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Parathyroid hormone disorder
It is a state of decrease or increase in parathyroid hormones. Its decrease is called hypoparathyroidism, and its increase is called hyperparathyroidism. They may develop as a complication of abnormal structures or systemic disorders that cause functional damage to the parathyroid glands.
Hypoparathyroidism
The parathyroid gland consists of four glands behind and attached to the thyroid gland. Parathormone is secreted from these glands, each of which is 30-40 g. Parathormone has very important functions in maintaining blood calcium level, vitamin D and phosphate balance.
In patients with low blood calcium levels (hypocalcemia), low calcium levels may be due to low parathormone or magnesium. Even if parathormone levels are normal, it may also be due to decreased tissue response to parathormone.
Hypocalcemia due to low parathormone levels is called hypoparathyroidism. The occurrence of hypocalcemia even though parathormone levels are normal or high is called pseudohypoparathyroidism.
Hypoparathyroidism is a rare disease. It usually develops after surgery of the thyroid or parathyroid glands.
The most common causes of hypoparathyroidism are:
- Post-surgical complications
- Autoimmune polyglandular insufficiency
- Type 1
- Type 2 (Schmidt syndrome)
- Graves’ disease after iodine treatment
- After radiotherapy
- Pernicious anemia
- Thyroid cancer
- Due to iron accumulation (Wilson’s disease)
- Di George syndrome (an autosomal recessive disease characterized by congenital absence of the parathyroid glands)
- Inherited forms of hypoparathyroidism
- Mutations that activate calcium receptors
- Conditions secondary to magnesium deficiency
- Tumor invasion
- Kearns-Sayre and Kenny syndromes
- Hereditary nephrosis
- Alcoholism
In patients with autoimmune polyglandular insufficiency Type 1, mucocutaneous candidiasis, Addison’s disease and hypoparathyroidism are seen, which usually starts between the ages of 10-20. Antibodies developed against both adrenal and parathyroid tissues. In this case, it may be possible to affect other endocrine glands. This disease is an autosomal recessive disorder.
Autoimmune polyglandular insufficiency Type 2 (Schmidt) disease is characterized by hypothyroidism and adrenal insufficiency. It does not affect the parathyroid glands.
Although there is enough parathormone in the blood circulation in patients with pseudohypoparathyroidism, the response to this hormone in the target tissues is low.
Symptoms of hypocalcemia are more common in patients with hypoparathyroidism. Muscle spasms, tingling in fingers, painful carpal spasms, twitching of facial muscles, Chvostek and Trousseau sign, dry skin, brittle nails, confusion, weakness, mental retardation, behavioral changes, psychosis, paresthesias, seizures, irritability, arrhythmias, cataracts, tooth development Pulmonary symptoms such as delays and bronchospasm may be seen.
Blood phosphate levels are usually elevated in these patients.
hyperparathyroidism
Hyperparathyroidism is a condition that occurs as a result of the parathyroid glands secreting too much parathormone. When the parathormone level in the blood increases, the blood calcium level also increases with the effect of the parathormone. Increased blood calcium level can cause serious life-threatening conditions.
The average parathormone level ranges from 10 to 65 pg/ml. If a person’s parathormone level rises above this range, it can be said to be hyperparathyroidism.
In patients with hyperparathyroidism, symptoms of depression, frequent tiredness, excessive desire to drink water, frequent urination, feeling sick and weak, muscle weakness, frequent constipation, abdominal pain, confusion and loss of concentration can be seen. If hyperparathyroidism progresses, symptoms of hypercalcemia may be added to the picture. In this case, symptoms such as vomiting, dehydration, muscle spasms, confusion, bone and joint pain, arrhythmia and hypertension can be seen.
In chronic conditions of hyperparathyroidism, conditions such as osteoporosis, kidney stones, stomach ulcers and pancreatitis may also develop in patients with the effect of hypercalcemia. In more advanced or rapidly developing cases, life-threatening conditions such as kidney failure, loss of consciousness or coma may occur.
Causes of hyperparathyroidism
Hyperparathyroidism can develop in 3 ways:
- Primary hyperparathyroidism; Caused by the parathyroid gland itself
- Secondary hyperparathyroidism; It is an increase in parathormone levels as a result of decreased blood calcium levels due to other diseases in the body while the parathyroid glands are normal.
- Tertiary hyperparathyroidism; Secondary hyperparathyroidism behaves like primary hyperparathyroidism due to conditions that develop after a long time. It is often associated with kidney failure.