Hyperparathyroidism
Some patients become noticeable due to bone discomfort. The osteoclasts activated by the parathyroid hormone described above lead to the mobilization of calcium from the bone, which gradually loses its stability. In extreme cases that have not been treated for a long time, the patient's bones can become so unstable that fractures result. This condition is known as osteoporosis.
If the bone is found, the patients complain more of bone pain, which should also substantiate the suspicion of hyperparathyroidism.
You can find more about osteoporosis under our topic: osteoporosis.
A manifestation of the gastrointestinal system is also possible. Increased calcium absorption from food can result in loss of appetite, nausea, constipation, gas, and weight loss. An increased incidence of is also noticeable Gallstones in patients with hyperparathyroidism. It happens less often Inflammation of the gastric mucosa or Inflammation of the pancreas. The following rule of thumb makes the symptoms of hyperparathyroidism easier to remember: "Stone, leg, stomach pain"
Patients can also be psychological (depressed -> see also depression) or react nervously (rapid fatigue, muscle weakness, EKG changes) to parathyroidism.
The great danger lies in one that often occurs suddenly hypercalcaemic crisis. This can turn into confusion, Vomit, increased thirst, increased need to urinate up to coma to make noticable.
The symptoms of secondary hyperparathyroidism (overactive parathyroid glands) mostly relate to the underlying disease. It can also cause bone pain, through osteoporosis conditionally, come.
therapy
In symptomatic primary hyperparathyroidism (overactive parathyroid glands), surgical removal of the parathyroid epithelial cells should be sought. In the case of asymptomatic disease, an operation should be performed if the calcium in the serum is greater than 0.25 mmol / l, which reduces kidney function Bone density decreased, the calcium level in the urine increased with 400mg in 24 hours or the patient is younger than 50 years. During the operation, any enlarged epithelial cells should be exposed and removed. If all the epithelial cells that are working abnormally have been removed, the measured parathyroid hormone level would have to drop by 50% during the operation. The removed epithelial cells are frozen after the operation so that they can be reinserted in the patient in rare cases of permanent calcium deficiency. After the operation, you should pay more attention to the calcium content of the blood, as a suddenly decreased parathyroid hormone excretion can lead to an extreme calcium deficiency. Here calcium has to be supplied to the patient.
If surgery is not feasible, patients should drink plenty of fluids, no drugs to wash out water (thiazide diuretics), and no cardio-tonic drugs from the digitalis group. It should also be a drug Osteoporosis prophylaxis should not be forgotten in menopausal women. Regular monitoring of the calcium level at three-month intervals should be ensured.
In the case of secondary hyperparathyroidism (overactive parathyroid glands), the triggering underlying disease should first be treated, and the administration of calcium and vitamin D3 should be considered.
prophylaxis
Apart from a regular medical check of the blood count and thus an early detection of primary hyperparathyroidism (overactive parathyroid gland), no prophylactic measures are known. In order to prevent the development of a secondary form, the underlying diseases that cause them should be treated quickly.
forecast
With an early diagnosis and possible surgery, the prognosis is very good. In the case of symptomatic, non-surgical therapy, close calcium control leads to an improvement in the prognosis.
Is a so-called Nephrocalcinosis (very severe calcification of the kidneys) can be diagnosed in addition to hyperparatyroidism (overactive parathyroid gland), the prognosis is rather unfavorable.
Summary
Hyperparathyroidism (overactive parathyroid gland) is a metabolic disease of the parathyroid gland that can be divided into primary, secondary and tertiary forms.
The cause of the primary form are mostly adenomatous changes in the parathyroid gland, which cause an increased excretion of the parathyroid hormone. A increased parathyroid hormone levels acts through various mechanisms to increase the calcium level. In secondary hyperparathyroidism (overactive parathyroid glands), other underlying diseases are responsible for a lowered calcium level, which then regulates the release of the parathyroid hormone. The most common causes are:
- Kidney disease and
- Food utilization disorders
in front.
In the tertiary form it occurs due to a mismatch between parathyroid hormone and calcium requirements increased calcium levels.
Hyperparathyroidism often runs without symptoms and is usually recognized by chance. In those cases where the disease causes symptoms, patients complain of:
- Bone pain
- Kidney stones
- Discomfort of the gastrointestinal system
- mental or
- nervous complaints.
In order to make a diagnosis, it is important to find out what the relationship between calcium and parathyroid hormone is through a laboratory test. Under Inclusion of kidney values (Creatinine) can be distinguished between primary, secondary or tertiary hyperparathyroidism.
Tumor diseases, which can also trigger elevated calcium levels, must not be ignored.
In the case of symptomatic clinical pictures of the primary form, surgical removal of the epithelial cells should be sought. In these cases, the patient is usually symptom-free. In asymptomatic forms, the patient should drink plenty of fluids and check the calcium level at regular intervals blood to get a check up. In secondary hyperparathyroidism, the underlying disease should be treated in any case, as surgical removal of the epithelial cells would not eliminate the cause.
In most cases that is The prognosis for this disease is very good. It is important to check your calcium levels regularly even after an operation. If what is known as nephrocalcinosis (calcification of the kidneys) has been detected, the prognosis is rather poor.
