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PATOLOGIA DE LA
GLANDULA
PARATIROIDES
ADRIANA CARDONA ASTAIZA
R4 CIRUGIA GENERL U.CES
CONTENIDO
 ANATOMIA QUIRURGICA
 FISIOLOGIA
 ENDOCRINOLOGIA DE LA GLANDULA PARATIROIDES
 FISIOLOGIA DEL CALCIO
 EVALUA...
ANATOMIA
ANATOMIA
IRRIGACION
ENDOCRINOLOGIA DE LA
GLANDULA PARATIROIDES
FISIOLOGIA DEL CALCIO
CALCIO EXTRACELULAR= PLASMA= IONIZADO LIBRE
55 % SE UNE A PROTEINAS 80 % ALBUMINA
TOTAL 8,5-10,2
Mg/...
FISIOLOGIA DEL CALCIO
FISIOLOGIA DEL CALCIO
UNIDAD DE REMODELACION OSEA
Osteoblastos
receptores PTH
REASORCION
ACTIVACION X
OSTEOCLASTOS
DEGRADACION
EN LA MATRIZ
OSEA
HIPERPARATIROIDISMO
Aumento de la síntesis y secreción
PTH de la hormona paratiroidea (PTH
PRIMARIO
SECUNDARIO
TERCIARIO
HIPERPARATIROIDISMO PRIMARIO
 ADENOMA PARATIROIDEO 80-85 %
 CUARTA DECADA
 MUJERES
 ESPORADICOS
 MEN 1
HIPERPARATIROIDISMO PRIMARIO
HIPERCALCEMIA Y AUMENTO DE PTH
OSTEITIS FIBROSA QUISTICA
NEFROCALCINOSIS
DEBILIDAD NEUROMUSCU...
MANIFESTACIONES CLINICAS DEL
HIPERPARATIROIDISMO
HIPERPARATIROIDISMO PRIMARIO
AGUDO
CRISIS PARATIROIDEA
HIPERCALCEMIA SEVERA
ELEVACION EXTREMA DE PTH
MANEJO MEDICO AGUDO …...
CANCER DE PARATIROIDES
 < 1 %
 4-6 DECADA
 >14MG/DL
HIPERPLASIA
CELULAS PRINCIPALES
15 %
MUJERES
AUMENTO DE LA MASA CELULAR DEL PARENQUIMA
LOCALIZACION PREOPERATORIA
EVALUACION
HIPERCALCEMIA
¿ QUE PRUEBAS PEDIR ?
CALCIO IONIZADO
PTH
FOSFORO
HIPERCALCIURIA
DESCARTAR INSUFICIENCIA
RENAL
PARATIROIDES
PTH
Calcio
HIPERCALCEMIA HIPOFOSFATEMIA HIPERCALCIURIA
PRIMARIO SECUNDARIO
MEN 1 INSUFICIENCIA RENAL
(HIPERPL...
LOCALIZACION
GAMMAGRAFIA -------------------ADENOMA
MONITORIZACION
INTRAOPERATORIA DE LA PTH
 PTH VIDA EN PLASMA 3-5 MINUTOS
 50 %
 FALSOS POSITIVOS
TRATAMIENTO
QUIRURGICO
ÉXITO DE LA CIRUGIA
PHT PREVIA A LA CIRUGIA Y 10-15
MINUTOS DESPUES DE LA ESCISION
DEL ADENOMA
SI P...
CUIDADOS POSOPERATORIOS
 HIPOPARATIROIDISMO POP
 2SS Y 6 MESES ENDOCRINO
 CALCIO SERICO PTH
MANIFESTACIONES CLINICAS DEL
HIPOPARATIROIDISMO
SINDROME DEL HUESO HAMBRIENTO
Hipocalcemia
Formación
de hueso
Calcio
Fosfato
Magnesio
CUADRO
CLINICO
Reasorción
ósea
Dismi...
GRACIAS
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
Patologia de la glandula paratiroides
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Patologia de la glandula paratiroides

