OVERVIEW
Overview.
Parathyroid osteodystrophy is an adverse skeletal change that occurs in the presence of hyperparathyroidism. It is characterized by fatigue and weakness, dyspepsia, generalized multiple bone loss, and bone pain, most commonly in the lower extremities.
Whether medical insurance
yes
Department
Endocrinology, Orthopedics
Clinical symptoms
Fatigue and weakness, indigestion, bone pain, kidney stones.
Hazards
If not treated in time, bone lesions will develop further and pathological fractures may occur; kidney stones may lead to progressive renal impairment.
Examination
Physical examination, blood routine, parathyroid hormone radioimmunoassay, X-ray film, ultrasound.
Diagnosis
Clinical symptoms and laboratory tests are consistent with the diagnostic conditions of hyperparathyroidism; early X-ray shows subperiosteal bone erosion at the tip of the terminal phalanx.
Treatment principle
Surgical removal of adenoma and other parathyroid lesions.
Curability
Skeletal symptoms may improve or even disappear after surgery. Improvement of skeletal decalcification takes a longer time.
Dietary advice
A diet rich in vegetables, fruits, and iron-rich foods is recommended.
Causes
Causes
Caused by parathyroid pathology resulting in autonomous, persistent overproduction of parathyroid hormone (PTH).
Symptoms and Diagnosis
Typical symptoms
1. Skeletal changes: generalized widespread bone pain, most common in the lower extremities. Cysts appearing in the mandible can cause facial changes.2. Urinary stones: about half of the patients will develop kidney stones.3. Hypercalcemia: manifested by generalized fatigue, anorexia, nausea, vomiting, constipation, thirst, nocturnal enuresis, lack of concentration, drowsiness, etc.4. Intestinal manifestations: epigastric pain and dyspepsia are the main symptoms.
Other symptoms
Scleral calcification in a few cases, and hypocalcemic convulsions in nursing hyperparathyroid infants.
Diagnostic basis
The patient presents with bone pain, dyspepsia, etc. X-rays show generalized multiple bone loss in the form of cystic and osteoporotic forms. The most diagnostic early radiographic manifestation is subperiosteal bone erosion at the tip of the terminal phalanx. High blood calcium is necessary for the diagnosis of hyperparathyroidism, normal blood calcium is 9.0-10.3mg/dl, more than 10mg/dl should be suspected abnormal. Laboratory tests show elevated parathyroid hormone.
Treatment
Treatment guidelines
Once hyperparathyroidism is diagnosed, surgery is the only effective treatment.
Medication
Postoperative low calcium should be supplemented with calcium and vitamin D to relieve tics and numbness of the fingers. In severe cases, the tics will be rapidly controlled by calcium gluconate injection.
Surgical treatment
Frozen section should be done after removal of adenoma to confirm that parathyroid hyperplasia can be excluded. If the adenoma cannot be found and you are not sure whether parathyroid hyperplasia is present, a frozen section of the parathyroid glands should be taken. In cases where the parathyroid glands are located within the thyroid tissue, lobectomy of the thyroid gland may be performed.3. Parathyroid carcinoma should be treated by removing the tumor and surrounding adipose tissue, as well as adjacent thyroid tissue.4. Orthopedic surgery should be performed after the disease is under control.
Prognosis
Skeletal symptoms will improve rapidly after surgery. Pain, muscle weakness and generalized symptoms can be largely eliminated within weeks or months. Improvement of skeletal decalcification will take about 2 years, and the deformity will be permanent.
Care
Daily care
During the recovery period, calcium and vitamin D should be supplemented, and activities should be limited to prevent pathological fractures.
Diet
Diet should be rich in vegetables, fruits, and iron-rich foods.