What Is Hyperparathyroidism?

Hyperparathyroidism is an abnormal disease of calcium and phosphorus metabolism caused by excessive secretion of parathyroid hormone.

Basic Information

Visiting department: Endocrinology
Multiple groups: 20-50 years old

Common causes: Cause is not fully elucidated
Common symptoms: Hypercalcemia, urinary system, skeletal system, hypercalcemia crisis

Causes of hyperparathyroidism

The specific cause has not yet been fully elucidated.
1. Primary hyperparathyroidism is due to excessive secretion of parathyroid hormone caused by parathyroid adenoma, hyperplasia, hypertrophy, or adenocarcinoma. The etiology is unknown, and may be related to radiation damage or family Genetically related.
2. Secondary is due to the presence of stimulating factors of parathyroid hormone in the body, causing hyperparathyroidism, hypertrophy or the formation of free adenomas. This disease is more common in vitamin D deficiency, severe renal insufficiency, osteomalacia, and small intestinal malabsorption.
3. Tertiary is developed on the basis of secondary hyperparathyroidism. For example, the parathyroid glands are overreacting to various stimulating factors or the glands are continuously proliferated and hypertrophy exceeds physiological needs. Some of the proliferative tissues in the glands are transformed into adenomas, and they automatically secrete excessive parathyroid hormone. Causes obvious fibroosteitis. Calcium from normal or slightly lower and significantly more than normal.
4 Falseness is caused by parathyroid hormone-like polypeptides or osteolytic factors secreted by malignant tumors such as lung, kidney, and liver.

Clinical manifestations of hyperparathyroidism

The disease is more common in adults 20 to 50 years of age, and the incidence generally increases significantly after the age of 40. The clinical manifestations of this disease mainly have the following points.
1. Hypercalcemia The central nervous system manifests as memory loss and emotional instability. When the blood calcium concentration exceeds 3 mmol / L, hallucinations, mania and even EMG abnormalities are prone to occur. Digestive system can appear loss of appetite, bloating, constipation, indigestion, nausea, and vomiting. If skin calcium deposits, it can also cause itching.
2. Urinary system manifests as increased urine output, nocturia, thirst and so on. Can also appear kidney stones and renal parenchyma calcification, recurrent renal colic and hematuria. Renal calcification can lead to gradual decline of renal function and eventually renal insufficiency.
3. In the early stage of the skeletal system, bone pain occurred mainly in the hips, lower back, ribs and limbs, with local tenderness. In the later stage, fibrocystic osteitis, skeletal deformities and pathological fractures, short stature, and difficulty walking; some patients may also have bone cysts, which are presented as local fractures and bulges.
4. Severe hypercalcemia may occur in patients with severe hypercalcemia, accompanied by significant dehydration, which is life-threatening and should be treated urgently.

Examination of hyperparathyroidism

1. Laboratory examination: blood calcium determination, blood phosphorus determination, serum alkaline phosphatase determination, urine calcium determination, serum parathyroid hormone determination, etc.
2. X-ray film inspection.

Diagnosis of hyperparathyroidism

1. The patient has recurrent urinary stones and bone pain.
2. X-rays of bone have subperiosteal absorption, cyst-like changes, multiple fractures or deformities.
3. Laboratory tests include hypercalcemia, hypophosphatemia, elevated serum alkaline phosphatase, and elevated urine calcium.
Basically, the diagnosis can be determined through the above three points. In order to determine the diagnosis of this disease, serum parathyroid hormone measurement must be performed, combined with serum calcium measurement, especially in early asymptomatic patients, serum parathyroid hormone is often accompanied by hypercalcemia is an important diagnostic basis.

Treatment of hyperparathyroidism

1. Surgical treatment (1) Parathyroid adenoma is usually cured after resection. Pay attention to the existence of multiple and ectopic tumors.
(2) Subtotal resection is performed for proliferative patients.
2. Treatment of hypercalcemia (1) Intravenous saline.
(2) Diuretics can be applied only after blood volume is replenished, but thiazines cannot be used because they will inhibit calcium excretion and aggravate hypercalcemia.
3. Treatment of mild patients with blood calcium <2.5mmol / L (<11mg / dl) and asymptomatic treatment measures are as follows: appropriate fluid supplements; appropriate exercise to avoid braking; the use of thiazide drugs is prohibited; Those with good renal function should add phosphate preparations; postmenopausal women need to add estrogen; monitor bone mineral content.

Nursing of hyperparathyroidism

1. According to the general nursing routine treatment of endocrine diseases.
2. Encourage patients to drink more water to promote calcium excretion. The moderate calcium intake of the patient's diet before surgery is appropriate. A low-calcium diet can stimulate the secretion of parathyroid hormone, and hypocalcemia can occur after surgery. A high-calcium diet should be given.
3. Eat a high-fiber diet to maintain smooth bowel movements. If necessary, laxatives or enemas can be given.
4. Properly restrict activities and do good life care. Instruct patients to sleep on a hard bed to avoid pathological fractures. Bedridden patients should step up to prevent pressure ulcers. Turn over gently to prevent new fractures. Those who already have a fracture should stay in bed absolutely, 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 in retaining various test specimens to facilitate doctors' diagnosis and treatment.
6. Do a good job of patient psychological care. Relieve the anxiety and tension of patients, and make patients actively cooperate with treatment.