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ANATOMIA QUIRURGICA
FISIOLOGIA
ENDOCRINOLOGIA DE LA GLANDULA PARATIROIDES
FISIOLOGIA DEL CALCIO
EVALUACION GENERAL
TECNICA DE LA PARATIROIDECTOMIA
SINDROME DEL HUESO HAMBRIENTO

Veröffentlicht in: Gesundheit & Medizin
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Patologia de la glandula paratiroides

  1. 1. PATOLOGIA DE LA GLANDULA PARATIROIDES ADRIANA CARDONA ASTAIZA R4 CIRUGIA GENERL U.CES
  2. 2. CONTENIDO  ANATOMIA QUIRURGICA  FISIOLOGIA  ENDOCRINOLOGIA DE LA GLANDULA PARATIROIDES  FISIOLOGIA DEL CALCIO  EVALUACION GENERAL  TECNICA DE LA PARATIROIDECTOMIA  SINDROME DEL HUESO HAMBRIENTO
  3. 3. ANATOMIA
  4. 4. ANATOMIA
  5. 5. IRRIGACION
  6. 6. ENDOCRINOLOGIA DE LA GLANDULA PARATIROIDES
  7. 7. FISIOLOGIA DEL CALCIO CALCIO EXTRACELULAR= PLASMA= IONIZADO LIBRE 55 % SE UNE A PROTEINAS 80 % ALBUMINA TOTAL 8,5-10,2 Mg/Dl IONIZADO 4,5- 5,0 PH
  8. 8. FISIOLOGIA DEL CALCIO
  9. 9. FISIOLOGIA DEL CALCIO
  10. 10. UNIDAD DE REMODELACION OSEA Osteoblastos receptores PTH REASORCION ACTIVACION X OSTEOCLASTOS DEGRADACION EN LA MATRIZ OSEA
  11. 11. HIPERPARATIROIDISMO Aumento de la síntesis y secreción PTH de la hormona paratiroidea (PTH PRIMARIO SECUNDARIO TERCIARIO
  12. 12. HIPERPARATIROIDISMO PRIMARIO  ADENOMA PARATIROIDEO 80-85 %  CUARTA DECADA  MUJERES  ESPORADICOS  MEN 1
  13. 13. 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
  14. 14. MANIFESTACIONES CLINICAS DEL HIPERPARATIROIDISMO
  15. 15. HIPERPARATIROIDISMO PRIMARIO AGUDO CRISIS PARATIROIDEA HIPERCALCEMIA SEVERA ELEVACION EXTREMA DE PTH MANEJO MEDICO AGUDO ………….CIRUGIA
  16. 16. CANCER DE PARATIROIDES  < 1 %  4-6 DECADA  >14MG/DL
  17. 17. HIPERPLASIA CELULAS PRINCIPALES 15 % MUJERES AUMENTO DE LA MASA CELULAR DEL PARENQUIMA
  18. 18. LOCALIZACION PREOPERATORIA
  19. 19. EVALUACION HIPERCALCEMIA ¿ QUE PRUEBAS PEDIR ? CALCIO IONIZADO PTH FOSFORO HIPERCALCIURIA DESCARTAR INSUFICIENCIA RENAL
  20. 20. PARATIROIDES PTH Calcio HIPERCALCEMIA HIPOFOSFATEMIA HIPERCALCIURIA PRIMARIO SECUNDARIO MEN 1 INSUFICIENCIA RENAL (HIPERPLASIA)
  21. 21. LOCALIZACION GAMMAGRAFIA -------------------ADENOMA
  22. 22. MONITORIZACION INTRAOPERATORIA DE LA PTH  PTH VIDA EN PLASMA 3-5 MINUTOS  50 %  FALSOS POSITIVOS
  23. 23. 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
  24. 24. CUIDADOS POSOPERATORIOS  HIPOPARATIROIDISMO POP  2SS Y 6 MESES ENDOCRINO  CALCIO SERICO PTH
  25. 25. MANIFESTACIONES CLINICAS DEL HIPOPARATIROIDISMO
  26. 26. 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/DL 1-2 G GLUCONATO DE CALCIO EN 50 CC DAD 5 % EN 20 MINITOS
  27. 27. GRACIAS

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