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"slug": "travmatologiya_i_ortopediya",
"lead": "Область медицины, включающая в себя лечение 351 заболевания. В 523 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "пульмонология",
"code": "B37",
"branch_medicine_code": "037",
"slug": "pulmonologiya",
"lead": "Область медицины, включающая в себя лечение 145 заболеваний. В 181 клинике России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "ревматология",
"code": "B40",
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"slug": "revmatologiya",
"lead": "Область медицины, включающая в себя лечение 136 заболеваний. В 177 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "оториноларингология",
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"branch_medicine_code": "028",
"slug": "otorinolaringologiya",
"lead": "Область медицины, включающая в себя лечение 685 заболеваний. В 631 клинике России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "офтальмология",
"code": "B29",
"branch_medicine_code": "029",
"slug": "oftalmologiya",
"lead": "Область медицины, включающая в себя лечение 851 заболевания. В 696 клиниках России оказывается помощь по этому направлению медицины.",
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{
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"disease_count": null,
"name": "ультразвуковая диагностика",
"code": "B52",
"branch_medicine_code": "052",
"slug": "ultrazvukovaya_diagnostika",
"lead": "Область медицины, включающая в себя лечение 515 заболеваний. В 980 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 27,
"disease_count": null,
"name": "онкология",
"code": "B27",
"branch_medicine_code": "027",
"slug": "onkologiya",
"lead": "Область медицины, включающая в себя лечение 354 заболеваний. В 378 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 24,
"disease_count": null,
"name": "нейрохирургия",
"code": "B24",
"branch_medicine_code": "024",
"slug": "neyrohirurgiya",
"lead": "Область медицины, включающая в себя лечение 173 заболеваний. В 95 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 14,
"disease_count": null,
"name": "инфекционные болезни",
"code": "B14",
"branch_medicine_code": "014",
"slug": "infekcionnye_bolezni",
"lead": "Область медицины, включающая в себя лечение 518 заболеваний. В 499 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 38,
"disease_count": null,
"name": "радиология и радиотерапия",
"code": "B38",
"branch_medicine_code": "038",
"slug": "radiologiya_i_radioterapiya",
"lead": "Область медицины, включающая в себя лечение 237 заболеваний. В 15 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 18,
"disease_count": null,
"name": "колопроктология",
"code": "B18",
"branch_medicine_code": "018",
"slug": "koloproktologiya",
"lead": "Область медицины, включающая в себя лечение 37 заболеваний. В 153 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 59,
"disease_count": null,
"name": "эндоскопия",
"code": "B59",
"branch_medicine_code": "059",
"slug": "endoskopiya",
"lead": "Область медицины, включающая в себя лечение 53 заболеваний. В 414 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 55,
"disease_count": null,
"name": "фтизиатрия",
"code": "B55",
"branch_medicine_code": "055",
"slug": "ftiziatriya",
"lead": "Область медицины, включающая в себя лечение 204 заболеваний. В 249 клиниках России оказывается помощь по этому направлению медицины.",
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{
"id": 65,
"disease_count": null,
"name": "стоматология терапевтическая",
"code": "B65",
"branch_medicine_code": "065",
"slug": "stomatologiya_terapevticheskaya",
"lead": "Область медицины, включающая в себя лечение 87 заболеваний. В 1270 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "аллергология и иммунология",
"code": "B2",
"branch_medicine_code": "002",
"slug": "allergologiya_i_immunologiya",
"lead": "Область медицины, включающая в себя лечение 66 заболеваний. В 202 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "неонатология",
"code": "B32",
"branch_medicine_code": "032",
"slug": "neonatologiya",
"lead": "Область медицины, включающая в себя лечение 54 заболеваний. В 163 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "другое",
"code": "B69",
"branch_medicine_code": "069",
"slug": "drugoe",
"lead": "Область медицины, включающая в себя лечение 268 заболеваний. В 3931 клинике России оказывается помощь по этому направлению медицины.",
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{
"id": 64,
"disease_count": null,
"name": "стоматология и стоматология детская",
"code": "B64",
