parathyroid osteodystrophy
Introduction
Introduction to parathyroid malnutrition The parathyroid gland is a small endocrine organ. The function of the secreted hormone (parathyroid hormone) is to regulate the metabolism of calcium, maintain blood calcium balance, mainly release bone calcium into the blood, and then regulate the blood calcium balance by renal excretion. Therefore, the target organs of the parathyroid gland are bone and kidney. When the secretion is insufficient, it can cause blood calcium to drop, and there is a hand and foot sputum; when the function is hyperactive, it causes excessive bone absorption and is prone to fracture. Parathyroid dystrophy is a skeletal change that occurs when the nail parathyroid function is hyperactive. It was only 50 years ago that it was recognized that the parathyroid gland could break into the disease and it is considered to be very rare and difficult to diagnose. Later Only to realize that this disease is not uncommon, its clinical manifestations are diverse, involving multiple systems of the body. basic knowledge Sickness ratio: 0.0001% Susceptible people: more common in middle-aged women Mode of infection: non-infectious Complications: Osteoporosis Fracture
Cause
Cause of parathyroid malnutrition
The disease is mainly caused by hyperparathyroidism. The main function of the parathyroid gland is to maintain the normal concentration of serum calcium. The pathological changes of hyperparathyroidism are mainly parathyroid adenoma, diffuse glandular enlargement or gland. Cancer causes excessive secretion of parathyroid hormone, which leads to calcium "mobilization" from the bone to the blood circulation, causing high calcium and hypophosphatemia; due to increased secretion of parathyroid hormone, causing extensive bone resorption and decalcification.
Prevention
Parathyroid bone malnutrition prevention
The disease is caused by hyperparathyroidism, so prevention of A and its complications is the key to the prevention and treatment of this disease:
1. Prevent fractures: go to bed, move gently on the toilet, do not lift heavy objects, do strenuous activities, and strengthen accompanying if necessary.
2, due to high blood calcium caused by a large amount of calcium excreted by the urine, patients often complain of polyuria, thirst, should encourage more drinking water, 3000mL / day, encourage more to drink orange juice, plum juice and other acidic drinks, to prevent dehydration caused by blood calcium Increased, and acidified urine can prevent kidney stones.
Complication
Parathyroid dystrophy complications Complications Osteoporotic fractures
Patients with this disease may have psychiatric symptoms and psychiatric treatment. There are also reports of hyperparathyroidism during lactation, low calcium sputum in infants, scleral calcification in a few cases, and small and soft parathyroid tumors. It is difficult to find, the above various manifestations are the complications of this disease, and because the disease is mainly due to excessive secretion of parathyroid hormone, it can cause increased bone resorption in the later stage, and calcified bone loss leads to osteoporosis. Destruction, severe cases can be manifested as fibrocystic osteitis, skeletal deformities, and pathological fractures.
Symptom
Symptoms of parathyroid malnutrition Common symptoms Osteopathic hypercalcemia Multiple urinary fistula Face abdominal pain Anorexia Osteoporosis Indigestion Attention Not concentrated Hematuria
Hyperparathyroidism is more common in middle-aged women, accounting for 70%. Its clinical manifestations are mainly reflected in the following aspects:
Parathyroid gland dystrophy
Cystic fibrosis nephritis causes extensive bone pain throughout the body. The lower extremities are most common. They are often diagnosed as rheumatic pain, lumbar muscle strain and fibrositis. Cysts in the mandible can change the face. Patients often go to the dentist first. At the time of treatment, sometimes fibrous osteitis occurs at both ends of the long bone, and pathological fractures can occur. However, the disease is diagnosed, and only 1/4 of the hyperparathyroidism has bone changes.
X-ray showed systemic multiple bone loss, manifested as cystic and osteoporotic. The most diagnostic early X-ray manifestation was the subendothelial bone erosion at the tip of the distal phalanx, which was more corrosive than the alveolar groove plate. More reliable, the common site of bone erosion is the outer third of the clavicle, the distal end of the femur, the medial side of the femoral neck and the medial side of the upper end of the humerus.
A small number of cases appear as a single cystic lesion, which is more common in the femoral neck and knee, and is difficult to diagnose.
