Hyperparathyroidism is caused by excessive secretion of parathyroid hormoneCalcium and phosphorus metabolismAbnormal diseases can be divided into primary, secondary, tertiary and pseudo diseases.
At present, the specific etiology has not been fully clarified.
1. Primary
Primary hyperparathyroidism is due to excessive parathyroid hormone secretion caused by parathyroid adenoma, hyperplasia, hypertrophy or adenocarcinoma. Its etiology is unknown, and may be related to radiation damage or family inheritance.
2. Secondary
It is due to the presence of parathyroid hormone stimulating factors in the body, which can cause parathyroid hyperplasia, hypertrophy or the formation of free adenoma.This disease is mostly found in vitamin D deficiency, severe renal insufficiency, osteomalacia, intestinal malabsorption, etc.
3. Tertiary
It developed on the basis of secondary hyperparathyroidism.For example, the parathyroid gland overreacts to various stimulus factors or the gland is constantly proliferating and hypertrophic beyond the physiological needs when subjected to persistent stimulation, and part of the hyperplastic tissue in the gland is transformed into adenoma, which spontaneously secretes excessive parathyroid hormone and causes obvious fibroosteitis.The blood calcium is from normal or slightly lower to obviously higher than normal.
4 False
It is caused by parathyroid hormone like polypeptides or osteolytic factors secreted by lung, kidney, liver and other malignant tumors.
clinical manifestation
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This disease is mostly seen in adults aged 20 to 50 years old, and the incidence rate increases significantly after the age of 40.The clinical manifestations of this disease mainly include the following points.
1. Hypercalcemia
The central nervous system is characterized by memory loss and emotional instability.When the blood calcium concentration exceeds 3 mmol/L, hallucinations, mania, and even abnormal electromyography are prone to occur.The digestive system may suffer from anorexia, abdominal distention, constipation, indigestion, nausea and vomiting.If calcium salt deposits on the skin, it can also cause itching.
2. Urinary system
The symptoms are increased urine output, nocturnal urination, thirst, etc.Kidney stones and renal parenchyma calcification, recurrent renal colic and hematuria can also occur.Renal calcinosis can lead to gradual decline of renal function, and finally cause renal insufficiency.
3. Skeletal system
In the early stage, bone pain mainly occurs in the hips, waist and back, ribs and limbs, and tenderness occurs locally.In the later stage, it showed fibrocystic osteitis, bone malformation and pathological fracture, short stature and difficulty in walking;Some patients may also have bone cysts, which are manifested as local fracture protrusions.
4. High calcium crisis
Severe patients may have severe hypercalcemia, accompanied by significant dehydration, which is life-threatening, and should be given emergency treatment.
1. The patient has recurrent urinary calculi and bone pain.
2. Bone X-ray films include subperiosteal cortical absorption, cyst like changes, multiple fractures or deformities.
3. Laboratory examination showed high blood calcium, low blood phosphorus, elevated serum alkaline phosphatase, and elevated urine calcium.
It can be basically determined through the above three diagnosis points.In order to determine the diagnosis of the disease, serum parathyroid hormone and serum calcium should also be measured. Especially in early asymptomatic patients, the increase of serum parathyroid hormone often accompanied by hypercalcemia is an important diagnostic basis.
treatment
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1. Surgical treatment
(1) Parathyroid adenoma can usually be cured after resection. Pay attention to the existence of multiple and ectopic tumors.
(2) Subtotal resection was performed for hyperplastic patients.
2. Treatment of hypercalcemia
(1) Intravenous drip of normal saline.
(2) Diuretics can be used only after the blood volume is replenished, but thiazides cannot be used because they will inhibit the excretion of calcium and aggravate hypercalcemia.
3. Treatment of mild patients
Blood calcium<2.5mmol/L (<11mg/dl) and no symptoms, the treatment measures are as follows: ① appropriate fluid supplement; ②Move properly to avoid braking; ③It is forbidden to use thiazides; ④If the kidney function is good, add phosphate preparation; ⑤Postmenopausal women need to add estrogen; ⑥Bone mineral content was monitored.
nursing
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1. Treat according to the general nursing routine of endocrine disease.
2. Encourage patients to drink more water to promote calcium excretion.The calcium intake in the diet of patients before surgery should be moderate. A low calcium diet can stimulate the secretion of parathyroid hormone. After surgery, hypocalcemia may occur, and a high calcium diet should be given.
3. Eat a high fiber diet and keep the bowel movement smooth.Give laxative or enema if necessary.
4. Properly limit activities and do a good job of life care.Ask the patient to sleep in a hard bed to avoid pathological fracture.The bedridden patients should strengthen turning over to prevent pressure sores.Turn over gently to prevent new fractures.Those with fractures should absolutely lie in bed, raise the affected limb, and pay attention to the blood circulation at the fracture site.
5. Do a good job of health education for patients, and assist them to keep various test specimens, so as to facilitate doctors' diagnosis and treatment.
6. Do a good job of psychological care for patients.Alleviate patients' anxiety and tension, and make patients actively cooperate with treatment.
