Pregnancy with hypoparathyroidism
Introduction
Introduction to pregnancy with hypoparathyroidism Hypoparathyroidism (referred to as hypoparathyroidism) is a group of clinical symptoms caused by too little secretion of parathyroid hormone (PTH), manifested as increased neuromuscular excitability, hypocalcemia, hyperphosphatemia Reduced or undetectable with serum PTH. Due to the defect of target cells to PTH, it is called pseudohypoparathyroidism, which is extremely rare. After thyroidectomy, the parathyroid gland was removed by mistake, after the parathyroid surgery. That is, the parathyroid gland is normal, and the target organ does not respond to parathyroid hormone. basic knowledge The proportion of illness: 0.001% Susceptible population: pregnant women Mode of infection: non-infectious Complications: anemia
Cause
Pregnancy with hypoparathyroidism
(1) Causes of the disease
Hypoparathyroidism is a rare disease, the main causes are:
Suffering from autoimmune diseases (20%):
For example, Addison disease, chronic lymphocytic thyroiditis, and patients with premature ovarian failure also have hypoparathyroidism.
Pseudohypoparathyroidism (20%):
That is, the parathyroid gland is normal, and the target organ does not respond to parathyroid hormone.
After neck surgery (10%):
After thyroidectomy, the parathyroid gland was removed by mistake, after the parathyroid surgery.
Thyroid 131 irradiation also causes damage to the parathyroid glands, and the parathyroid function is reduced after irradiation.
Idiopathic hypoparathyroidism (familial or sporadic).
(two) pathogenesis
Parathyroid hypofunction caused by the above reasons can be divided into two categories, one is true hypoparathyroidism, that is, parathyroid surgery due to surgery, radiation therapy caused by dysfunction, secretion of parathyroid hormone decreased, peripheral blood Low levels of parathyroid hormone cause hypocalcemia in patients. Calcium plays an important role in regulating nerves and muscle excitability. Hypocalcemia and hyperphosphatemia increase muscle excitability, resulting in muscle spasm and convulsions in patients. The wrist and foot muscle twitching is called hand and foot snoring. Chvosteksign or Trousseau sign is positive during nerve examination, hyperreflexia is hyperthyroidism, and the other type is pseudohypoparathyroidism, ie the parathyroid gland is normal, and the target organ is parathyroid. The hormone does not react.
Women with hypoparathyroidism do not affect fertility:
1. The effect on pregnant women: PTH decreased when parathyroidism decreased, causing the kidney to block the conversion of 25(OH)D3 to 1,25(OH)2D3. The main physiological function of 1,25(0H)2D3 is to promote intestinal absorption. Calcium, while the amount of calcium in the mother and child during pregnancy increases, which is 1 times higher than that during the non-pregnancy period. Severe hypocalcemia can cause the symptoms of hypoparathyroidism to worsen during pregnancy and puerperium. Pregnant women have severe hand, foot and stagnation, and low calcium can also cause pregnancy-induced hypertension. The incidence of signs increases, because calcium can accelerate the synthesis of prostaglandins after entering smooth muscle cells, interfering with the vasopressor's pressurization effect. Research data suggest that PTH is a vasodilator.
2. The impact on the fetus, the newborn: The baby born to the pregnant woman of this disease has reported hyperparathyroidism, the reason is that the mother's blood calcium is low, the calcium transferred to the fetus is reduced, and the fetal blood calcium is low to stimulate the parathyroid gland. Excessive hyperplasia, resulting in hypersecretion of PTH, in the newborn 1 week after birth, X-ray film can be seen in the subclavian cortical resorption phase of the clavicle, carpal, lower limb and thigh bone and cystic fibrosis, and thigh Bone fractures of the end of the bone, etc., may have intrauterine death and neonatal death, no reports of fetal malformations, the latter most of the surgery has been diagnosed and treated before pregnancy, newborns are generally normal.
Prevention
Pregnancy with hypoparathyroidism prevention
1. Maintain an optimistic and happy mood. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood.
2, life restraint pay attention to rest, work and rest, life orderly, maintain an optimistic, positive, upward attitude towards life. Do the regularity of tea and rice, live daily, not overworked, open-minded, and develop good habits.
3, reasonable diet can eat more high-fiber and fresh vegetables and fruits, balanced nutrition, including protein, sugar, fat, vitamins, trace elements and dietary fiber and other essential nutrients, meat and vegetables, diversified food varieties, Give full play to the complementary role of nutrients in food.
Complication
Pregnancy with complications of hypoparathyroidism Complications anemia
Pregnancy with hypoparathyroidism, high maternal and child complications, complications of various low calcium and high phosphorus in pregnant women, fetal secondary degeneration of parathyroid function, resulting in decalcification of the head, fetal, neonatal mortality High, serious treatment during pregnancy, such as treatment, so that blood calcium remains normal.
Symptom
Pregnancy with hypoparathyroidism Symptoms Common symptoms Easy to irritate skin Rough depression Finger (toe) A fragile soft atrophy Hair loss Asphyxia Candida infection Smooth muscle tendon Bronchospasm Increased intracranial pressure
Long-term blood calcium reduction with paroxysmal aggravation causes increased stress in the neuromuscular system. Mild people develop irritability, irritability, depression, numbness and tingling in the fingertips or lips, and muscles in the hands and feet and facial muscles. Serum calcium is less than 2mmol. In the case of /L, there may be hand and foot spasm, which is characterized by strong adduction of bilateral thumb, flexion of the metacarpophalangeal joint, extension of the interphalangeal joint, flexion of the wrist and elbow joint to form eagle claws, and severe skeletal muscle and smooth muscle spasm , throat and bronchospasm, asphyxia and other dangers, especially children may have epileptic seizures, a small number of patients may have increased intracranial pressure and optic disc edema, the above symptoms can occur in infection, fatigue or emotional excitement, women before and after menstruation It is more prone to episodes of extrapyramidal symptoms, including Parkinson's disease.
Some patients with mild or chronic illness do not necessarily have hand and foot spasms, and their neuromuscular excitability is mainly manifested by the Chevostek sign and the Trousseau sign.
The side-to-side reduction time is too long, and the skin may be rough, the hair may fall off, the nails may be soft and atrophic, the cataract, the idiopathic hypoparathyroidism is prone to Candida albicans infection, anemia and the like.
Examine
Pregnancy with hypoparathyroidism
1. Serum calcium: decreased in the attack period (usually less than 2mmol / L), should be repeatedly extracted, and simultaneously detect plasma protein to rule out the reduction of total calcium caused by low protein concentration, elevated blood phosphorus (normally high At 2mmol/L), in patients with hypomagnesemia, blood magnesium is less than 0.4mmol/L.
2. PTH: Significantly reduced or unmeasurable.
3. Urinary calcium: significantly reduced or disappeared.
4. Most of the X-ray cranial radiographs showed calcification of the basal ganglia, dense bone, and calcification of the cerebellum.
Diagnosis
Diagnosis and differentiation of pregnancy complicated with hypoparathyroidism
Have a history of thyroid surgery with repeated hand and foot sputum, not difficult to diagnose, idiopathic parathyroidism is slow, early disease is not easy to diagnose, easy to be misdiagnosed as neurosis or epilepsy.
The disease must be differentiated from pseudohypothyroidism, the latter is a hereditary disease, the PTH receptor is defective, the PTH in the body is normal or increased, and the urinary phosphorus and urinary cAMP are not increased after the injection of exogenous PTH, often accompanied by other development. abnormal.
