Hipoparatiroidismo

Descripción General

Definición

El hipoparatiroidismo es una enfermedad asociada a una secreción insuficiente de la hormona paratiroidea (PTH). La hipocalcemia y la hiperfosfatemia son las características bioquímicas patognomónicas del hipoparatiroidismo, y son resultado directo de la falta de acción de la PTH en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el riñón.

Epidemiología

• La prevalencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum Estados Unidos es de 37 por cada 100 000 personas por año
• El 74% de los LOS Neisseria pacientes tienen 45 años de edad o más.
• Más frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las mujeres (75%)

Etiología

• Iatrogénica (la más común):
  • Tiro/paratiroidectomía
  • Disección del cuello
  • Irradiación
• Hipoparatiroidismo idiopático/familiar
• Destrucción autoinmune de las paratiroides: Síndrome poliendocrino autoinmune tipo 1
• Genética: Síndrome de DiGeorge (tríada de: anomalías cardíacas conotruncales, timo hipoplásico (→ inmunodeficiencia de células T e hipocalcemia (por hipoplasia paratiroidea)
• Enfermedad infiltrativa de las glándulas paratiroides:
  • Hemocromatosis
  • Enfermedad de Wilson

Fisiopatología y Presentación Clínica

Fisiopatología

Fisiología normal de la PTH:

• Hormona producida por las glándulas paratiroides
• Esencial para la regulación de los LOS Neisseria niveles séricos de calcio ( Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)) y fosfato
• Regula los LOS Neisseria niveles de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) y fosfato mediante:
  • Activación de los LOS Neisseria osteoclastos: ↑ liberación de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) y fosfato del hueso.
  • ↓ Excreción de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) renal
  • ↑ Excreción de fosfato renal
  • ↑ Síntesis de 1,25-dihidroxivitamina D, que aumenta la absorción intestinal del Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts).

Efectos del hipoparatiroidismo:

• ↓ PTH → ↓ niveles séricos de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) (y ↑ niveles de fosfato).
• Los LOS Neisseria efectos fisiológicos están relacionados con la hipocalcemia:
  • Actividad desinhibida de los LOS Neisseria canales de sodio (Na) activados por voltaje
  • Aumento de la irritabilidad neuromuscular → tetania

Presentación clínica

Aguda:

• Tetania (aumento de la excitabilidad neuromuscular):
  • Leve:
    • Adormecimiento perioral
    • Parestesias
    • Calambres/espasmos musculares
  • Grave:
    • Espasmo carpopedal
    • Laringoespasmo
    • Convulsiones
• Hallazgos cardíacos:
  • Prolongación del intervalo QT
  • Arritmias
  • Hipotensión
  • Insuficiencia cardíaca
• Síntomas neuropsiquiátricos:
  • Depresión
  • Fatiga
  • Irritabilidad/ansiedad

Crónica:

• Calcificaciones de los LOS Neisseria ganglios basales:
  • Parkinsonismo
  • Demencia
• Cabello áspero y quebradizo y piel seca
• Cataratas tetánicas (calcificación paradójica del cristalino)
• Disminución de la secreción de insulina
• Osteoesclerosis, engrosamiento cortical, anomalías craneofaciales
• Anomalías dentales cuando la hipocalcemia está presente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la primera infancia
• El hipoparatiroidismo familiar idiopático puede estar asociado a un trastorno inmunológico y a la candidiasis Candidiasis Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis.

