Hypofunction of the parathyroid gland symptoms. Diseases of the parathyroid glands: hyperfunction and hypofunction. Removal of the parathyroid gland

Hyper- and hypofunction of the parathyroid glands, the main clinical manifestations.

Hypofunction

Loss of parathyroid function leads to parathyroid tetany (experimental)

Manifestation: lethargy, thirst, decrease in body temperature, shortness of breath. A decrease in the concentration of calcium in the blood, a change in the ratio of one- (Na +, K +) and divalent (Ca2 +, Mg2 +) ions. As a consequence of this - an increase in neuromuscular excitability. Muscle rigidity appears, gait is disturbed. At the same time, multiple fibrillar contractions of the muscles of the whole body, which are then joined by attacks of clonic convulsions, which turn into tonic ones, opisthotonus occurs. Convulsive contractions can also pass to the internal organs. In one of the attacks, the experimental animal dies.

Simultaneously with hypocalcemia, the content of inorganic phosphorus in the blood increases. Violation of mineral metabolism is caused by a violation of bone resorption, calcium absorption in the gastrointestinal tract and an increase in phosphorus resorption in the kidneys.

Hypoparathyroidism in humans

Reason: accidental damage or removal of the parathyroid glands during surgery on the thyroid gland. Relative hypofunction is observed with intensive growth in children, during pregnancy, lactation, etc.
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conditions associated with an increased need for calcium.

Manifestation: increased neuromuscular excitability (spasmophilia may be observed in children 1-2 years old - periodic muscle cramps with an increase in ambient temperature, etc.
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adverse influences. In this case, laryngospasm is a great danger, which can lead to asphyxia and death).

Hyperfunction of the parathyroid glands.

With increased secretion of parathyrin, the activity and formation of osteoclasts increases and their differentiation into osteoblasts is inhibited. The absorption of calcium in the gastrointestinal tract increases, the reverse absorption of phosphates in the kidneys decreases.

Reason: adenoma or hyperplasia of the parathyroid glands. At the same time, generalized fibrous osteodystrophy develops.

Manifestation: Pain in muscles, bones, joints, softening of bones, sharp deformation of the skeleton. Mineral components are "washed out" of the bones and deposited in the internal organs. Nephrocalcinosis develops, narrowing of the lumen of the tubules of nephrons and blockage of their stones (nephrolithiasis) and, as a result, renal failure (ARF). Due to the deposition of calcium salts in the walls of blood vessels, hemodynamics and blood supply to tissues are disturbed.

For the oral cavity: With hyperfunction of the parathyroid glands (observed in Recklinghausen's disease), parathyroid osteodystrophy occurs (calcium from the bones is "washed out" into the blood, osteoporesis develops with the replacement of bone tissue with fibrous tissue - osteolysis occurs), swelling, pain in the bones and in particular in the lower jaw. Further fractures are noted. In the case of chronic hypofunction of the parathyroid glands, a violation of the calcification of the dentin of the teeth and hypoplasia of the enamel develop. These changes are due to the influence of parathyroid hormone on the excretion of calcium and phosphorus by the kidneys, the absorption of calcium in the intestines, as well as its direct effect on bone tissue. The action of parathyroid hormone on bone tissue is expressed in the inhibition of the Krebs cycle by inactivating the coenzyme lectate - and isocitrate dehydrogenase in osteoblasts, which leads to the accumulation of citric and lactic acids. An excess of organic acids contributes to the leaching of calcium from the skeleton through the formation of its soluble salts and chelates. Parathyroid hormone also activates the transport of Ca 2+ from the extracellular fluid into the cells and enhances the synthesis of lysosomal hydrols by osteoclasts, which destroy the organic basis of bone tissue.

Hyper- and hypofunction of the parathyroid glands, the main clinical manifestations. - concept and types. Classification and features of the category "Hyper- and hypofunction of the parathyroid glands, the main clinical manifestations." 2017, 2018.

