Overview
Primary hyperparathyroidism (hyperparathyroidism) is a disease caused by excessive secretion of parathyroid hormone (PTH) due to parathyroid adenomas (single adenomas account for the majority of cases, about 75%), hyperplasia or adenocarcinoma (rare), resulting in disorders of bone, kidney, digestive and neurological systems and calcium and phosphorus metabolism. Once the disease is diagnosed, it can be cured by surgical resection.
Symptoms and symptoms
1. Hypercalcemia syndrome.
(1) Gastrointestinal symptoms: nausea, anorexia, abdominal distension, persistent constipation, persistent peptic ulcer and Er’s 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 calculi, renal calcification, hematuria, recurrent urinary tract infections.
(2) Calcium salt deposits in the conjunctiva and eyelids of the eye, 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.
Diagnostic basis
1, clinical manifestations: hypercalcemia symptom group; bone pain, pathological fracture, fibrocystic osteitis; renal calculi, renal calcification; recurrent intractable peptic ulcer or with pancreatic 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) Decrease in renal tubular phosphorus reabsorption rate to less than 83%.
(2) Calcium tolerance test with unsuppressed PTH.
(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. Renal calculi, renal calcification, soft tissue calcification.
7.Localization tests: high-resolution ultrasound, CT scan; 75Se parathyroid scan; jugular vein cannulation, segmental blood sampling from vascular branches to determine PTH.
8.Except secondary hyperparathyroidism, ectopic parathyroid hormone secreting tumor, chronic renal failure, osteochondrosis, etc.
Treatment principles
1.Surgical removal of parathyroid adenoma or cancer;
2.Treatment of complications;
3. symptomatic treatment (management of hypercalcemia crisis);