Hypoparathyroidism

Hypoparathyroidism( Tetanias) is a disease characterized by increased neuromuscular excitability, decreased parathyroid function and convulsive syndrome. This disease can occur at any age, and there are cases of functional hypoparathyroidism in newborns

Etiology

Damage or removal of parathyroid glands during surgery;Their defeat with intoxication, infections, autoimmune disorders;Due to a decrease in tissue sensitivity to parathyroid hormone

. Pathogenesis of

. Insufficient parathyroid hormone release, which leads to hyperphosphatemia and hypocalcemia( calcium-phosphor homeostasis disorders).There is a danger of convulsive syndrome development, neuromuscular excitability appears

Course and symptoms of

The convulsive attack in most cases is preceded by a sensation of crawling and numbness in the region of the upper lip, fingers and toes;Coldness of the limbs and a feeling of stiffness are observed. After this, quite painful clonic and tonic convulsions of certain muscle groups develop: limbs, trunk, face.

Convulsive manifestations are predominantly observed in the flexor muscles, in this connection the hand takes a rather characteristic position, which is called "the hands of an obstetrician".When hypoparathyroidism of the flexor muscles of the lower extremities, the fingers are bent to the sole, and the foot itself is bent inward( "horse foot").Due to convulsive phenomena of facial musculature, which are accompanied by trismus, the so-called "fish mouth" is formed.

If seizures spread to the muscles of the neck, laryngospasm may occur, accompanied by cyanosis, shortness of breath, and sometimes asphyxia. Perhaps the development of pylorospasm with nausea, vomiting and acidosis;Spasms of the bladder and musculature of the intestine. Due to spasm of the coronary vessels of the heart, there are sharp pains in the region of the heart. Also attacks of tetany can be provoked by various stimuli: mechanical, thermal, painful, hyperventilation.

In case of prolonged course of the disease during periods between attacks of patients may be disturbed: hearing loss, ringing in the ears, deterioration of vision, sweating. There is caries and fragility of teeth, brittle nails, develops hypocalcemic cataract. Often observed changes in the psyche: neuroses, memory impairment, decreased intelligence.

In the blood there is a decreased content of calcium( especially its ionized fraction) and parathyroid hormone, and in contrast the phosphorus content is much higher than normal. Excretion of phosphorus and calcium in the urine is reduced

Treatment of

To stop the attack of hypoparathyroidism, 10 to 20 ml of 10% of calcium gluconate or chloride is injected intravenously, and 2 ml of parathyroidin is injected intramuscularly. After the administration of these drugs, the attack usually stops quickly enough.

When the parathyroid hormone is introduced, the effect is much slower( in two to three hours).He is prescribed in a dosage of 2 to 4 ml intramuscularly or subcutaneously, every three to four hours until the complete cessation of the attack.

To prevent the occurrence of seizures, inwardly prescribed preparations of calcium( glycerophosphate, lactate, gluconate) in a dosage of 4 - 6 g per day;Parathyreidine in a dosage of 2 ml three times a week for courses from one and a half to two months;Preparations to improve absorption of calcium in the intestine( dihydrotachysterol) in a dosage of 10 to 25 drops 3 times a day;Anabolic steroids( non-roboly, silobolin, retabolil, methandrostenolone).In addition, patients should adhere to a certain diet, which emphasizes the intake of foods rich in calcium( lemons, strawberries, apricots, cheese, milk, cabbage, etc.).