Hypofunction

Loss of parathyroid function leads to parathyroid tetany (experimental)

Manifestation: lethargy, thirst, decrease in body temperature, shortness of breath. A decrease in the concentration of calcium in the blood, a change in the ratio of one- (Na +, K +) and divalent (Ca2 +, Mg2 +) ions. As a consequence of this - an increase in neuromuscular excitability. Muscle rigidity appears, gait is disturbed. At the same time, multiple fibrillar contractions of the muscles of the whole body, which are then joined by attacks of clonic convulsions, which turn into tonic ones, opisthotonus sets in. Convulsive contractions can also pass to the internal organs. In one of the attacks, the experimental animal dies.

Hypoparathyroidism in humans

Reason: accidental damage or removal of the parathyroid glands during surgery on the thyroid gland. Relative hypofunction is noted with intensive growth in children, during pregnancy, lactation, and other conditions associated with an increased need for calcium.

Manifestation: increased neuromuscular excitability (spasmophilia can be observed in children 1-2 years old - periodic muscle cramps with an increase in ambient temperature and other adverse influences. Laryngospasm is a great danger, which can lead to asphyxia and death).

Hyperfunction of the parathyroid glands.

Reason: adenoma or hyperplasia of the parathyroid glands. At the same time, generalized fibrous osteodystrophy develops.

For the oral cavity: With hyperfunction of the parathyroid glands (observed in Recklinghausen's disease), parathyroid osteodystrophy occurs (calcium from the bones is “washed out” into the blood, osteoporesis develops with the replacement of bone tissue with fibrous tissue - osteolysis occurs), swelling, pain in the bones and in particular in the lower jaw. Further fractures are noted. In the case of chronic hypofunction of the parathyroid glands, a violation of the calcification of the dentin of the teeth and hypoplasia of the enamel develop. These changes are due to the influence of parathyroid hormone on the excretion of calcium and phosphorus by the kidneys, the absorption of calcium in the intestines, as well as its direct effect on bone tissue. The action of parathyroid hormone on bone tissue is expressed in the inhibition of the Krebs cycle by inactivating the coenzyme lectate - and isocitrate dehydrogenase in osteoblasts, which leads to the accumulation of citric and lactic acids. An excess of organic acids contributes to the leaching of calcium from the skeleton through the formation of its soluble salts and chelates. Parathyroid hormone also activates the transport of Ca 2+ from the extracellular fluid into the cells and enhances the synthesis of lysosomal hydrols by osteoclasts, which destroy the organic basis of bone tissue.

The main symptom of hypoparathyroidism due to parathyroid insufficiency is hypocalcemia. As a result, neuromuscular excitability increases, which is manifested by attacks of tonic convulsions, spasmophilia (convulsions of the respiratory muscles). Neurological and cardiovascular disorders may occur.

Calcitonin- a polypeptide consisting of 32 amino acid residues. It is synthesized in the parafollicular cells of the thyroid gland or in the cells of the parathyroid glands. The secretion of calcitonin increases with an increase in the concentration of Ca 2+ and decreases with a decrease in the concentration of Ca 2+ in the blood.

Calcitonin is a parathyroid hormone antagonist. Target organs: bones, kidneys, intestines. Effects of calcitonin:

inhibits the release of Ca 2+ from the bone, reducing the activity of osteoclasts;

promotes the entry of phosphate into bone cells;

stimulates the excretion of Ca 2+ by the kidneys in the urine.

The rate of calcitonin secretion in women depends on the level of estrogen. With a lack of estrogens, the secretion of calcitonin decreases, which leads to the development of osteoporosis.

Calcitriol(1,25-dihydroxycholecalciferol) is a steroid hormone synthesized in the kidneys from an inactive precursor of 25-hydroxycholecalciferol. Target organs: intestines, bones, kidneys. Effects of calcitriol:

contributes to the absorption of Ca 2+ in intestines, stimulating the synthesis of calcium-binding protein;

in bones stimulates the destruction of old cells by osteoclasts and activates the uptake of Ca 2+ by young bone cells;

increases the reabsorption of Ca 2+ and P in kidneys.

end effect - an increase in the level of Ca 2+ in blood.

