A pathological condition in which the functions of the parathyroid glands are reduced and excessive neuromuscular irritability, as well as pain convulsive syndrome, is called tetany or hypoparathyroidism, its symptoms are due to hypocalcemia. Modern diagnostics and the right course of therapy can stabilize the patient's condition and minimize the consequences of the disease.
Classification of hypoparathyroidism
There are several classifications of this ailment. The nature of the pathological process distinguishes such forms as:
- Latent - there are no signs of the disease. To identify the disease and establish a diagnosis, diagnostic tests are performed: Hofi, Erba, Hofmann and Trousseau.
- Acute - the individual has frequent and rather severe cramps.
- Chronic - attacks are accompanied by physical or mental stress, stress, as well as trauma.
According to etiology, the following types are distinguished:
- Congenital - improper intrauterine development of the embryo contributes to the development of this type of pathology. Signs of the disease appear in the first months of the baby's life. They can be both permanent and passing.
- Post-traumatic - a provocative factor is the exposure or infection of an individual's body.
- Autoimmune - the reason lies in the pathological processes that occur in the endocrine glands. It is mainly diagnosed in children.
- Postoperative - the cause of its occurrence is the consequences after surgery on the thyroid gland or cervical region.
Depending on the magnesium content, which provokes the development of hypoparathyroidism, the following types are distinguished:
- Pseudohypoparathyroidism - as a result of pathological changes in the skeletal system, a malfunction in the balance of phosphorus and magnesium occurs, which leads to deviations in physical and mental development.
- Functional - is associated with an insufficient concentration of magnesium in the body that occurs against the background of kidney pathology, diabetes mellitus, and the intake of certain medications. As a result, the parathyroid gland malfunctions. When replenishing the trace element to normal, the pathology disappears.
- Hypermagesemia is a consequence of kidney disease, as well as treatment with magnesium preparations.
Diagnosis of the disease
Women and men have the same symptoms of hypoparathyroidism. Diagnosis of this ailment is not difficult. The doctor evaluates the patient's complaints, anamnesis, visual examination data. Information on the work of the parathyroid glands and on the state of electrolyte metabolism is obtained by studying the following analysis results:
- Calcium deficiency is hypocalcemia.
- Low serum parathyroid hormone.
- A low concentration of calcium in urine is hypocalciuria.
- Increased phosphorus - hyperphosphatemia.
- Lack of bone protein.
With a latent form, attacks of the disease are detected using diagnostic tests:
- Weiss symptom - contraction of the frontal and circular muscles of the eyelids occurs when tapping with a special hammer at the outer edge of the eye socket.
- Symptom of Trusso with hypoparathyroidism - cramps in the muscles of the hand are observed after two to three minutes when a tourniquet is applied to the shoulder region.
- A sign of Khvostek - when striking in front of the external auditory meatus, the facial muscles contract in the place where the facial nerve comes out.
In addition, perform ECG, MRI, densitometry. Using radiography, bone density is determined. Differential diagnostics are carried out, which is especially important for making the correct diagnosis.
The causes of the disease
Before considering the symptoms and treatment of hypoparathyroidism, we will familiarize ourselves with the causes of its occurrence. It is proved that this ailment can be part of the polyglandular endocrine insufficiency syndrome, and not just an independent pathology. In this case, such disorders as adrenal insufficiency, thyroid and gonadal functions adjoin it. Factors provoking the disease:
- autoimmune or infectious process;
- exposure due to radioactive iodine therapy or radiation therapy;
- removal of part or all of the gland;
- absence of parathyroid glands or congenital hypoplasia;
- failure of blood supply to glands or violation of innervation.
Such a cause of the symptoms of hypoparathyroidism, as an insufficient concentration of parathyroid hormone in the body of the individual, contributes to the failure of the exchange of electrolytes. Hypocalcemia, which was formed due to a deterioration in calcium absorption in the intestine and low reabsorption in the kidneys, is considered one of the manifestations of hypoparathyroidism. In addition, a low concentration of calcium in the blood provokes a decrease in the production of the active metabolite of vitamin D in the kidney tissues. The level of phosphorus in the blood serum increases as a result of a decrease in the phosphaturic effect of parathyroid hormone. These disorders lead to the failure of the processes of repolarization in nerve tissues and the permeability of cell membranes.