Other symptoms caused by hyperparathyroidism
Urinary tract stones
Stone is the main manifestation of hyperparathyroidism, accounting for 1/2, more common with kidney stones, renal calcification is rare, a few cases have both fibrous osteitis and renal calcification, blood urea nitrogen is often elevated in such cases There are kidney stones alone, unless it is bilateral, there will be no increase in urea nitrogen; and urea nitrogen with renal calcification will be retained, even if only fibrous osteitis and no evidence of renal calcification on the X-ray film There is also a persistent retention of urea nitrogen. Those with fibrous osteitis are more likely to have urea nitrogen retention than those with kidney stones, indicating that most patients with kidney stones are hyperactive with primary parathyroid glands and partial strains with fibrous osteitis. Secondary hyperparathyroidism is hyperactive.
Hypercalcemia
The symptoms are weak, tired, anorexia, nausea, vomiting, constipation, thirst, nighttime polyuria, inattention, sleepiness, etc. These symptoms are often overlooked.
Intestinal performance
More common in primary and third hyperparathyroidism, abdominal pain and dyspepsia are the main symptoms, the main cause of upper abdominal pain is the combination of peptic ulcer.
other aspects
There may be psychiatric symptoms and psychiatric treatment. There are also reports of hyperparathyroidism during lactation, low calcium sputum in infants, and scleral calcification in a few cases. Parathyroid tumors are usually small and soft, and it is difficult to detect the neck. .
Examine
Parathyroid gland dystrophy
The disease mainly has the following inspection methods:
(1) Increased blood calcium
Normal blood calcium is 9.0 ~ 10.3mg / dl, more than 10mg / dl should be suspected abnormal, more than 40% of serum calcium combined with protein to become protein-bound calcium, plasma protein concentration and plasma specific gravity, due to increased plasma protein Reduction can increase or decrease the total serum calcium by nearly 0.25 mg/dl. Therefore, the total serum calcium must be corrected by the normal serum specific gravity value of 1.027. In hypoproteinemia, uncorrected blood calcium can be normal. After the correction, the total amount of blood calcium increased, and it was found that the dissociated calcium ions were increased.
(2) Cortisone test
There are many reasons for high blood calcium. The cortisone test can induce hypercalcemia caused by occult cancer, sarcoma-like disease and vitamin D poisoning, and hypercalcemia caused by hyperactive calcium and primary and parathyroid hyperfunction. The difference is that cortisone 50mg or hydrocortisone 40mg, once every 8 hours for 10 consecutive days, primary and third hyperparathyroidism patients do not respond to the cortisone test, while others The high blood calcium caused by the situation will decrease after the application of cortisone.
(C) Parathyroid hormone radioimmunoassay
Hypercalcemia is a necessary condition for the diagnosis of hyperparathyroidism, but in a small number of cases, blood calcium is not high, or only intermittent hyperparathyroidism is hyperactive, blood calcium fluctuations are less than 1mg%, and it is very difficult to diagnose such cases. Now, it has been used as a radioimmunoassay for parathyroid hormone.
Diagnosis
Diagnosis and differentiation of parathyroid bone dystrophy
diagnosis
The diagnosis of hyperparathyroidism is based on:
1 high blood calcium;
2 low blood phosphorus and;
3 subendothelial bone resorption at the tip of the phalanx.
Differential diagnosis
The disease needs to be differentiated from many diseases, including multiple myeloma, osteopenic osteoporosis, deformed osteitis, and even metastatic tumors. It is not helpful to diagnose the hyperparathyroidism by puncture. It can only eliminate some diseases and sometimes puncture. On the contrary, it will cause confusion, because giant cells can be found in the puncture, sometimes misdiagnosed as multiple giant cell tumor of the bone, and even diagnosed as malignant giant cell tumor due to the continuous appearance of the lesion.
According to the level of blood phosphorus, the secondary hyperparathyroidism can be differentiated from the hyperparathyroidism, but it is difficult to diagnose the third hyperparathyroidism. Only the development process can be based on the whole history. Make a diagnosis.
It is more difficult to locate and qualitatively diagnose the lesions of the parathyroid glands. Diagnosis can be made by isotope selenium scanning and selective angiography, and by subthyroid venous catheterization and determination of subthyroid intravenous parathyroid hormone.