"branch_medicine_code": "064",
"slug": "stomatologiya_i_stomatologiya_detskaya",
"lead": "Область медицины, включающая в себя лечение 116 заболеваний. В 1200 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 43,
"disease_count": null,
"name": "сердечно сосудистая хирургия, рентгенэндоваскулярная диагностика и лечение",
"code": "B43",
"branch_medicine_code": "043",
"slug": "serdechno_sosudistaya_hirurgiya_rentgenendovaskulyarnaya_diagnostika_i_lechenie",
"lead": "Область медицины, включающая в себя лечение 110 заболеваний. В 78 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 68,
"disease_count": null,
"name": "челюстно лицевая хирургия",
"code": "B68",
"branch_medicine_code": "068",
"slug": "chelyustno_licevaya_hirurgiya",
"lead": "Область медицины, включающая в себя лечение 13 заболеваний. В 42 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 46,
"disease_count": null,
"name": "сурдология оториноларингология",
"code": "B46",
"branch_medicine_code": "046",
"slug": "surdologiya_otorinolaringologiya",
"lead": "Область медицины, включающая в себя лечение 36 заболеваний. В 23 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 67,
"disease_count": null,
"name": "стоматология хирургическая",
"code": "B67",
"branch_medicine_code": "067",
"slug": "stomatologiya_hirurgicheskaya",
"lead": "Область медицины, включающая в себя лечение 13 заболеваний. В 630 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "дерматовенерология и косметология",
"code": "B8",
"branch_medicine_code": "008",
"slug": "dermatovenerologiya_i_kosmetologiya",
"lead": "Область медицины, включающая в себя лечение 376 заболеваний. В 728 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 36,
"disease_count": null,
"name": "психиатрия наркология",
"code": "B36",
"branch_medicine_code": "036",
"slug": "psihiatriya_narkologiya",
"lead": "Область медицины, включающая в себя лечение 149 заболеваний. В 377 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "хирургия, хиругия (трансплантация органов и тканей) и комбустиология",
"code": "B57",
"branch_medicine_code": "057",
"slug": "hirurgiya_hirugiya_transplantaciya_organov_i_tkaney_i_kombustiologiya",
"lead": "Область медицины, включающая в себя лечение 253 заболеваний. В 632 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 13,
"disease_count": null,
"name": "диетология",
"code": "B13",
"branch_medicine_code": "013",
"slug": "dietologiya",
"lead": "Область медицины, включающая в себя лечение 114 заболеваний. В 600 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 25,
"disease_count": null,
"name": "нефрология",
"code": "B25",
"branch_medicine_code": "025",
"slug": "nefrologiya",
"lead": "Область медицины, включающая в себя лечение 175 заболеваний. В 146 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 39,
"disease_count": null,
"name": "рентгенология",
"code": "B39",
"branch_medicine_code": "039",
"slug": "rentgenologiya",
"lead": "Область медицины, включающая в себя лечение 4 заболеваний. В 933 клиниках России оказывается помощь по этому направлению медицины.",
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"disease_count": null,
"name": "клиническая фармакология",
"code": "B17",
"branch_medicine_code": "017",
"slug": "klinicheskaya_farmakologiya",
"lead": "Область медицины, включающая в себя лечение 16 заболеваний. В 110 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 26,
"disease_count": null,
"name": "общая врачебная практика (семейная медицина)",
"code": "B26",
"branch_medicine_code": "026",
"slug": "obschaya_vrachebnaya_praktika_semeynaya_medicina",
"lead": "Область медицины, включающая в себя лечение 151 заболевания. В 203 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 49,
"disease_count": null,
"name": "торакальная хирургия",
"code": "B49",
"branch_medicine_code": "049",
"slug": "torakalnaya_hirurgiya",
"lead": "Область медицины, включающая в себя лечение 34 заболеваний. В 23 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 12,
"disease_count": null,
"name": "диабетология",
"code": "B12",
"branch_medicine_code": "012",
"slug": "diabetologiya",
"lead": "Область медицины, включающая в себя лечение 33 заболеваний. В 15 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 22,
"disease_count": null,
"name": "мануальная терапия",
"code": "B22",
"branch_medicine_code": "022",
"slug": "manualnaya_terapiya",
"lead": "Область медицины, включающая в себя лечение 11 заболеваний. В 217 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 44,
"disease_count": null,
"name": "скорая медицинская помощь",
"code": "B44",
"branch_medicine_code": "044",
