Hypoparathyroidism
| Classification according to ICD-10 | |
|---|---|
| E20.- | Hypoparathyroidism |
| E89.2 | Hypoparathyroidism after medical measures |
| ICD-10 online (WHO version 2019) | |
The hypoparathyroidism (also hypoparathyroidism ) is a by underactive parathyroid glands caused disease in which a lack of parathyroid hormone -Ausschüttung to calcium deficiency leads.
etiology
Most often, hypoparathyroidism is caused by surgery on the thyroid gland . The parathyroid glands can be accidentally removed in a subtotal (partial) thyroidectomy (removal of the thyroid gland), in radical thyroidectomies they may have to be removed together with the posterior (dorsal) capsule of the thyroid gland.
Less common causes of hypoparathyroidism include:
- Autoimmune polyglandular syndromes (e.g. APS type I)
- Radiation on the neck area
- long-term and severe magnesium deficiency
- DiGeorge syndrome (due to the lack of anchoring of the parathyroid glands)
- Removal of one or more parathyroid glands due to hyperparathyroidism
- Oversupply of vitamin D.
Symptoms
The symptoms are characterized by a calcium deficiency ( hypocalcemia ) and the resulting paraesthesia and tetany . Among other things, there is a paw position of the hands. As clinical signs, the Chvostek sign and the Trousseau sign are positive. There are cognitive losses in the sense of subcortical dementia .
Other inconsistent symptoms include alopecia (hair loss), headaches, indigestion, cataract formation (cataracts) and dry, chapped skin .
Long-term calcium deficiency can lead to Fahr's disease ( Fahr's disease ).
Diagnosis
The clinical picture in connection with the anamnesis arouses suspicion.
A low calcium in the serum should be the reason for the determination of the parathyroid hormone level. The parathyroid hormone level would have to be reactively increased in the case of hypocalcemia, but in the case of hypoparathyroidism it is greatly reduced (to below the detection limit). This may be accompanied by hyperphosphataemia (an increase in phosphate in the blood).
Therapy / prophylaxis
In surgery every possibility is used to preserve the parathyroid glands. Even inadvertently removed parathyroid glands can “grow into” muscle tissue again through an autotransplantation (transplantation in one's own body) and start functioning again. Autotransplantation is also suitable for prophylaxis if, for example, damage can be foreseen during radiation treatment.
If the parathyroid function has ceased, a normal calcium level must be established with medication. Oral calcium administration in combination with preparations containing vitamin D is suitable for this . Intravenous calcium may be necessary during tetany .
Calcitriol or alpha calcidiol are vitamin D analogs that are used as long-term therapy with constant monitoring of the calcium level.
Serum levels of calcium and phosphate should be checked at regular intervals during therapy . The administration of calcium in high quantities can increase the excretion of calcium with the urine ( hypercalciuria ). This can result in kidney stones or nephrocalcinosis .
As a control, the calcium excretion from urine should also be determined regularly .
See also
Web links
- Network Hypopara - self-help group for people with hypoparathyroidism
- Official recommendations for treatment of postoperative hypoparathyroidism , Thyroid Section of the German Society for Endocrinology
- Leaflet on the treatment of patients with hypoparathyroidism (PDF file, 800 kB), European Society of Endocrinology
