Ipoparatiroidismo
Table of Contents
Le paratiroidi sono piccole ghiandole site sulla superficie tiroidea che assicurano la produzione e la secrezione endocrina (cioè interna) dell’ormone paratiroideo o paratormone.
Che cos’è l’ipoparatiroidismo?
L’ipoparatiroidismoè la condizione morbosa che risulta da un deficit della secrezione o dell’azione del PTH. Le paratiroidi non producono quantità sufficienti diormone paratiroideocomportando l’insorgenza diipocalcemiaL’alterazione biochimica caratteristica è l’ipocalcemia, associata a iperfosforemia, e il quadro clinico che ne deriva è dominato dai sintomi dell’ipereccitabilità neuromuscolare.
Quali sono le cause dell’ipoparatiroidismo?
La causa più comune di ipoparatiroidismo è l’asportazione delle paratiroidi o una lesione vascolare accidentale che ne comprometta l’irrorazione sanguigna in corso di interventi di tiroidectomia. L’ipoparatiroidismo che ne deriva può esseretransitorio (quando si risolve entro 6 mesi)opermanentee la sua incidenza varia nelle diverse casistiche dallo 0,51%, oltre il 10% di tutti gli interventi chirurgici sul collo. Le manifestazioni cliniche insorgono solitamente 1-2 giorni post- intervento ma non è infrequente osservarle come esordio in 3°-4° giornata per cui il monitoraggio della calcemia dovrebbe essere esteso per alcuni giorni spesso in ambito domiciliare dopo la dimissione.Più raro è l’ipoparatiroidismo idiopatico. Questo termine comprende una serie di disordini per una parte dei quali è nota una causa genetica.
Quali sono i sintomi dell’ipoparatiroidismo
La sintomatologia dipende dalla severità e dalla cronicità dell’ ipocalcemia. Una rapida diminuzione della concentrazione plasmatica del Ca++ favorisce la comparsa di crisi tetanica. Questa in genere è preceduta da parestesie periorali e alle dita delle mani o più raramente dei piedi.
Manifestazioni principali:
- Eccitabilità neuromuscolare: parestesie, tetania, iper-riflessia, spasmi, convulsioni, laringospasmo.
- SNC:ansia,depressione, labilità emotiva, difficoltà di concentrazione.
- Disturbi trofici: unghie fragili con striature trasversali, cute secca, desquamante, ritardi dentizione.
- I peli sono diradatial pube e alle ascelle, mentre le unghie sono fragili e deformate, con striature trasversali.
- Le dita della mano sono contratte e serrate tra loro in modo che la mano assume la forma di un cono.
- A livello del voltosi può avere contrazione del muscolo orbicolare con protrusione delle labbra.
- Se l’ipoparatiroidismoinsorge in età infantile sono possibili ritardi nell’ eruzione dentaria.
- La cataratta, subcapsulare, è particolarmente frequente e la correzione dell’ipocalcemia può arrestare la sua progressione.
- Nei casi più gravi, soprattutto nei bambini, si possono avere spasmi laringei, anche potenzialmente fatali, e convulsioni generalizzate.
- Possono comparirealtre manifestazioni cliniche che regrediscono con la correzione dell’ ipocalcemia, quali unoscompenso cardiaco congestizio,resistente alla digitale, una sindrome da malassorbimento intestinale, con steatorrea. Le aritmie sono rare.
- Insufficienza cardiaca refrattaria
- Sviluppo dicalcolie coliche renali
- Nefrocalcinosi (eccesso di calcio depositato nei reni)
- Insufficienza renale cronica
Come si fa a diagnosi di ipoparatiroidismo?
E’ facile sospettare l’ipoparatiroidismo in un soggetto che presenti crisi tetanichee sia stato sottoposto atiroidectomia. Nell’ ipotiroidismo cronico la sintomatologia può essere varia e aspecifica. La malattia può non essere riconosciuta per lungo tempo. La diagnosi si basa sul riscontro di bassi o indosabili livelli di PTH in presenza diipocalcemiaeiperfosfotemia.
Terapia
La terapia si attua con lavitamina D, o con il suo metabolita attivo , ilcalcitriolo, associati a sali di Ca, a dosaggio sufficiente a correggere l’ipocalcemia senza mettere il paziente al rischio di ipercalcemia punto. Durante il trattamento devono essere periodicamente monitorata lacalcemiae lacalciuria.
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