Diagnóstico y Tratamiento

Diagnóstico

Historia clínica:

• Cirugía reciente del cuello/tiroidectomía/paratiroidectomía
• Historia familiar
• Síndromes genéticos

Examen físico:

• Signo de Chvostek: Al AL Amyloidosis golpear el nervio facial en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la zona de la mejilla se produce una contracción de la musculatura bucal.
• Signo de Trousseau: espasmos musculares de la mano (“garra”) después de inflar el manguito de presión arterial en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el brazo
• Piel seca e inflamada
• Alopecia Alopecia Alopecia is the loss of hair in areas anywhere on the body where hair normally grows. Alopecia may be defined as scarring or non-scarring, localized or diffuse, congenital or acquired, reversible or permanent, or confined to the scalp or universal; however, alopecia is usually classified using the 1st 3 factors. Alopecia, pelo fino/quebradizo

Estudios de laboratorio:

• ↓ Niveles de PTH en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero
• Niveles de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) ↓ y ↑ fosfato en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum suero
• ↓ Niveles de fosfato en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina
• El nivel de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la orina puede ser bajo o alto dependiendo del grado de corrección del Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) sérico.
• Niveles normales de magnesio sérico, creatinina y 25-hidroxivitamina D

Tratamiento

Hipoparatiroidismo agudo:

• Generalmente ocurre después de la cirugía
• Síntomas graves o Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) ≤ 7,5 mg/dL:
  • Tratamiento de emergencia con gluconato de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) IV
  • Calcitriol Calcitriol The physiologically active form of vitamin d. It is formed primarily in the kidney by enzymatic hydroxylation of 25-hydroxycholecalciferol (calcifediol). Its production is stimulated by low blood calcium levels and parathyroid hormone. Calcitriol increases intestinal absorption of calcium and phosphorus, and in concert with parathyroid hormone increases bone resorption. Parathyroid Glands: Anatomy oral (vitamina D)
  • Transición a suplementos orales de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) cuando el Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) > 7,5 mg/dL
• Síntomas leves a moderados y Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) > 7,5 mg/dL:
  • Suplementos orales de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts)
  • Calcitriol Calcitriol The physiologically active form of vitamin d. It is formed primarily in the kidney by enzymatic hydroxylation of 25-hydroxycholecalciferol (calcifediol). Its production is stimulated by low blood calcium levels and parathyroid hormone. Calcitriol increases intestinal absorption of calcium and phosphorus, and in concert with parathyroid hormone increases bone resorption. Parathyroid Glands: Anatomy oral (vitamina D)

Hipoparatiroidismo crónico:

• Suele ocurrir debido a una enfermedad autoinmune o infiltrativa, o después de la radiación
• Inicio insidioso
• Suplementos de vitamina D y Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) a largo plazo:
  • Necesario medir la excreción urinaria de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) periódicamente para prevenir la hipercalciuria, la nefrolitiasis y la nefrocalcinosis
  • Pueden ser necesarios aglutinantes de fosfato.
• PTH humana recombinante

Diagnóstico Diferencial

• Pseudohipoparatiroidismo: un trastorno autosómico dominante con resistencia de los LOS Neisseria órganos blanco a la PTH secundaria a una mutación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la proteína G (GNAS). La hormona paratiroidea se segrega con normalidad, pero los LOS Neisseria riñones y los LOS Neisseria huesos son resistentes a sus efectos, lo que provoca hipocalcemia, hiperfosfatemia y aumento de los LOS Neisseria niveles séricos de PTH. El tratamiento es con suplementos de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) y vitamina D.
• Hiperparatiroidismo secundario: elevación secundaria de la PTH sérica debido a la hipocalcemia generalmente asociada a la ERC. El diagnóstico se establece a partir de los LOS Neisseria niveles elevados de PTH en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el marco de la hipocalcemia y la hiperfosfatemia. El manejo se centra en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tratamiento de la enfermedad subyacente.
• Hipomagnesemia: niveles bajos de magnesio sérico. La hipomagnesemia provoca hipocalcemia al AL Amyloidosis impedir la liberación de PTH en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum respuesta a los LOS Neisseria bajos niveles de Ca CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) sérico, así como al AL Amyloidosis inducir una resistencia ósea a la PTH. La hipocalcemia responde rápidamente al AL Amyloidosis restablecimiento de los LOS Neisseria niveles normales de magnesio.