this disease, the function of those receptors that are responsible for sensitivity to calcium levels in the body is reduced or absent altogether. Then the thyroid cells begin to produce parathyroid hormones in large quantities.

Secondary hyperparathyroidism most often develops with diseases of the digestive tract, lack of vitamin D, poor absorption of calcium into the blood, with renal failure that progresses to the chronic stage and diseases of bone tissue.

Tertiary hyperparathyroidism is accompanied by the development of adenoma and production in large quantities. Proceeds into a hypercalcemic crisis.

There is also pseudohyperparathyroidism. With this syndrome, they develop malignant tumors, which contain cells that produce parathyroid hormone.

As scientists have established, increased level parathyroid hormone is not always the cause of this disease. They believe that tumors have the ability to produce substances similar to parathyroid hormone, which, when exposed to bone, dissolve it and release it into the blood.

Symptoms of primary hyperparathyroidism

On initial stage Primary hyperparathyroidism is difficult to notice, but possible. Usually it has no symptoms, so it is diagnosed much later and it happens completely by chance during routine examinations or when some other disease is detected.

Primary hyperparathyroidism is accompanied by the following complaints:

• lethargy;
• weakness;
• poor appetite;
• Bad mood;
• nausea;
• pain in joints and bones;
• hair loss

Muscle pain is also a symptom of hyperparathyroidism. This is due to the fact that the neuromuscular system cannot work stably due to the high concentration of calcium in the body.

Pain begins to appear lower limbs. It becomes difficult to walk, difficulties arise when getting up from a chair or climbing stairs. The joints become loose, a duck's gait and flat feet appear.

May develop and begin to fall out healthy teeth. The patient rapidly loses weight due to poor appetite or loss of it, and polyuria also appears. During the first months of the disease, 10–15 kg are lost. The skin of the face and body becomes dry, acquires an earthy color, and anemia develops.

Clinical stage of hyperparathyroidism of the first form

Expanded stage clinical hyperparathyroidism divided into groups:

• neurological;
• articular;
• gastrointestinal;
• bone;
• vascular;
• renal;
• ophthalmological.

When exposed to parathyroid hormone, osteoporosis develops. This means that calcium and phosphorus quickly leave the bones, and the bone itself begins to dissolve.

Osteoporosis can be diffuse, i.e., the density of all bone tissue decreases, and limited, when the bone is destroyed in a certain area. Bone deformation can also occur due to the appearance of cysts in which fluid accumulates.

Most often, those bones of the skeleton that bear a heavy load are affected. This pelvic bones, spine, chest and hip bones. When they are deformed, a hump appears, scoliosis and kyphoscoliosis develop.

Fractures often occur with minor loads or spontaneously. They are difficult to diagnose, they grow poorly or incorrectly, and false joints may appear, which contribute to the lack of ability to work. Heal pathological fractures slower than usual.

Further, following the bones, the renal system begins to be damaged. If this process is not prevented in time, then it will be impossible to completely cure the kidneys. Calcium phosphates and coral stones appear in them, which fill the cup area.

When nausea and vomiting, flatulence and a tendency to constipation appear, as well as a decrease in appetite, this means that damage has begun gastrointestinal tract.

If calcium has a high density, then abdominal pain of varying degrees of severity appears. Ulcers and erosion begin to develop. There may be bleeding and formations in the gallbladder in the form of stones, pancreatitis.

Since calcium can also be deposited on the walls of blood vessels, pathology of the cardiovascular system can develop. Some organs that do not receive enough blood may become exhausted.

Course of secondary and tertiary hyperparathyroidism

When the body lacks vitamin D, secondary hyperparathyroidism occurs. Affected skeletal system, calcium is washed out of the bones, and parathyroid hormone, which is intensely produced, accelerates the process of calcium depletion in the bones. The eyes are affected by conjunctivitis, the cornea is affected.

Symptoms tertiary hyperparathyroidism very similar to secondary. Occurs during the prolonged course of the second stage of the disease. And even after restoration of calcium density in the blood, parathyroid hormone is still released in large quantities.

If you do not treat and do not maintain a constant level of control of calcium and parathyroid hormone in the body, then a rare hypercalcemic crisis develops. Completely broken nervous activity, blood clotting increases, which is deadly, blood clots may form or the heart may stop. General state the person deteriorates sharply.

