Hypoparathyroidism
The Hypoparathyroidism is caused by underactive parathyroid disease in which a lack of parathyroid hormone secretion leads to calcium deficiency.
Etiology
Most commonly, hypoparathyroidism is caused by surgery on the thyroid gland. The parathyroid glands may be accidentally removed at a subtotal (partial) thyroidectomy ( thyroidectomy ) wherein radical Thyroidektomien they may need to be removed together with the back ( posterior ) of the thyroid capsule.
Rarer causes of hypoparathyroidism are:
- Autoimmune polyglandular syndromes (eg APS type I)
- Radiotherapy to the neck area
- Prolonged and severe magnesium deficiency
- DiGeorge syndrome (due to lack of conditioning of the parathyroid glands )
- Removing one or more parathyroid glands due to hyperparathyroidism
Symptoms
The symptomatology is characterized by a deficiency of calcium ( hypocalcemia ) and the thus resulting paresthesia and tetany. Among other things, this results in an obstetrician 's hands. As clinical signs of the Chvostek sign and Trousseau the characters are positive. It come before cognitive losses in terms of a subcortical dementia.
More inconstant symptoms include alopecia ( hair loss ), headache, digestive disorders, cataracts (cataract ) and a dry, chapped skin.
Prolonged calcium deficiency can lead to driving disease ( Crohn's driving ).
Diagnostics
The clinical picture in the context of the history arouse the suspicion.
Lowered calcium in the serum should be the occasion for the determination of parathyroid hormone levels. The parathyroid hormone levels should be increased reactive in hypocalcemia, however, in the case of hypoparathyroidism is greatly reduced ( to below the detection limit). Accompanying can hyperphosphataemia ( phosphate levels in the blood) find.
Therapy / prophylaxis
In surgery all possibility is utilized to receive the parathyroid glands. Also inadvertently removed parathyroid glands can autotransplantation ( transplanting in your own body ) in muscle tissue again " grow " and record the function. Autotransplantation is also suitable for prophylaxis if damage is foreseeable, for example, at an irradiation.
Is extinguished the parathyroid function, a normal calcium levels must be medically established. To this end, the oral administration of calcium is combined with vitamin D preparations containing. During a tetany intravenous administration of calcium may be necessary.
Dihydrotachysterol or calcitriol are vitamin D analogues, which are used as long-term therapy with continuous monitoring of calcium levels.
Under the therapy should be done at regular intervals, a control serum levels of calcium and phosphate. Through the gift of calcium in large amounts may increase the excretion of calcium in the urine ( hypercalciuria ). This can result in kidney stones or nephrocalcinosis.
To check should also be made a determination of calcium excretion from urine regularly.