"slug": "skoraya_medicinskaya_pomosch",
"lead": "Область медицины, включающая в себя лечение 328 заболеваний. В 200 клиниках России оказывается помощь по этому направлению медицины.",
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"id": 42,
"disease_count": null,
"name": "сексология",
"code": "B42",
"branch_medicine_code": "042",
"slug": "seksologiya",
"lead": "Область медицины, включающая в себя лечение 3 заболеваний. В 9 клиниках России оказывается помощь по этому направлению медицины.",
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"slug": "stomatologiya_ortopedicheskaya",
"lead": "Область медицины, включающая в себя лечение 6 заболеваний. В 987 клиниках России оказывается помощь по этому направлению медицины.",
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},
"code": "E21",
"name": "Гиперпаратиреоз",
"icd_name": "Гиперпаратиреоз и другие нарушения паращитовидной [околощитовидной] железы",
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"slug": "e21_giperparatireoz",
"lead": "эндокринное заболевание, развивающееся при чрезмерном количестве паратиреоидного гормона (паратгормона) в организме, который выделяется околощитовидными железами",
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"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Первичный гиперпаратиреоз помимо нарушения околощитовидных желёз и избыточного выделения паратиреоидного гормона сопровождается верхне-нормальным или повышенным содержанием кальция в крови. Среди эндокринных заболеваний он встречается довольно часто: по распространённости эта форма гиперпаратиреоза находится на третьем месте после сахарного диабета и патологий щитовидной железы.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Ежегодная заболеваемость первичной формой составляет около 0,4–18,8% случаев на 10000 человек, а после 55 лет — до 2% случаев.</span><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">У женщин эта патология возникает чаще, чем у мужчин — примерно 3:1. Преобладающее число случаев первичного гиперпаратиреоза у женщин приходится на первое десятилетия после менопаузы.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Первичный гиперпаратиреоз может быть как самостоятельным заболеванием, так и сочетаться с другими наследственными болезнями эндокринной системы.</span><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Он проявляется многосимптомным поражением различных органов и систем, что приводит к значительному снижению качества жизни с последующей инвалидизацией, а также к риску преждевременной смерти.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Причины возникновения связаны с развитием в одной или нескольких околощитовидных железах таких патологий, как:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">солитарная аденома — до 80-85% случаев;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">гиперплазия (диффузное увеличение желёз) — до 10-15 % случаев;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">рак — до 1-5% случаев;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">спорадические заболевания — до 90-95% случаев.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В 5% случаев на возникновение первичного гиперпаратиреоза влияет наследственность.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">При вторичном гиперпаратиреозе кроме общих клинических признаков заболевания отличается снижением кальция и повышением фосфора в крови. Эта форма болезни обычно развивается как реакция компенсации и сочетает в себе усиленный синтез паратгормона и изменения в паращитовидных железах. Как правило, обнаруживается при синдроме недостаточного всасывания кальция в тонком кишечнике, дефиците витамина D и хронической почечной недостаточности.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Т</span><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ретичный гиперпаратиреоз развивается в случае аденомы околощитовидной железы и повышенном выделении паратгормона в условиях длительного вторичного гиперпаратиреоза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Псевдогиперпаратиреоз развиваться при других злокачественных опухолях, которые способны продуцировать вещество, похожее на паратгормон.</span></p>\r\n<p><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кальций является важным компонентом, который влияет на прочность костей и обменные процессы в организме. В норме уровень кальция, а также фосфора поддерживает паратгормон, выделяемый околощитовидными железами.