Clinical picture
Symptoms of hypoparathyroidism in women and men are the same. The main manifestation is the occurrence of a convulsive syndrome (tetany). Before an attack in an individual:
- the muscles are stiff and numb;
- limbs become cold;
- over the upper lip there is a crawling sensation;
- tingling in the upper and lower extremities.
Tetania is the main sign of illness. The following features are noted with convulsions:
- The facial muscles - the eyebrows move, the eyelids go down, the jaw contracts, and the corners of the mouth go down.
- Upper extremities - they bend at the elbow and carpal joints and are pressed to the body.
- The muscles of the body - it sharply leans back.
- Intercostal muscles, as well as the abdomen, neck and diaphragm - shortness of breath and difficulty breathing appear.
- Smooth muscles of the digestive tract - dysphagia, colic.
- Bladder muscles - contribute to anuria.
With a spasm of the coronary vessels, an attack of angina pectoris is observed.
Seizures with this pathology are very painful. With a mild form of the disease, they last several minutes and are from one to two times a day. In severe cases, an individual experiences a prolonged convulsive seizure, which is sometimes accompanied by loss of consciousness. There can be several such episodes during the day.
Symptoms of hypoparathyroidism, manifested by a violation of the autonomic nervous system:
- dizziness;
- increased sweat formation;
- increased heart rate;
- lack of vision in the dark;
- ringing and stuffy ears.
If the body of an individual experiences a shortage of calcium in the blood for a rather long period, then this leads to a decrease in intelligence, emotional lability, and sleep disturbance.
From trophic disturbances it should be distinguished:
- fungal lesions of the dermis;
- cataract
- fragility of nails;
- eczema
- peeling and dryness of the skin;
- baldness;
- enhanced pigmentation.
A non-drug treatment for the symptoms of hypoparathyroidism
Particular attention in this pathology is given to dietary nutrition of both children and adults. The diet is enriched with calcium, magnesium and depleted in phosphorus. Foods containing large amounts of phosphorus and calcium are limited. During periods of exacerbation, meat dishes are removed from the menu. In unlimited quantities you can eat fruits, vegetables and dairy products. It is recommended to include foods enriched with ergocalciferol in the diet - egg yolks, fish oil, liver and others.
In addition, all individuals are shown sunbathing or moderate UV exposure.
Drug treatment
Comprehensive methods of treating the symptoms of hypoparathyroidism are used, since monotherapy does not give a tangible effect. To bring the level of calcium to normal values, doctors recommend:
- "Calcium gluconate" or "Calcium carbonate" is used with solutions (ammonium chloride, gastric juice), which significantly improves the absorption of trace elements from the intestines.
- Ergocalciferol, Colecalciferol, Alfacalcidol are analogues of vitamin D.
Hypocalcemic crisis is stopped by intravenous administration of "Calcium gluconate."
Clinic of hypoparathyroidism in children
At the heart of the complex of symptoms of hypoparathyroidism in children is a decrease in the amount of ionized calcium in the body, which contributes to an increase in muscle and nervous excitability, which provokes convulsions. Signs of illness can be minor and can be manifested by cooling of the extremities, tingling and trembling in the facial muscles, fingers, hands, stiffness, numbness. And also severe, which are expressed by generalized convulsions and tetany.
Muscle cramps of the upper extremities are caused by contraction of the flexor muscles, and when the lower limbs are tetanic, the tone of the plantar flexors and extensors of the extremities predominates.
With convulsions of the muscles of the face - the jaw contracts, the eyebrows are moved, the corners of the mouth are lowered, the eyelids are half-lowered. This condition is called a “fish mouth,” or, in other words, a sardonic smile.
Contraction of the diaphragm and intercostal muscles provokes chest pain and respiratory distress. With a spasm of the coronary arteries, the pain radiates to the left upper limb and scapula.
Especially dangerous is a symptom of hypoparathyroidism, as a spasm of the bronchi and larynx muscles in young children.
