DISEASE OF THE ENDOCRINE GLANDS : TETANY (TETANIA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Loss or decrease of the hormonal function of the parathyroid glands, resulting in the body is disturbed calcium metabolism of N. phosphorus. The reduction of calcium in the blood causes an imbalance of electrolytes, which creates conditions for increased excitability of the neuromuscular system and causes the appearance of tonic convulsions. Development tetanii observed after removal of the goiter, when removed all or part of the parathyroid glands or suffered damage, causing lowering their functions after traumatic injury of the neck (injury, bleeding at the injury and compression), causing damage to the parathyroid glands, after scarring or destruction of the parathyroid glands as a result of their syphilitic (humongo) or tuberculous lesions in inflammatory processes in the parathyroid glands. There was also the development tetanii in infectious diseases (typhoid, malaria, influenza, tuberculosis, and others), poisoning (lead, phosphorus, morphine, carbon monoxide, chloroform, cocaine, LPV, and others), gastrointestinal disease (stenosis of the pylorus, gastroente, the expansion of the stomach, enteritis, dysfunction of the digestive system when malnutrition, worms), pregnancy (in recent months), in the postpartum period (lactation). Sometimes there idiopathic tetany, often occurring for no apparent reason, most likely associated with the inferiority of the parathyroid glands. In children there is a special form tetanii, the so - called children tetany (spazmofiliya or spasmophilia diathesis), associated with poor nutrition and poor hygienic living conditions (see Diseases of childhood).
Symptoms. Painful tonic spasms of the coming attacks and is not accompanied by loss of consciousness, tongue biting and involuntary urination (unlike epilepsy). Seizures are observed mainly from the extremities, manifesting itself most strongly in the area of the hands and feet, abnormal host, a forced position. For the upper limbs is characterized by a kind of pinch (obstetric hand); the lower limbs are most often observed plantar extension of the foot and flexion of the toes. In some cases there are cramps of all the limbs, in other cases, seizures are not distributed symmetrically on both halves of the body, and is marked only on the right or left side. Sometimes convulsions capture not only the muscles of the limbs, but also apply to other muscles, both striated and smooth. In children common manifestation tetanii is spasm of the glottis (laryngospasm); in adults it is exceedingly rare. Before the onset of seizures commonly observed different paresthesias in the extremities. The duration of a seizure happens from several minutes to days. The frequency of occurrence of attacks in different cases varies from two to three times a week to a few at Stepov during the day. Tetany often runs long. Observed and acute forms of the disease, mainly in children. In patients with chronic tetany occur trophic disorders cataracts, hair loss, brittle nails, poor growth of teeth; in children tetany is often combined with rickets. Often marked spasms of smooth muscle - spasms of the gastrointestinal tract, pilorospazm, spasms of the bronchi, bladder.
Honors tetaniceskih convulsions of an epileptic is the preservation of consciousness. For tetanii characterized by a decrease in the level of calcium in the blood and increased sensitivity of the neuromuscular system to mechanical, thermal, electrical stimuli. Signs of hypersensitivity neuromuscular system are: cramps of the muscles of the hand (the hand of the midwife) during prolonged (2 - 3 minutes) pressure on a nerve trunk of the shoulder or arm cuff from the device for measuring blood pressure; effleurage along the facial nerve in the ear that causes twitching of the corner of his mouth and nose; increased elektrovojvodina peripheral nerves (stimulus threshold for tripping galvanic current below 5 mA.
Prediction of almost all forms tetanii unfavorable. The sharper the beginning tetanii and the heavier attacks, the more serious predictions for life. Very seriously in the cases of postoperative tetanii, when removed all of the parathyroid gland. Prediction in slow-flowing forms tetanii more favorable worse it is when children tetanii, tetanii pregnant and tetanii associated with gastrointestinal diseases. Death tetanii can come out of the blue from suffocation at the time of the attack of laryngospasm.