| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 1.22 MB | Adobe PDF |
Advisor(s)
Abstract(s)
Introdução: O hiperparatiroidismo primário é uma das endocrinopatias mais comuns, afetando principalmente a população adulta, sendo mais comum em mulheres do que em homens. A doença tem um pico de incidência entre a terceira e quinta década, mas também ocorre em crianças e idosos. Esta patologia leva a um distúrbio generalizado no cálcio e no fosfato, bem como afeta o metabolismo ósseo devido a um aumento da secreção de hormona paratiroide. O acréscimo na secreção desta hormona traduz-se frequentemente em hipercalcémia e hipofosfatémia. Esta patologia tem um quadro clínico variável, podendo o paciente apresentar alterações do sistema esquelético, nefrolitíase, úlceras pépticas, alterações mentais, bem como outras alterações invulgares. O aumento da consciencialização sobre a doença, bem como o aumento do uso de testes multifásicos de triagem, permite que o diagnóstico seja feito numa etapa precoce minimizando-se assim os riscos que advêm de uma exposição prolongada a níveis elevados de cálcio. Como consequência deste desenvolvimento a maioria dos pacientes diagnosticados é assintomático, sendo assim raro a crise hipercalcémica.
Objetivo: Apresentar um caso clínico com hiperparatiroidismo primário e fazer uma revisão bibliográfica tendo por base tratados de medicina e artigos científicos dos últimos 15 anos.
Métodos: A recolha bibliográfica desta tese alicerçou-se nas bases de dados virtuais disponibilizadas pela Universidade aos estudantes, nomeadamente o Uptodate e a Sciencedirect. A pesquisa foi efetuada com os termos “Hiperparatiroidismo”, “Hipercalcémia”, “Tratamento”, “Sintomatologia”, “Paratiroidectomia”. nos idiomas Português e Inglês.
Resultados e Discussão: No caso clínico abordado, o doente foi enviado para o serviço de medicina interna do Centro Hospitalar Cova da Beira após ter sido detetado, em análises de rotina, uma hipercalcémia grave com valores elevados de hormona paratiroide. Assume especial importância o facto de o paciente ser assintomático, devido a ter sido efetuado uma deteção precoce do hiperparatiroidismo primário. A ausência de sintomatologia, hipercalcémia grave e níveis elevados de hormona paratiroide apontaram para um quadro de hiperparatiroidismo primário. Foi efetuada uma paratiroidectomia eletiva na qual foi removida a glândula paratiroide inferior direita. Após a cirurgia a acreção óssea aumentou gradualmente, contudo devido ao curto período de tempo entre a intervenção e a densitometria de controlo o risco de fratura mantém-se ainda elevado.
Conclusão: Pese embora o desenvolvimento recente da terapia médica, a paratiroidectomia é o único tratamento capaz de curar esta patologia. Pesquisas futuras serão necessárias para adaptar o tratamento adequado ao paciente certo.
Introduction: Primary hyperparathyroidism is one of the most common endocrine disorders, affecting mainly the adult population and is more common in women than in men. The disease has a peak of incidence between the third and fifth decade, but also occurs in children and in elderly. This condition leads to global disturbance on calcium and phosphate, as well as on bone metabolism due to increased parathyroid hormone secretion. The increased secretion of this hormone usually leads to hypercalcemia and hypophosphatemia. This disease has a broad clinical picture so that it may present itself with, skeletal changes, nephrolithiasis, peptic ulcers, mental disturbances, and also other unusual characteristics. With an increased awareness of the disease as well as an increase in the use of multiphase screening tests, this allows the diagnosis to be made at an earlier stage, thus minimizing the risks associated with a prolonged exposure to high levels of calcium. As a result of this development the majority of patients diagnosed are asymptomatic, so cases hypercalcemic crises are uncommon. Goal: The purpose of this thesis is to present a patient report of primary hyperparathyroidism and a review of the literature. This was achieved based on medical textbooks and scientific articles published on the past 15 years. Methods: The bibliographic research was done based up on virtual databases provided by university, mainly Uptodate and Sciencedirect. The investigation used the key words “Hyperparathyroidism”, “Hypercalcemia”, “Treatment”, “Symptoms” and “Parathyroidectomy” in Portuguese and in English. Results and Discussion: In the presented clinical case, the patient was sent to internal medicine department of Cova da Beira Interior Hospital by the general practitioner after a severe hypercalcemia and elevated levels of parathyroid hormone were detected on blood analysis performed because of a checkup. It´s important to highlight that the patient was asymptomatic all the way through, fact that might be due to an early diagnosis of primary hyperparathyroidism. The absence of symptoms, severe hypercalcemia and high levels of parathyroid hormone were strong indicators of primary hyperparathyroidism. One elective parathyroidectomy was performed to remove the right inferior parathyroid gland. After the surgery bone accretion gradually increased, however due to the short amount of time between the operation and the control densitometry fracture risk remains high. Conclusion: Despite the recent developments in pharmacological therapy, parathyroidectomy remains the only effective treatment. Future research will be necessary in order to adapt the appropriate treatment to the right patient.
Introduction: Primary hyperparathyroidism is one of the most common endocrine disorders, affecting mainly the adult population and is more common in women than in men. The disease has a peak of incidence between the third and fifth decade, but also occurs in children and in elderly. This condition leads to global disturbance on calcium and phosphate, as well as on bone metabolism due to increased parathyroid hormone secretion. The increased secretion of this hormone usually leads to hypercalcemia and hypophosphatemia. This disease has a broad clinical picture so that it may present itself with, skeletal changes, nephrolithiasis, peptic ulcers, mental disturbances, and also other unusual characteristics. With an increased awareness of the disease as well as an increase in the use of multiphase screening tests, this allows the diagnosis to be made at an earlier stage, thus minimizing the risks associated with a prolonged exposure to high levels of calcium. As a result of this development the majority of patients diagnosed are asymptomatic, so cases hypercalcemic crises are uncommon. Goal: The purpose of this thesis is to present a patient report of primary hyperparathyroidism and a review of the literature. This was achieved based on medical textbooks and scientific articles published on the past 15 years. Methods: The bibliographic research was done based up on virtual databases provided by university, mainly Uptodate and Sciencedirect. The investigation used the key words “Hyperparathyroidism”, “Hypercalcemia”, “Treatment”, “Symptoms” and “Parathyroidectomy” in Portuguese and in English. Results and Discussion: In the presented clinical case, the patient was sent to internal medicine department of Cova da Beira Interior Hospital by the general practitioner after a severe hypercalcemia and elevated levels of parathyroid hormone were detected on blood analysis performed because of a checkup. It´s important to highlight that the patient was asymptomatic all the way through, fact that might be due to an early diagnosis of primary hyperparathyroidism. The absence of symptoms, severe hypercalcemia and high levels of parathyroid hormone were strong indicators of primary hyperparathyroidism. One elective parathyroidectomy was performed to remove the right inferior parathyroid gland. After the surgery bone accretion gradually increased, however due to the short amount of time between the operation and the control densitometry fracture risk remains high. Conclusion: Despite the recent developments in pharmacological therapy, parathyroidectomy remains the only effective treatment. Future research will be necessary in order to adapt the appropriate treatment to the right patient.
Description
Keywords
Hiperparatiroidismo - Sintomatologia Hiperparatiroidismo - Tratamento Paratiroidectomia Hipercalcémia Glândula paratiróide
Citation
Publisher
Universidade da Beira Interior