Convulsions of the smooth muscles of the gastrointestinal tract and the muscles of the anterior abdominal wall contribute to pain in the abdomen. In addition, pain in the lower abdomen provokes a spasm of the bladder.
Muscle cramps are quite painful. With a mild stage of the disease, they are short-lived and disturb once or twice a week. In severe cases, it lasts several hours and is observed repeatedly throughout the day. May appear unexpectedly or under the influence of external stimuli. With a muscle spasm in a child, the following appears:
- nausea;
- loose stools;
- vomiting
- increased heart rate;
- pale skin.
Vegetative disorders are manifested by the following symptoms of hypoparathyroidism:
- hypersensitivity to various sounds and noise;
- dizziness
- increased sweating;
- hearing impairment;
- failure of heart rhythms;
- photophobia;
- pains in the heart;
- loss of consciousness;
- conjunctivitis;
- and others.
Muscle cramps with an asymptomatic course of the disease cause:
- intoxication;
- a shift in the balance of acids and alkalis;
- vitamin D hypovitaminosis;
- acute infections.
Signs of chronic hypoparathyroidism in children
A prolonged course of the disease provokes the following disorders:
- fragility of nails;
- peeling, discoloration and dryness of the dermis;
- the appearance of vesicles;
- fungal lesions;
- eczema
- early graying;
- violation of hair growth;
- loss of eyelashes and eyebrows;
- in babies there is a malfunction in the teething sequence;
- the kids are stunted;
- the lens becomes cloudy;
- visual acuity decreases, blindness develops.
Calcium deficiency over a long period reduces memory, intelligence and changes the psyche. Fatigue, fatigue is observed.
Therapy of hypoparathyroidism in children
The goal of treating the symptoms of hypoparathyroidism in children is to maintain a certain amount of calcium in the blood serum, which will avoid serious renal complications. After selecting an adequate dose of vitamin D, monthly monitoring of calcium concentration is carried out.
In acute manifestations of hypocalcemia, urgent manipulations are performed using the following medication, which is injected intravenously:
- “Calcium chloride” or “Calcium gluconate”.
- "Sodium chloride" or glucose solution.
- "Magnesium sulfate".
After the attack is removed, the dosage of vitamin D and calcium is individually selected - “Calcium carbonate” or “Calcium citrate”. If necessary, add magnesium preparations, which are necessary for the normal production of parathyroid hormone. In recent years, Calcitriol, Alfacalcidol have been actively used, which have proven themselves very successfully in the treatment of hypoparathyroidism. In the absence of treatment for the symptoms of hypoparathyroidism, the baby lags behind in mental and physical development.
Features of the course of hypoparathyroidism in childhood
In children, the autoimmune form of the disease is mainly diagnosed. Seizures have different intervals. Initially, in children, pain is concentrated in the abdomen, and then tonic cramps are observed, in which the head throws back. When attacks are repeated often, intracranial pressure rises, which provokes a constant headache and swelling of the optic disc. The layer of tooth enamel in these babies is poorly developed, and the crowns themselves are irregular in shape. In addition, teeth erupt late. Against the background of hypoparathyroidism, the following diseases appear in a child:
- chronic renal failure;
- baldness;
- keratoconjunctivitis autoimmune;
- chronic thyroiditis lymphocytic;
- cataract;
- and other pathologies.
Prediction and prevention of symptoms of hypoparathyroidism
In order to prevent the main symptom of the disease, anticonvulsant medications are indicated. To prevent the development of postoperative hypoparathyroidism, gentle surgical interventions should be followed. With toxic goiter with frequent relapses, it is necessary to carry out therapy with radioactive iodine, due to the fact that repeated surgery increases the damage to the parathyroid glands at times. After operations on the organs of the neck, it is recommended to prophylactically actively prevent postoperative complications that impair the supply of blood to the parathyroid glands.
With regular treatment and regular follow-up (every three months), the prognosis is very favorable. Every six months, the individual is shown an examination by an ophthalmologist, as there is a high risk of developing cataracts.
After reading the article, you became acquainted with the diagnosis, signs, symptoms and treatment of hypoparathyroidism. In women and men, the clinical manifestations are the same, in children there are some features that are described above.