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При аденоме или ином нарушении этих желёз взаимосвязь кальция и паратгормона нарушается: если раньше повышенное содержания кальция сдерживало уровень паратгормона, то теперь развивается дефект рецепторов, чувствительных к кальцию, которые расположены на поверхности главных клеток паращитовидных желёз.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При избытке паратгормона усиливается выведение из костной ткани кальция и фосфора. Клинически это проявляется изменениями в костях: их искривлением и размягчением, возникновением переломов. При этом уровень кальция в костях снижается, а его уровень в крови заметно увеличивается, т. е. возникает гиперкальциемия. Она проявляется мышечной слабостью, избыточным выделением минералов с мочой при учащенном мочеиспускании и постоянной жаждой, что приводит к почечнокаменной болезни и нефрокальцинозу — накоплению и отложению солей кальция в главной ткани почек. Также избыток кальция в крови становится причиной нарушения тонуса сосудов и возникновения артериальной гипертензии.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Первичный гиперпаратиреоз не обладает специфическими проявлениями, поэтому поставить диагноз по клинической картине довольно сложно. Необходима консультация эндокринолога, обследование пациента и трактовка полученных результатов:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">общего анализа мочи</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Моча приобретает щелочную реакцию, определяется экскреция кальция с мочой (гиперкальциурия) и повышение содержания в ней P (гиперфосфатурия). Относительная плотность понижается до 1000, часто бывает белок в моче (протеинурия). В осадке обнаруживаются зернистые и гиалиновые цилиндры.</span></p>\r\n<p><span><span> </span></span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">биохимического анализа крови (кальций, фосфор, паратгормон)</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Повышается концентрация общего и ионизированного Ca в плазме крови, содержание P ниже нормы, активность щелочной фосфатазы повышена. Более показательным при гиперпаратиреозе является определение концентрации паратгормона в крови (5—8 нг/мл и выше при норме 0,15—1 нг/мл).</span></p>\r\n<p><span><span> </span></span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ультразвукового исследования</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">УЗИ щитовидной железы информативно только при расположении паратиреоаденом в типичных местах - в области щитовидной железы.</span></p>\r\n<p><span><span> </span></span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">рентгенологического исследования, КТ и МРТ</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Рентгенография позволяет обнаружить остеопороз, кистозные изменения костей, патологические переломы. Для оценки плотности костной ткани проводится денситометрия. При помощи рентгенологического исследования с контрастным веществом диагностируют возникающие при гиперпаратиреозе пептические язвы в желудочно-кишечном тракте. КТ почек и мочевыводящих путей выявляет камни. Рентгенотомография загрудинного пространства с пищеводным контрастированием бариевой взвесью позволяет выявить паратиреоаденому и ее местоположнение. Магнитно–резонансная томография по информативности превосходит КТ и УЗИ, визуализирует любую локализацию околощитовидных желез.</span></p>\r\n<p><span><span> </span></span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сцинтиграфии паращитовидных желез</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Позволяет выявить локализацию обычно и аномально расположенных желез. В случае вторичного гиперпаратиреоза проводят диагностику определяющего заболевания.</span></p>\r\n<p><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Комплексное лечение гиперпаратиреоза сочетает операционную хирургию и консервативную терапию медикаментозными препаратами. Основным способом лечения первичного гиперпаратиреоза служит хирургическая операция, заключающаяся в удалении паратиреоаденомы или гиперплазированных паращитовидных желез. На сегодняшний день хирургическая эндокринология располагает малоинвазивными методиками хирургических вмешательств, проводимых при гиперпаратиреозе, в том числе и с применением эндоскопического оборудования.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если у пациента был диагностирован гиперкальциемический криз, необходимо проведение операции по экстренным показаниям. До операции обязательно назначение консервативного лечения, направленного на снижение Ca в крови: обильное питье, внутривенно - изотонический раствор NaCl, при отсутствии почечной недостаточности - фуросемид с KCl и 5% глюкозой, экстракт щитовидных желез скота (под контролем уровня Ca в крови), бифосфонаты (памидроновая к-та и этидронат натрия), глюкокортикоиды.