Zusammenfassung
Störungen der Nebenschilddrüsenfunktion mit klinisch und radiologisch ausgeprägten Symptomen und Befunden sind heutzutage seltener als früher, da anlässlich von Routine-Blutchemieuntersuchungen abnorme Kalziumspiegel früh erkannt, ursächlich weiter abgeklärt und entsprechend therapiert werden. Der Hyperparathyreoidismus manifestiert sich am häufigsten als Osteoporose mit pathologischen Frakturen. Zur Abklärung einer sekundären Osteoporose gehört deshalb die Bestimmung von Kalzium und Phosphat sowie ggf. des intakten Parathormons. Die Osteitis fibrosa cystica sowie braune Tumoren sind seltener. Bei Arthritiden und Knochenschmerzen, speziell im Bereich der Fingergelenke, muss differenzialdiagnostisch an einen Hyperparathyreoidismus gedacht werden. Weitere Manifestationen des Hyperparathyreoidismus umfassen Myopathien und Sehnenrupturen sowie unspezifische muskuloskelettale Symptome. Gicht und Chondrokalzinose sind oft mit einem Hyperparathyreoidismus assoziiert. Der Hypoparathyreoidismus kann zu Beschwerden des Muskel-Skelett-Systems führen, die eine ankylosierende Spondylitis imitieren oder radiologisch einer diffusen idiopathischen skelettalen Hyperostose ähnlich sehen. Auch Myopathien kann ein Hypoparathyreoidismus zugrunde liegen. Eine Assoziation von systemischem Lupus erythematosus und Hypoparathyreoidismus wird beschrieben.
Abstract
Parathyroid dysfunction, leading to severe clinical symptoms and radiographic changes, has decreased over the last years due to routine laboratory checks including serum calcium levels. Thus, abnormal calcium levels are detected early in the course of the disease and the underlying cause treated accordingly. Hyperparathyroidism often leads to osteoporosis and low-trauma fractures. When evaluating secondary osteoporosis analysis of calcium, phosphate and intact parathyroid hormone levels are mandatory. Osteitis fibrosa cystica and brown tumors are less frequent findings of hyperparathyroidism. However, in patients with arthritis or bone symptoms, hyperparathyroidism has to be evaluated as a possible reason. Other manifestations of hyperparathyroidism include myopathy, tendon ruptures and unspecific symptoms of the muscles and skeleton. Gout as well as pseudogout may be associated with hyperparathyroidism. Hypoparathyroidism may cause musculoskeletal diseases mimicking ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis. Myopathies are sometimes induced by hypoparathyroidism. An association between systemic lupus erythematosus and hypoparathyroidism seems to exist.
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Frey, D. Nebenschilddrüse und rheumatologische Manifestationen. Z. Rheumatol. 70, 740–746 (2011). https://doi.org/10.1007/s00393-011-0796-4
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DOI: https://doi.org/10.1007/s00393-011-0796-4