Post on 25-Feb-2018
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V.G. sex M, 16 aniM.I. Varsaturi
Poliurie, polidipsieCasexie, G 15 kg/2 luni
I.B.
Iulie 2000-sete, polidipsie ! l/"i#, poliurie !-5l/"i#
$oie%&rie 2000- 'arsaturi - Int. (p B. In)e*t. +nesti-in)ir%a V
e*e%&rie 2000- 'arsaturi - int. Medi*ala +nesti
poliurie, polidipsie
'arsaturi, G
2 *ri"e o&nu&ilare, tul&urari %ers, e*ili&ru, 'or&ire
pierdere stare *onstienta*on'ulsii toni*e 1 %in
iagnosti* pre"u%ti' ia&et insipid- in)ir%at (p. Paron
Ianuarie 2001- trans)erat 3
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! - 20. 01.2001- 3
*lini*- e'olutie
'arsaturi 10 "ile
*onstipatie - a&senta tran"it 4 "ile
G ! kg polidipsie - ingestie li*ide !000 %l/"i
poliurie- diure"a !000-5000 %l/"i
160/120- 150/110%%g
para*lini*
tul&urari idroele*troliti*e $a7 158%39/l, :7!,1 %39/l,
Cl-114 %39/l, Ca771! %g;
teste in)la%atorii V(
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20.01. 2001 - Internat Pediatrie
ex. *lini*
*asexie G 8< kg
tegu%ente us*ate, pliu *utanat usor lenes, tul&urari tro)i*e *u
des*ua%ari, prurit
de)or%are tora*i*a- stern in)undat
"go%ote *ardia*e asur"ite, rit%i*e V 40/>,
120/=0%%g
a&do%en ex*a'at, nu 'arsa, pri%este ali%ent, *onstipat ($C nor%al
e'olutie
stationare ponderala
nu 'arsa ingestie li*ide 8500-!000%l/"i
diure"a !000-5000%l/"i
115/60 %%G
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Para*lini*
?G - $ r 124 000/%%8#
uree- 68-!
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3x urina
densitate 1010-1015
os%olaritate 224%+s%/l
al&u%ine, glu*o"a- a&sente
Ca771 uro*ultura sterila
(tans)eld-e&&- $
@rogra)ie$
ran"it Ba Irigogra)iedoli*osig%oid
g). oase lungi, *raniu$
Ai&ros*opie gastrita iperpla"i*a
est sudoare- nu transpira C *raniuipo)i"a nor%ala, atro)ie *orti* )rontala, e%is) *ere&el
C paratiroide$
C a&do%inaldistensie i%portanta gastri*a, anse intest, *olon
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EKG
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EKG
Prelungire P 0,16s#BV gr. 1
aplati"at
D* s*urt 0,85s
@nda @
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ECHOGRAFIE PARATIROIDA
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ECHOGRAFIE PARATIROIDA
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DATE SUGESTIVE DIAGNOSTICC?I$IC
se%ne generale astenie
s*adere G
*utanat prurit
digesti' sete, polidipsie,
anorexie, 'arsaturi, (,
*onstipatie renal poliurie
*ardio'as*ular
neurologi* so%nolenta,
o&nu&ilare, tul&urarie*ili&ru, *on'ulsii
PC?I$IC
%odi)i*ari ionogra%a
iper*al*e%ie
ipo)os)ate%ie
os%olaritate *res*uta
ex. urina *al*iurie
xdistensie gastri*a a*uta 3:G BV gr I, s*urtare D,
aplati"are
or%onalP *res*ut
3 3 3V?@
pro&e in)la%atorii po"iti'e
PrimarPrimar
7/25/2019 Hi Per Calc Emie
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PTH
Ca++
CT
PTH
Ca++
CT
P ur,
P sg
1,25 +#28
a&s intest Ca77
resor&ie os Ca77
ex*retia renala Ca77
resor&ie os Ca77
a&s intest Ca77
ex*retia renala Ca77
1,25 +#28
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FIIOPATO!OGIE1. Mo&ili"are osoasa ex*esi'a Ca
%etasta"e liti*e osoase, *an*er
osos, %ielo% %ultiplu se*retie *res*uta P
ipertiroidis% 20;#
)eo*ro%o*iro%
I li%)o%
tul&urari %eta&olis% tripto)an
i%o&ili"are
litiu
2. edu*erea eli%inarii Ca
ipotiroidie
insu) *orti*osuprarenala
8. &sor&tie *res*uta Ca
iper'ita%ino"a
iper'ita%ino"a
sindro% lapte-al*aline
sar*oido"a
a*ro%egalie
ad% estrogeni/androgeni
!. Me*anis% %ixt/nepre*i"at
ad% diureti*e tia"idi*e
iper*al*e%ia idiopati*a a
*opilului sdr illia%s %al)#
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ETIO!OGIE " n#$"nas%$&
A+M3 PIMIIV3
ipreparatiroidis%
tran"itor in
ipoparatiroidis% %atern
iperparatiroidis% de)initi'
)a%ilial sau nu
iper*al*e%ie idiopati*a
%ai )re*'. dupa sapt
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ETIO!OGIE" s$'ar, %#(i)A+M3 C@ (P3C EPIMIIVF
1. iperparatiroidis% pri%ar adeno% paratiroidian
*ar*ino% paratiroidian
iperpla"ie *elulara sporadi*a/)a%iliala
neopla"ia endo*rina %ultipla
tip I M3$ I- B. er%ers# adenoa%e ipo)i"are, pan*reati*e,
iperparatiroidis%#
