Focus on parathyroid disorders (3) Classification and clinical manifestations of parathyroid disorders
Classification of parathyroid disorders: hyperparathyroidism (also known as hyperparathyroidism) and hypoparathyroidism (also known as hypoparathyroidism).
(i) Hyperparathyroidism refers to excessive secretion of parathyroid hormone (PTH) by the parathyroid glands. Parathyroid resistance is further divided into 4 categories. (1) primary hyperparathyroidism (2) secondary hyperparathyroidism (3) triphasic hyperparathyroidism (4) pseudohyperparathyroidism.
1. The parathyroid glands themselves have undergone lesions, such as excessive hyperplasia, neoplastic changes or even cancer, which is medically called primary hyperparathyroidism; it is commonly seen in parathyroid tumors or parathyroid hyperplasia, parathyroid cancer, etc.
2. Due to other medical conditions, such as long-term vitamin D deficiency, small intestine dysfunction or renal insufficiency, blood calcium is lower than normal and the parathyroid glands need to increase secretion of parathyroid hormone to raise blood calcium levels, therefore, it can be considered as compensatory hyperparathyroidism, which is called secondary hyperparathyroidism.
3. If the parathyroid glands are tumorigenic on top of the long-term secondary hyperparathyroidism, it is called triphasic hyperparathyroidism.
In another case, the parathyroid glands themselves do not have the above-mentioned lesions, but because other diseased organs in the body secrete substances similar to parathyroid hormone, their performance is to a large extent the same as excessive secretion of parathyroid hormone, which is medically called pseudohyperparathyroidism, but not true hyperparathyroidism.
The manifestations of parathyroid disease: (1) General symptoms: High blood calcium reduces neuroexcitability, thus producing neuromuscular and mental changes, such as easy fatigue, decreased muscle strength and tone, personality changes, decreased intelligence and memory, emotional instability and insomnia, etc. Occasionally, psychotic episodes may occur, and in severe cases, coma. Patients may have loss of appetite, nausea, vomiting and constipation, etc., some with ulcer disease, some patients with chronic pancreatitis.
(2) Urinary tract symptoms.
When the blood calcium exceeds the renal threshold, the urinary calcium excretion increases and calcium salts are easily deposited in the urinary system, thus forming urinary stones and renal calcification. About half of the patients have symptoms such as renal colic, hematuria and urinary gravel. Patients are prone to urinary tract infections, leading to kidney function damage and even uremia. In addition, high blood calcium and high urinary calcium can cause hyperosmolar diuresis, so patients often urinate and drink more.
(3) Bone changes.
Patients have generalized bone decalcification, and the characteristic changes are bone cortical defects on the outer edge of the finger (toe) bones, which are called subperiosteal resorption; dental sclerites may also be resorbed; cranial X-ray shows sand-like bone resorption changes; long bones of the limbs, ribs, clavicle and pelvis may have cystic changes, giant cell tumor-like changes or brown tumors. Most patients often have local or generalized skeletal pain and tenderness, and have difficulty walking, squatting and standing up. Patients often have skeletal deformities and pathological fractures, and their stature may become significantly shorter; teeth are easily lost. Secondary, triphasic and pseudohyperparathyroidism may also have manifestations of the primary disease.
Summary: Pay attention to the following points
1 Unexplained generalized aches and pains, fatigue and weakness or joint pain
2 Recurrent urinary tract stone attack
3 Unexplained abnormal mental activity, such as indifference or irritability, especially with excessive drinking and urination, etc.
4 Unexplained constipation, poor appetite, abdominal distension and pain, or recurrent peptic ulcers or pancreatitis, etc.
5 long-term renal dysfunction, etc.
6 Elevated blood calcium
7Bone density is significantly lower than that of the same sex and age
8 people with a history of thyroid, adrenal or pituitary gland tumors
(ii) Hypoparathyroidism: generally there are three types: (1) primary, such as congenital parathyroid deficiency, certain hereditary diseases or due to some autoimmune diseases. (2) Secondary, such as hypoparathyroidism can be caused when the parathyroid glands are damaged or ischemic. (3) Trichotillomania. (4) The disorder can also be due to a defective target cell response to PTH, called pseudohypoparathyroidism.
Clinical manifestations of hypoparathyroidism: When a large amount of blood calcium enters the bones causing hypocalcemic convulsions, it can be transient or unresolved for months and years. The most obvious manifestation is hand-foot tics due to increased neuromuscular stress. Early in the disease, there is only abnormal sensation, tingling and numbness in the extremities, hand and foot spasms, and rigidity. When the blood calcium decreases to a certain level, twitchy symptoms often appear, and the fingers of both hands are flexed to form an “eagle’s claw”, after which the feet are also tonicly extended. In severe cases, the whole body skeletal muscle and smooth muscle may also be in spasm, and the well is accompanied by laryngospasm and bronchospasm, resulting in asthma, laryngeal tinnitus, asphyxia, apnea and other critical signs. Myocardial involvement may include tachycardia, diaphragmatic spasm, and occasional erratic rebellion. All of these symptoms can be triggered by infection, overwork and emotions. Women are also prone to attacks around the time of menstruation. When the blood calcium is 7-8 mg%, there may be no obvious clinical symptoms, which is called occult tics.
(iii) Diagnosis of parathyroid disease: 1. clinical manifestations; 2. examination: ultrasound, CT, X-ray; 3. laboratory: blood calcium, blood phosphorus; blood PTH; urine calcium, phosphorus.