Hypercalcemic crisis is often confused with pancreatitis due to similar symptoms:

• ulcers and intracavitary bleeding develop;
• fever appears;
• worries about skin itching;
• body temperature rises above 40 degrees.

The patient does not understand what is happening, he begins to experience psychosis, and subsequently shock. Fatal outcome occurs with paralysis respiratory system or stopping the main organ - the heart.

How is hyperparathyroidism diagnosed?

Hyperparathyroidism in patients is diagnosed in several stages:

• taking anamnesis;
• examination in an objective way;
• laboratory research;
• instrumental;
• differential.

The results of the history collection show not only the level of parathyroid hormone in the blood, but also diseases of the urinary system. The diagnosis of hyperparathyroidism is confirmed by the presence of a patient complaint such as frequent spontaneous fractures.

At objective examination found:

• muscle weakness;
• duck walk;
• deformation of the facial skull, bones and joints;
• pallor, lethargy and drowsiness;
• broken nail structure.

At laboratory diagnostics the concentration of parathyroid hormone, creatinine, urea in the blood, filtration rate, and alkaline phosphatase are detected. To do this, blood and urine are analyzed.

Instrumental diagnostics for hyperparathyroidism involves ultrasound or MRI of the thyroid gland, kidneys, radiography, densitometry, bone tissue biopsy, and gastroscopy.

Differential diagnosis finds malignant tumors, metastases, leukemia, multiple myeloma and others associated with hyperparathyroidism.

Treatment of the disease

Using these diagnostics, symptoms of hyperparathyroidism are identified and treatment is prescribed accordingly. Most often, treatment is carried out surgical method, which can be absolute and relative. Such methods involve removing the tumor that produces parathyroid hormone.

There are also operations that have subtotal and parathyroidectomy stages, leaving a small area of ​​the gland well supplied with blood. The relapse rate is small and amounts to only 5%.

Those who do not need surgery need to be monitored every six months. It is necessary to measure blood pressure and undergo its monitoring, take tests to determine the amount of calcium in the blood, examine the functioning of the kidneys and do an ultrasound.

For secondary hyperparathyroidism, medications containing vitamin D and sometimes calcium are prescribed. If parathyroid hormone increases significantly in the blood, then surgical intervention takes place.

Tertiary hyperparathyroidism is common in patients who have undergone a kidney transplant. At this time, doctors prescribe taking. If parathyroid hormone does not return to normal, then surgery is prescribed.

Prediction of hyperparathyroidism

The prognosis of hyperparathyroidism will be favorable with timely diagnosis and surgical treatment. If the bone tissue has been damaged in mild degree, then the recovery period takes about 4 months.

When a severe case of hyperparathyroidism has been identified, normal work capacity will return only 2 years after the operation. If the disease has been neglected, then often the full functionality of the organs is not restored.

With kidney damage, a less favorable recovery is predicted. It also depends on the size of the lesion. In case of untimely surgery and improper administration medications, patients become bedridden and may die from kidney failure.

Hyperparathyroidism in pets

Hyperparathyroidism in cats is similar to that in humans. The symptoms are almost the same as in humans, namely aching bones and joints, lethargy and lameness. The animal sleeps a lot and eats little.

Hyperparathyroidism in pets is also divided into three stages. Treated with surgical removal damaged areas of bone tissue, as well as the use medicines before and after surgery. During the recovery period, the animal is limited in movement using knitting needles and splints.

Hyperparathyroidism in pets can occur from the moment of birth, as well as during improper care and nutrition. The disease is diagnosed by X-ray and laboratory tests.

parathyroid hormone. Increased hormone production is a consequence glandular hyperplasia , which in turn leads to disruption of phosphorus-calcium metabolism. This results in increased removal of phosphorus and calcium from the skeleton, an increase in osteoclastic processes and their excessive entry into large quantities into the blood.

Simultaneous increased phosphorus release, as well as decreased tubular reabsorption leads to the emergence hypophosphatemia And hyperphosphaturia , at the same time, signs and osteomalacia . Most often, 2-3 times more than men, the disease affects women aged 25 to 50 years.

Hyperparathyroidism is caused by a tumor of the parathyroid glands.

