Download - Patologia de la glandula paratiroides
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PATOLOGIA DE LA GLANDULA PARATIROIDES ADRIANA CARDONA ASTAIZA
R4 CIRUGIA GENERL U.CES
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CONTENIDO
ANATOMIA QUIRURGICA
FISIOLOGIA
ENDOCRINOLOGIA DE LA GLANDULA PARATIROIDES
FISIOLOGIA DEL CALCIO
EVALUACION GENERAL
TECNICA DE LA PARATIROIDECTOMIA
SINDROME DEL HUESO HAMBRIENTO
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ANATOMIA
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ANATOMIA
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IRRIGACION
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ENDOCRINOLOGIA DE LA GLANDULA PARATIROIDES
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FISIOLOGIA DEL CALCIO
CALCIO EXTRACELULAR= PLASMA= IONIZADO LIBRE
55 % SE UNE A PROTEINAS 80 % ALBUMINA
TOTAL 8,5-10,2 Mg/DlIONIZADO
4,5-5,0
PH
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FISIOLOGIA DEL CALCIO
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FISIOLOGIA DEL CALCIO
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UNIDAD DE REMODELACION OSEA
Osteoblastos receptores PTH
REASORCION
ACTIVACION X OSTEOCLASTOS DEGRADACION EN LA MATRIZ OSEA
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HIPERPARATIROIDISMO
Aumento de la síntesis y secreción PTH de la hormona paratiroidea (PTH
PRIMARIO
SECUNDARIO TERCIARIO
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HIPERPARATIROIDISMO PRIMARIO
ADENOMA PARATIROIDEO 80-85 %
CUARTA DECADA
MUJERES
ESPORADICOS
MEN 1
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HIPERPARATIROIDISMO PRIMARIO
HIPERCALCEMIA Y AUMENTO DE PTH
OSTEITIS FIBROSA QUISTICA
NEFROCALCINOSIS
DEBILIDAD NEUROMUSCULAR
50-60 AÑOS
MUJERES 3:1
DEBILIDAD , FATIGA FACIAL , DEPRESION , CANSANCIO INTELECTUAL
DX DIFERENCIAL CON MALIGNIDAD
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MANIFESTACIONES CLINICAS DEL HIPERPARATIROIDISMO
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HIPERPARATIROIDISMO PRIMARIO AGUDO
CRISIS PARATIROIDEA
HIPERCALCEMIA SEVERA
ELEVACION EXTREMA DE PTH
MANEJO MEDICO AGUDO ………….CIRUGIA
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CANCER DE PARATIROIDES
< 1 %
4-6 DECADA
>14MG/DL
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HIPERPLASIA
CELULAS PRINCIPALES
15 %
MUJERES
AUMENTO DE LA MASA CELULAR DEL PARENQUIMA
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LOCALIZACION PREOPERATORIA
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EVALUACIONHIPERCALCEMIA
¿ QUE PRUEBAS PEDIR ?
CALCIO IONIZADO PTH FOSFORO HIPERCALCIURIA DESCARTAR INSUFICIENCIA RENAL
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PARATIROIDES
PTHCalcio
HIPERCALCEMIA HIPOFOSFATEMIA HIPERCALCIURIA
PRIMARIO SECUNDARIOMEN 1 INSUFICIENCIA RENAL (HIPERPLASIA)
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LOCALIZACION
GAMMAGRAFIA -------------------ADENOMA
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MONITORIZACION INTRAOPERATORIA DE LA PTH
PTH VIDA EN PLASMA 3-5 MINUTOS
50 %
FALSOS POSITIVOS
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TRATAMIENTO
QUIRURGICO
ÉXITO DE LA CIRUGIA
PHT PREVIA A LA CIRUGIA Y 10-15 MINUTOS DESPUES DE LA ESCISION DEL ADENOMA
SI PTH DISMINUYE > 50 % DEL VALOR PREQUIURURGICO O VUELVE A LA NORMALIDAD SE TERMINA EL PROCEDIMIENTO
PTH ESTABLE : VALORACION SISTEMATICA DEL RESTO DE LAS PARATIROIDES
SECUNDARIO
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CUIDADOS POSOPERATORIOS
HIPOPARATIROIDISMO POP
2SS Y 6 MESES ENDOCRINO
CALCIO SERICO PTH
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MANIFESTACIONES CLINICAS DEL HIPOPARATIROIDISMO
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SINDROME DEL HUESO HAMBRIENTO
Hipocalcemia
Formación de hueso
Calcio Fosfato
Magnesio
CUADRO CLINICO
Reasorción ósea
Disminución abrupta PTH
CALCIO ORAL EV 2-4G (4MG/DL)/7.5 MG/DL1-2 G GLUCONATO DE CALCIO EN 50 CC DAD 5 % EN 20 MINITOS
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GRACIAS