Adrenal hormones Adrenal medulla hormones

In the adrenal medulla, chromaffin cells synthesize catecholamines dopamine, adrenaline and noradrenaline. The immediate precursor of catecholamines is tyrosine. Norepinephrine is also formed in the nerve endings of the sympathetic nervous tissue (80% of the total). Catecholamines are stored in the granules of the cells of the adrenal medulla. Increased secretion of adrenaline occurs with stress and a decrease in the concentration of glucose in the blood.

Adrenaline is predominantly a hormone, norepinephrine and dopamine are mediators of the sympathetic link of the autonomic nervous system.

Biological action

The biological effects of epinephrine and norepinephrine affect almost all functions of the body and are to stimulate the processes necessary to resist the body in emergency situations. Adrenaline is released from the cells of the adrenal medulla in response to signals from the nervous system coming from the brain during extreme situations (for example, fight or flight) that require active muscle activity. It should instantly provide the muscles and brain with a source of energy. Target organs - muscles, liver, adipose tissue and the cardiovascular system.

There are two types of receptors in target cells, on which the effect of adrenaline depends. Binding of adrenaline to β-adrenergic receptors activates adenylate cyclase and causes metabolic changes characteristic of cAMP. Binding of the hormone to α-adrenergic receptors stimulates the guanylate cyclase signal transduction pathway.

in the liver adrenaline activates the breakdown of glycogen, resulting in a sharp increase in the concentration of glucose in the blood (hyperglycemic effect). Glucose is used by tissues (mainly the brain and muscles) as an energy source.

in the muscles adrenaline stimulates the mobilization of glycogen with the formation of glucose-6-phosphate and the breakdown of glucose-6-phosphate to lactic acid with the formation of ATP.

In adipose tissue hormone stimulates the mobilization of TAG. In the blood, the concentration of free fatty acids, cholesterol and phospholipids increases. For muscles, heart, kidneys, liver, fatty acids are an important source of energy.

Thus, adrenaline has catabolic action.

Adrenaline acts on cardiovascular system, increasing the strength and frequency of heart contractions, blood pressure, expanding small arterioles.

The parathyroid glands are located near the thyroid gland (in the region of the cervical zone), but function separately from it: they correct the phosphorus-calcium metabolism in the body.

The parathyroid glands produce parathyroid hormone, a protein biologically active substance that regulates the amount of calcium in the blood, which is especially important for maintaining bone strength, muscle functionality, the functioning of the heart and nervous systems, and proper blood clotting. A decrease in the level of a macroelement in the blood causes the uncontrolled formation of parathyroid hormone.

Hyperfunction: symptoms, diagnosis, treatment

Hyperfunction of the parathyroid gland is a disease caused by excessive release of parathyroid hormone, which leaches calcium from the bones and thereby causes the fragility of the latter, which aggravates the condition of the skeletal system.

Note. Parathyroid hormone, the amount of which in the body is not deviated from the norm, has a minimal effect on the skeletal system, the strength of which is maintained at the required level by vitamin D, delivered to the body with food, and calcitonin, a product of the thyroid gland that lowers calcium levels.

You can determine the presence of this disease by the following symptoms:

frequent fractures of limbs with minimal loads, occurring due to a disturbed bone structure;
constant feeling of fatigue;
general weakness;
lack of appetite;
increased thirst;
weight loss;
frequent constipation.

It should be remembered. It is very important in the process of treatment not only to take medicines, but also to strictly follow the recommendations of the attending physician on their use. We should not forget about the regular passage of a medical examination of the body in order to determine the content of calcium in the blood.

Treatment of the pathology of the parathyroid glands is performed by surgical intervention. In case of contraindications to the operation or its ineffectiveness, conservative therapy is used.

Reasons for the manifestation of hypofunction

Hypofunction of the parathyroid gland occurs as a result of the production of parathyroid hormone in small doses, which leads to hypocalcemia (decrease in calcium in the blood) and hyperphosphatemia (increased phosphorus content in the blood).

The cause of the disease can be injury to the parathyroid glands, their absence or congenital underdevelopment, as well as the erroneous production of antibodies by the immune system that destroy the tissues of this organ.

Note. A typical sign of hypofunction of the parathyroid gland is the deformity of the hands with reflexively flattened and straightened fingers ("obstetrician's hand").