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">После оперативного вмешательства по поводу злокачественных опухолей паращитовидных желез проводится лучевая терапия, также применяют противоопухолевый антибиотик – пликамицин. После хирургического лечения у большинства пациентов снижается количеств Ca в крови, поэтому им назначают препараты витамина D (в более тяжелых случаях - соли Ca внутривенно).</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Мер профилактики, которые бы позволили создать иммунитет к данному заболеванию, не существует. Для того, чтобы снизить вероятность возникновения гиперпаратиреоза, рекомендуется вести здоровый образ жизни.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Людям с дефицитом D для устранения риска развития патологии стоит регулярно гулять на свежем воздухе, употреблять продукты и витаминно-минеральные комплексы, содержащие недостающий витамин.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гиперпаратиреоз протекает длительно и бессимптомно и может быть выявлен случайно во время обследования по поводу другого заболевания.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У пациентов с гиперпаратиреозом одновременно возникают симптомы поражения различных органов и систем: язва желудка, остеопорозные проявления, мочекаменная и желчнокаменная болезни и другие. При пальпации шеи в зоне паращитовидных желёз можно нащупать достаточно большую \"аденому\".</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Развивается быстрая утомляемость при физической повседневной нагрузке, мышечная слабость, ноющая головная боль, затруднение при ходьбе (особенно во время подъёма по лестнице или при преодолении больших расстояний), формируется как бы переваливающаяся походка.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">У большинства людей с гиперпаратиреозом нарушено восприятие и память, они эмоционально неуравновешенны, тревожны, депрессивны.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При опросе пациенты с подозрением на нарушение функции околощитовидных желёз обычно жалуются на:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">длительно существующие боли в костях рук и ног, неровности и деформирующие изменения, возникающие при надавливании, частые судороги в ногах;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">эмоциональную неустойчивость, беспокойство и нарушение концентрации внимания, возникающее при нахождении в обществе;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">частое желание пить жидкость — вплоть до жажды с учащённым мочеиспусканием (не связанное с сахарным или несахарным диабетом);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">прерывистое нарушение сна и значительную утомляемость при выполнении любой работы;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">неуверенность и шаткость при ходьбе;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">повышенную потливость всего тела и конечностей;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">периодические сердцебиения днём и ночью;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">искривления и переломы (в основном трубчатых костей) при непредсказуемых обстоятельствах (даже при движениях лёжа в постели) — возникает в позднем периоде заболевания, сопровождается ноющими болями в позвоночнике.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; 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"lead": " Это патологическое состояние, при котором характерна повышенная секреция одного, нескольких или всех гормонов, которые вырабатываются гипофизом.",
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"code": "A28",
"name": "Бактериальные зооноз неуточненный",
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"lead": "Псевдотуберкулёз — зоофильный сапроноз с фекально- оральным механизмом передачи возбудителя.",
"description": "Характеризуется полиморфизмом клинических проявлений, интоксикацией, лихорадкой, поражением желудочно-кишечного тракта, печени, кожи, суставов и других органов.",
"etiology": "<p>Yersinia pseudotuberculosis— грамотрицательная палочковидная бактерия с перитрихиальными жгутиками, относится к семейству Enterobacteriaceae. Капсул не содержит. Спор не образует.</p>",