Depending on the cause of its occurrence, hyperparathyroidism is divided into the following types:

• Primary appears as a consequence of the formation of parathyroid adenoma in the vast majority of cases of the disease. And only in one out of ten cases of disease is the cause carcinomas or hyperplasia, proliferation and enlargement of normal gland cells.
• Secondary hyperparathyroidism- there is an increase in function, pathological growth and enlargement of the glands, prolonged reduced content calcium with a simultaneous increased content of phosphates in the blood. There is an increase in production parathyroid hormone for chronic renal failure.
• Tertiary- development is observed benign tumors parathyroid glands, as well as increased production parathyroid hormone due to long-term secondary hyperparathyroidism.
• Pseudohyperparathyroidism– production of parathyroid hormone is observed in tumors that did not arise from the cells of the parathyroid glands.

According to severity, the disease is divided into

• manifesto form.
• asymptomatic (soft) form.
• asymptomatic form.

In addition, according to the degree of disease, the disease is divided into bone , renal , visceral And mixed forms.

Symptoms of hyperparathyroidism

The danger of the disease is that it can occur without symptoms and the discovery or diagnosis of hyperparathyroidism occurs by chance during examination. In the early stages of the disease, the patient develops rapid fatigue even with light loads, difficulty walking, and especially when climbing stairs, a characteristic waddling “duck” gait.

Patients experience emotional imbalance, resentment and anxiety, memory deteriorates, and depression appears. The skin takes on an earthy gray color. In old age, various symptoms may appear.

Subsequently, signs of damage to various internal organs develop - cholelithiasis, osteoporosis, etc.

The late stage of bone hyperparathyroidism is characterized by softening and curvature of the bones, the appearance of scattered pain in the bones of the arms or legs, and in the spine. Normal movements can lead to bone fractures, which are not painful, but grow together slowly, and sometimes false joints form.

Because of deformed skeleton, the patient may even become shorter. With osteoporosis of the jaws, the patient's healthy teeth become loose or fall out. A large one is felt on the neck in the area of ​​the parathyroid glands. Visible signs appear on the limbs periarticular calcifications .

At visceropathic hyperparathyroidism there is nausea, vomiting, a sharp decline weight. Patients complain of loss, stomach pain, flatulence. Upon examination, the appearance of peptic ulcers with and also various signs damage to the pancreas and gallbladder, polyuria and symptoms of renal failure develop. The nutrition of organs and tissues is disrupted, high concentration calcium in the blood causes damage to the blood vessels of the heart, increased blood pressure,. With calcification of the ocular conjunctiva, the so-called “red eye” syndrome is observed.

In the renal form, the main symptoms of hyperparathyroidism are: polyuria And alkaline reaction urine. Possible development of bilateral nephrocapcinosis , which, in turn, can lead to and uremia . The patient is worried high blood pressure, seizures renal colic, dyspeptic disorders. An ulcer appears duodenum or stomach, perforation of the wall of the stomach and intestines is possible. Often possible chronic , formation of gallstones.

Diagnosis of hyperparathyroidism

Diagnosis of the disease is carried out on the basis of blood tests that determine calcium and phosphorus in the body and urine analysis.

When found high level calcium, other tests and studies are carried out: ultrasound, X-ray examination, CT and MRI, which can detect osteoporosis, pathological ulcers of the gastrointestinal tract, cystic changes bones and other changes. Scintigraphy parathyroid glands reveals the localization of the glands and their anomaly.

In secondary hyperparathyroidism, the underlying disease is diagnosed.

The doctors

Treatment of hyperparathyroidism

Treatment of the disease is carried out comprehensively in combination conservative therapy medications and operating surgery. Before surgery, conservative treatment is carried out, the goal of which is to reduce blood Ca level.

Malignant tumors of the parathyroid glands are surgically removed, followed by radiation therapy.

The prognosis of hyperparathyroidism is favorable with timely diagnosis of hyperparathyroidism and adequate surgical treatment. Full restoration of ability to work depends on the degree of damage to the bone tissue. If treatment for hyperparathyroidism is started at an early stage, the patient recovers within a maximum of six months. In moderate to severe cases, recovery lasts for 2 years. In advanced cases, disability is likely.

Less favorable prognosis for renal forms hyperparathyroidism and depends entirely on the degree of kidney to surgical intervention. Without surgery - disability and death due to progressive cachexia and chronic renal failure.

At hypercalcemic crisis the prognosis depends on the timeliness of treatment, mortality is 32%.

List of sources

• Endocrinology. Ed. N. Lavin. - Moscow: Praktika, 1999;
• Pathophysiology of the endocrine system / ed. ON THE. Smirnova. - M.: Binom, 2009;
• Endocrinology / Dedov I.I. and others. M.: Medicine, 2007.