tip II M3$ II- B. (ipple# )eo*ro%*ito%, *ar*ino% %edular tiroidian,
iperparatiroidis%#
tip III M3$ III# *ar*ino% %edular tiroidian, )eo*ro%o*ito%,neurinoa%e %u*oase, aspe*t %ar)anoid, iperpla"ie paratiroidiana#
iperparatiroidis% )a%ilial ipo*al*iuri*
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ETIO!OGIE" s$'ar, %#(i)
A+M3 C@ (P3C EPIMIIVF
2. iperparatiroidis% paraneopla"i*
se*retie de su&stante EP-likeF#
leu*e%ii a*ute
tu%ori extraparatiroidiene in ordinea )re*'entei# *ar*ino%
pul%onar, %a%ar, %ielo% %ultiplu, *ar*ino% in s)era +?,
eso)agian, renal, o'arian, *ol uterin, testi*ular, epati*, li%)o%
li%)o*itar, *olon, pan*reati*, tiroidian, 'e"i*a urinara, *utanat
8. iper*al*e%ii idiopati*e
tip Aan*oni- (*lesinger
tip Aole iper*al*e%ie )a%iliala &enigna#
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A+M3 (3C@$3 EIatrogeneF *au"e )re*'ente
intoxi*atie *u 'it /analogi/%eta&oliti
erori terapeuti*e
utili"are do"e %ari in insu) paratiroidiana, raitis% 'it- re"ist
sensi&ilitate parti*ulara sdr. ?igtHood, sugari ali% *u lapte
in&ogatit in 'it
*au"e putin )re*'ente
i%o&ili"are gipsata prelungita diali"a *roni*a la IC de"' unui iperparatiroidis% tertiar#
*au"e rare
ad%inistrarea diureti*e tia"idi*e
aport prelungit/i%portant lapte7antia*ide sdr. lapte-al*aline Burnett# iper'ita%ino"a
ad% litiu
diete de iperali%entare
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A+M3 (3C@$3- patologi*e
1. ipersensi&ilitate 'it
pneu%onie pneu%o*istis *arinii
sar*oido"a
insu)i*ienta glu*o*orti*oi"i
ipotiroidie
2. )e*tiuni geneti*e
osteopatii disosto"a %eta)i"ara,
ipo)os)ata"ia
)ara a)e*tare osoasa
%ala&sor&tia ereditara tripto)an
E&oala s*lere al&astreF#8. )e*tiuni do&andite *u li"a osoasa
parali"ii extinse *u i%o&ili"are
%etasta"e osoase %ultiple
ipertiroidie
!. Boli endo*rine
ipertiroidie
a*ro%egalie
)eo*ro%o*ito%
insu). suprarenala a*uta
5. Boli in)la%atorii
sar*oido"a
BC
&erilio"a
istoplas%o"a
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TA*!OU C!INICgenerale astenie fizica, oboseala, slabiciune, G, T, prurit
digesti'e anorexie, greturi, varsaturi,constipatie, dureri
abdominale, sete, polidipsie, pancreatita acuta,ulcer, distensie gastrica acuta
neuropsii*e somnolenta, iritabilitate, convulsii, scaderea capconcentrare, memorie, cefalee, ameteli, letargie,dezorientare, confuzie , depresie, halucinatii, ataxie,
tulb vorbire, vaz, auz, retard mental n nasc!neuro%us*ulareosteoarti*ulare
"boseala musculara, chiar pseudoparalizie,hiporeflexie, hipotonie,mialgii, artralgii, exudatarticular, dureri osoase
sdr poliuro-
polidipsi*
#ete, poliurie, polidipsie
*ardio-'as* HT$, bradicardie, tahicardie, %#, &$' gr (,
renale Poliurie, ()$, ()
*al*i)i*ari *eratopatie in banda, ochi rosu, nefrocalcinoza,
litiaza, vasculare
7/25/2019 Hi Per Calc Emie
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MODIFICARI EKG
(*urtare D proportional *u *resterea Ca
D* 850-!!0 %s#
aplati"are
unda @
*reste durata PD
BV gr. I
3( 'entri*ulare,
V
7/25/2019 Hi Per Calc Emie
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TRATAMENT3 @G3$ Ca 15 %g;
*ore*tarea desidratarii, tul& idro-ele*troliti*e
sol i"otone/ipertone $a *reste *al*iuria prin expansiune ?3C#
Aurose%id 2 %g/kg/8 ore
tJ Core*tia ipo $a7si ipo :7 1,5g :Cl/1000%l (A#
diure"aK 1-2 l/ora
Cal*itonina 2 u/kg/4 ore Celatori Ca - Cal*iu% 3 3deta%in# i' lent
Aos)at I.'. 20-80 %g )os)or /kg a*t 12-1< ore#/ Bi)os)onati
Galliu% nitrat I.'. la %etasta"e osoase#
diali"a peritonela paratiroide*to%ie
%itra%*ine/Pli*a%i*ina 25g/kg P3V la adult %axi% ! "ile
M3$ 3 ?@$G @
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M3$ 3 ?@$G @
I3 ipo*al*i*a ex*lus lapte, gal&enus ou, nu*i, alune, )asole, %a"are
3I+?+GICIdeal *irurgi*al, %o&ili"are, sistare aport#
P+G3$IC
*resterea ex*retiei de Ca
)urose%id, solutii saline
*elatori Ca- 3 *ure inter%itente
di%inuarea a&sor&tiei de Ca
*orti*oterapie 1%g/kg/"i 80 "ile
)os)ati s*ad a&sor&tia# 1,5-8g/"i
*resterea )ixarii osoase
)os)ati *al*iu p.o. 0,25-2 g/"i, potasiu, sodiu p.o. 2-! g/"i
*al*itonina !u/kg s.*. la 12-2! ore
estrogeni *onLugati 0.