In many cases, autoimmune hypoparathyroidism is accompanied by baldness, eye diseases, fear of light, keratoconjunctivitis.

Symptoms of hypofunction

For the most part, hypofunction of the parathyroid gland manifests itself as a concomitant phenomenon during a surgical operation on the thyroid gland and is accompanied by the following symptoms:

tingling, cramps of the facial muscles and limbs, accompanied by soreness and caused by a lack of calcium;
temporary numbness of the legs and arms;
feeling of lack of oxygen;
constricting pain behind the sternum, caused by a malfunction of the heart.

05.06.2014

For the normal functioning of the body, a certain level of hormones is needed, which are produced by the endocrine glands, these include the parathyroid glands. Located on the posterior surface of the thyroid gland, they are located in pairs on the sides of the trachea. Despite the small size, violation - hyperfunction and hypofunction of the parathyroid gland - leads to the development of many diseases.

Hormones and their role in the body

The main function is the production of parathyroid hormone (parathyroid hormone, parathyroidin, PTH), which, together with calcitonin, its antagonist, and vitamin D, are involved in the metabolism of calcium and phosphorus. Thus, parathyroid hormones increase the level of calcium in the body and reduce the concentration of phosphorus. It is thanks to them that the body is able to adapt to changes in the external environment, as well as restore the balance of the internal environment. The further course of the disease depends on the direction in which the hormonal balance is disturbed.

hyperfunction

As a result of excessive production of hormones, the activity of the organ increases, in which hyperfunction of the parathyroid gland develops. Causes of increased formation of parathyroidin may be

gland tumors found in the majority of patients (80%)
hyperplasia
malignant tumors, which account for about 2%

Hyperfunction of the parathyroid gland has, first of all, a negative effect on the bones, kidneys, intestines

As a result of an imbalance of hormones, various deviations develop:

in the bone tissue - there are pains, softening of the bones, deformation of the skeleton. Osteoporosis is possible, the risk of fractures of the femur, spine, forearm increases. At the same time, mineral components, being washed out of the bone tissue, are deposited in various internal organs.
in the urinary system - nephrocalcinosis develops (formation of stones in the kidneys) and blockage of the lumen of the tubules, leading to renal failure.
on the part of the digestive system, the development of peptic ulcer, pancreatitis is possible
increased function of the parathyroid glands can cause disorders of the nervous system and the development of muscle weakness, accompanied by fatigue, muscle pain.
as a result of deposits of calcium salts in the vessels, hemodynamics is disturbed, leading to a lack of blood supply to tissues.

Hypofunction

A decrease in hormonal levels leads to a decrease in activity, hypofunction of the parathyroid gland develops. The cause may be damage or removal of the glands, as well as inflammatory lesions, resulting in hypocalcemia and hyperphosphatemia. As a result of insufficiency, neuromuscular excitability increases, the patient is disturbed by seizures, including the respiratory system. Convulsive contractions can spread to internal organs, often there are violations of the cardiovascular system. Thirst, lethargy, shortness of breath, body temperature decreases. Relative hypofunction of the parathyroid gland sometimes occurs during the intensive growth of the child, during pregnancy and lactation, i.e. in a state where the body needs more calcium.

Both hypofunction and hyperfunction of the parathyroid gland are very dangerous conditions and require immediate medical attention, the absence of which leads not only to dysfunction of the whole organism, but in advanced cases to death.

Of course, a thorough examination is necessary to make a correct diagnosis. Today there are many very effective diagnostic methods. Among them there are both biochemical methods and instrumental:

Ultrasound procedure
Magnetic resonance imaging
Scintigraphy

In addition to these methods, additional methods of examination are prescribed, which makes it possible to detect the presence of pathological changes in organs and systems, as well as to assess the degree of their damage.

Treatment

Therapy consists in eliminating the causes of the disease and the resulting disorders. In hyperparathyroidism, if the cause of the development of the disease is tumors, surgical treatment is always prescribed. In hypoparathyroidism, therapy is usually medical and is aimed at compensating for the lack of calcium in the body resulting from gland dysfunction.