Primary hyperparathyroidism
Primary hyperparathyroidism is a disease in which the secretion of parathyroid hormone (PTH) is excessive due to parathyroid adenoma, hyperplasia or adenocarcinoma, resulting in disorders of bone, kidney, digestive and nervous system pathologies and disorders of calcium and phosphorus metabolism.
This disease is most common in women and requires surgery.
What are the manifestations of primary hyperparathyroidism?
1. Hypercalcemia.
(1) Gastrointestinal symptoms: nausea, anorexia, abdominal distension, intractable constipation, intractable peptic ulcer and Zokkinger-Ekkison II syndrome.
(2) Lethargy, fatigue, muscle weakness.
(3) Mental abnormalities: emotional instability, agitation, personality changes, convulsions, drowsiness, coma.
2.Osteolysis and fibrocystic osteitis symptoms.
(1) Bone pain and deformity;
(2) pathological fracture;
(3) Bone cystic degeneration.
3.Symptoms caused by calcification of internal organs and organs.
(1) urinary stones, renal calcification, hematuria, recurrent urinary tract infections;
(2) Calcium salt deposits in the conjunctiva and eyelids of the eyes, corneal calcification;
(3) joint calcification, pain and ankylosis.
4. Hyperparathyroidism crisis.
Headache, muscle weakness, thirst, polyuria, dehydration, vomiting, hypotension, drowsiness, delirium, coma, tachycardia, arrhythmia, anuria, renal failure.
Diagnosis of primary hyperparathyroidism
1, clinical manifestations: hypercalcemia symptom cluster; bone pain, pathological fracture, fibrocystic osteitis; renal calculi, renal calcification; recurrent intractable peptic ulcer or with islet gastrinoma.
2. Repeatedly and repeatedly measured elevated blood calcium, decreased blood phosphorus, increased serum alkaline phosphate plum, and high blood chloride.
3, urinary calcium, urinary phosphorus, urinary CAMP is increased, urinary hydroxyproline is increased.
4. Parathyroid function tests.
(1) Renal tubular phosphorus reabsorption rate decreased to less than 83%;
(2) Calcium tolerance test, PTH is not inhibited;
(3) Low calcium diet test, urinary calcium does not decrease;
(4) Glucocorticoid test, blood calcium does not decrease.
5.Serum parathyroid hormone (h-PTH) is elevated.
(6) X-ray examination, bone resorption, decalcification, osteoporosis, alveolar bone resorption, fracture, deformity, fibrocystic osteitis. Kidney stone, kidney calcification, soft tissue calcification.
7.Localization examination for ectopic parathyroid glands: The location, number and size of parathyroid glands are variable, and according to various reports, ectopic parathyroid glands account for 3%-39%. The common locations of ectopic parathyroid glands include the upper mediastinum, parathyroid glands, posterior pharynx and esophagus, thymus or thyroid glands, and occasionally at the carotid bifurcation, other parts of the mediastinal barrier or the pericardium. Therefore, for a small number of patients who fail the first surgical exploration, it is important to make a local diagnosis before reoperation; the following special tests can be selected as appropriate.
(1) Ultrasound examination of the neck: using a high-resolution ultrasound probe has a correct diagnostic rate of more than 80%, but it is not easy to detect adenomas less than 1 cm in diameter and ectopic parathyroid glands.
(2) CT scan: it can detect mediastinal adenoma with diameter greater than 1 cm and ectopic PHPT syndrome caused by malignant tumor.
(3) Radionuclide examination: 125I, 99mTc, 201TI and 75Se methionine scans can detect about 80% or more of lesions.
(4) Selective venous cannulation for PTH measurement: Blood is cannulated in the lateral jugular and mediastinal veins for PTH measurement, and the concentration of PTH in the draining veins is compared with that in the peripheral blood. If the former is significantly higher than the latter, it indicates a parathyroid adenoma on that side. If there is no significant difference between the PTH values in the upper and lower parathyroid veins bilaterally, this suggests hyperplasia or a lesion in the mediastinum. The correct rate of diagnosis is over 80%.
(5) Other local diagnostic tests: In a very small number of patients, enlarged parathyroid glands can be visualized on physical examination. In a small number of patients with large adenomas at the pharyngoesophageal junction and in the mediastinum, esophageal indentation, tracheoesophageal displacement, or mediastinal masses can be found on chest radiographs. In some patients, calcification of the adenoma envelope can be seen. Although selective arteriography and tumor staining have a high rate of correct localization, they have been replaced by these methods in recent years due to serious complications such as hemiplegia, blindness and spinal cord injury.
8. Excluding secondary hyperparathyroidism, ectopic parathyroid hormone secreting tumor, chronic renal failure, osteochondrosis, etc.
Treatment of primary hyperparathyroidism
(1) Surgical removal of hyperplastic parathyroid glands, parathyroid adenoma or cancer
(2) Treatment of complications: mainly symptomatic treatment