Mental disorders associated with abnormal parathyroid function
Introduction
Introduction to mental disorders associated with parathyroid dysfunction Parathyroid dysfunction includes hyperparathyroidism and hypoparathyroidism. Hyperparathyroidism can be divided into primary and secondary types. The primary is caused by parathyroid gland; secondary is caused by physical factors. Metabolic disorders, long-term hypocalcemia, excessive secretion of the parathyroid glands. The occurrence of mental disorders is generally thought to be associated with a significant increase in blood calcium, and renal failure and circulatory dysfunction also play a role. Most of the hypoparathyroidism occurs after thyroid surgery; followed by parathyroidectomy; in addition, there is a so-called idiopathic hypoparathyroidism for unknown reasons. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: ataxia
Cause
The cause of mental disorders associated with parathyroid dysfunction
(1) Causes of the disease
The main factors associated with parathyroid dysfunction and mental disorders are closely related to blood calcium. It is generally believed that a significant increase in blood calcium is a major factor in hyperparathyroidism accompanied by mental disorders; and a decrease in blood calcium leads to "hand and foot spasm ".
(two) pathogenesis
The pathogenesis of mental disorders associated with parathyroid dysfunction is currently unclear and is associated with calcium ions.
Prevention
Prevention of mental disorders associated with parathyroid dysfunction
Parathyroid dysfunction with the prevention of mental disorders, mainly to actively prevent the predisposing factors of mental disorders, such as respiratory infections, gastrointestinal diseases, hemorrhage, shock, surgery, trauma and psychological factors, at the same time, early treatment of the primary thyroid Gland disease.
Complication
Symptoms of mental disorders associated with parathyroid dysfunction Complications, ataxia
Ataxia.
Symptom
Symptoms of parathyroid dysfunction associated with mental disorders Common symptoms Attention deficit in appetite loss dizziness, apathy, myasthenia gravis, constipation, anxiety, coma, easy to cry, easy to irritate
1. Hyperparathyroidism with mental disorders
(1) Mental disorders: Common mental disorders have the following types:
1 neurasthenia syndrome: mostly symptoms of autonomic dysfunction, apathy, active decline, memory loss, inattention, blood calcium is generally 10 ~ 20mg / dl.
2 depression, anxiety state: mainly emotional depression, accompanied by loss of will, anxiety, restlessness and so on.
3 mental retardation: more common in children's cases, generally lighter, can also occur sputum - forgetfulness syndrome.
4 disturbance of consciousness: mostly convulsions or disordered state, more common in acute cases, can develop to coma in the parathyroid crisis, blood calcium is generally above 16 ~ 19mg / dl or 19mg / dl, blood calcium and mental disorders The prognosis is related, the higher the blood calcium, the heavier the mental disorder.
(2) Neurological and physical symptoms: thirst, nausea, loss of appetite, constipation, excessive sweating, dizziness and muscle relaxation, decreased muscle tone, general weakness, myasthenia gravis and convulsions, and dance-involuntary movements for children Specific symptoms.
2. Hypoparathyroidism with mental disorders
(1) Mental disorders: The psychiatric symptoms of this disease are quite common, and the incidence rate is about 30% to 60%, of which:
1 affective disorder: emotional instability, changeable, easy to cry, irritability, irritability, sputum-like episodes.
2 manic or depressed state: mostly depression, anxiety, and some manifested as madness.
3 Illusion or delusion state: There are many illusion-like symptoms such as auditory hallucinations, murders, relationship delusions.
4 mental retardation: severe cases may have severe memory loss, personality decline and so on.
5 disturbance of consciousness: conscious turbidity, acute disorder or stupor, etc. The above mental symptoms usually occur about 3 to 4 months after the hand, foot and ankle, and can last for several months, 3 to 4 weeks after the blood calcium returns to normal. That is, it gradually disappears.
(2) neurological symptoms: the most common hand, foot and ankle, epileptic seizures, extrapyramidal symptoms (tremor palsy, dance-like or hand-foot-like involuntary movements, etc.), cerebellar ataxia, torticollis, muscle contracture, optic disc edema Increased intracranial pressure, basal ganglia calcification in the primary hypoparathyroidism abnormal rate of up to 100%, it is related to EEG, clinical symptoms and prognosis.
Examine
Examination of mental disorders associated with parathyroid dysfunction
1. Blood calcium reduction and blood phosphorus increase
Insufficient PTH can weaken the role of osteoclasts, reduce bone calcium mobilization, and reduce the production of 1,25-(OH)2D3 and the reabsorption of calcium by renal tubules and the reduction of phosphorus excretion. High blood phosphorus, only a small number of oral antacids or blood phosphorus in the diet can be normal.
2. Urinary calcium and urinary phosphorus reduction
The reduction of urinary calcium caused by parathyroidism is less than the reduction of urinary calcium in rickets, because the former is secondary to lowering blood calcium, while the latter's blood PTH is mostly increased, which can promote renal tubular reabsorption of calcium. PTH can inhibit the reabsorption of phosphorus by renal tubules, so the reabsorption of urinary phosphorus increases and the phosphorus excretion decreases when PTH is insufficient.
3. Determination of PTH in blood
Most of the clinical hypothyroidism due to PTH deficiency, blood PTH is lower than normal, but some patients can also be in the normal range, because non-parathyroidism hypocalcemia has a strong stimulating effect on the parathyroid gland, which is low There is a significant negative correlation between blood calcium and PTH in the blood. Therefore, even if the PTH in the blood is in the normal range, it indicates that the parathyroid gland is dysfunctional. However, the parathyroid glands secrete non-bioactive PTH and PTH. When the hypothyroidism caused by resistance, PTH has a compensatory increase in secretion, the former can measure the increase of iPTH, the latter can measure the increase of biologically active PTH.
4. Reduced cAMP in urine
CAMP in the urine is a functional indicator of PTH. Therefore, the cAMP in the urine of patients with hypoparathyroidism is mostly lower than normal.
5. Normal alkaline phosphatase in the blood
ALP is elevated in patients with hyperparathyroidism with serum alkaline phosphatase (ALP), and ALP in patients with low parathyroid is normal.
6. Identification of laboratory parameters for hypocalcemia of different causes is shown in Table 1.
The type of parathyroidism and its laboratory tests.
7. The electrocardiogram shows ST segment lengthening, QT interval prolongation and T wave change.
8. Imaging examination
About 20% of the skull X-ray shows basal ganglia calcification, and a few patients still have pineal and choroid plexus calcification; CT scan is more sensitive than X-ray, and can detect intracranial calcification earlier and more.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with parathyroid dysfunction
Diagnostic criteria
First, it meets the diagnostic criteria for the diagnosis of primary disease; mental disorders are closely related to parathyroid dysfunction.
1. There is evidence of parathyroid function lesions.
2. Symptoms, signs and laboratory tests for parathyroid dysfunction.
3. Psychiatric symptoms change with the development of physical symptoms.
4. It should be differentiated from other endocrine dysfunction accompanied by mental disorders and other functional psychosis such as schizophrenia, snoring and depression.
Differential diagnosis
Exclude other mental disorders associated with decreased endocrine function, and pay attention to distinguish between functional psychosis, such as schizophrenia, affective disorder and neurosis.