"pathogenesis": "<p>Люди при контакте с грызунами заражаются крайне редко. Человек не может быть источником инфекции.</p>\r\n<p>Главный механизм передачи — фекально-оральный. Пути — пищевой и водный.</p>\r\n<p>Основные факторы передачи Y. pseudotuberculosis — овощи и зелень, употребляемые без термической обработки, соления (квашеная капуста, солёные огурцы, помидоры), реже — фрукты, молочные продукты и вода. Возможно заражение воздушно-пылевым путём через пыль, контаминированную вирулентными штаммами (сухая уборка помещений, подметание).</p>\r\n<p>Внедрение Y. pseudotuberculosis начинается сразу в ротовой полости, что клинически проявляется синдромом тонзиллита. Значительная часть возбудителя, преодолев желудочный барьер, колонизирует эпителий преимущественно лимфоидных образований подвздошной и слепой кишки (первая фаза). Затем происходит инвазия эпителия слизистых оболочек кишечника; возбудитель проникает в слизистый слой и преодолевает эпителий кровеносных сосудов — развиваются первичная бактериемия и гематогенная диссеминация (вторая фаза). Далее наблюдают генерализацию инфекции, характеризующуюся диссеминацией возбудителя в органах и тканях, размножение в них и развитие системных нарушений (третья фаза).</p>",
"diagnostics": "<p>Сложна при спорадической заболеваемости и становится сравнительно простой при вспышечной. Основывается на характерной клинической симптоматике и лабораторной диагностике.</p>\r\n<p>В гемограмме обнаруживают нейтрофильный лейкоцитоз, моноцитоз, эозинофилию, относительную лимфопению и увеличение СОЭ. В биохимическом анализе крови повышение активности ферментов, реже — гипербилирубинемия.</p>\r\n<p>Специфическая лабораторная диагностика псевдотуберкулёза такая же, как и при иерсиниозе. Перспективными методами специфической диагностики выступают иммуноферментная тест-система на основе белка порина.</p>",
"treatment": "<p>Рекомендуют повторное внутривенное или внутримышечное введение нормального человеческого иммуноглобулина с промежутком 2–3 дня, курс 5–6 введений.</p>\r\n<p>Если развиваются симптомы острого живота при абдоминальной форме проводят аппендэктомию. Выбор физиотерапевтических и санаторно-курортных методов лечебно-реабилитационных мероприятий зависит от формы псевдотуберкулёза и основного синдрома.</p>",
"prevention": "<p>Специфической профилактики у людей не разработано; неспецифическая включает контроль за продуктами питания, предусмотренный соответствующими нормативными документами, и санитарно-просветительную работу среди населения, особенно в группах риска.</p>",
"clinical_picture": "<p>Инкубационный период продолжается от 3 до 19 дней (в среднем 5–10 дней), иногда сокращается до 1–3 сут.</p>\r\n<p>Выделяют следующие периоды заболевания: инкубационный, начальный, разгара, реконвалесценции или ремиссии.</p>\r\n<p>Начальный период длится от 6–8 ч до 2–5 дней. Клинические проявления начального периода у всех форм псевдотуберкулёза сходны: выраженная интоксикация и полиморфизм симптомов. Своеобразие каждой формы выявляют только в период разгара. У большинства больных заболевание начинается остро, иногда бурно. Общее самочувствие резко ухудшается. Температура тела быстро повышается до 38–40 °С, может быть с ознобом. Беспокоят сильная <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома <a href=\"/symptom/migren/\" title=\"Перейти на страницу симптома Мигрень\">Головная боль</a>\"><a href=\"/symptom/migren/\" title=\"Перейти на страницу симптома Мигрень\">головная боль</a></a>, <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома <a href=\"/symptom/narushenie_koordinacii/\" title=\"Перейти на страницу симптома Нарушение координации\">Головокружение</a>\"><a href=\"/symptom/narushenie_koordinacii/\" title=\"Перейти на страницу симптома Нарушение координации\">головокружение</a></a>, резкая <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/bessonnica/\" title=\"Перейти на страницу симптома Бессонница\">бессонница</a>, артралгия, <a href=\"/symptom/bol_v_myshcah/\" title=\"Перейти на страницу симптома Боль в мышцах\">миалгия</a>, боли в пояснице, <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома Потливость\">потливость</a>\"><a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома Потливость\">потливость</a></a>, <a href=\"/symptom/apatiya/\" title=\"Перейти на страницу симптома Апатия\">апатия</a>, <a href=\"/symptom/anoreksiya/\" title=\"Перейти на страницу симптома Анорексия\">анорексия</a>, иногда обмороки. Больные раздражительны, адинамичны. Нередко появляются признаки острого катара верхних дыхательных путей, жжение на ладонях и подошвах. При осмотре обнаруживают симптомы «капюшона» , «перчаток» , «носков» и инъекцию сосудов склер. Слизистая оболочка ротоглотки гиперемирована, у некоторых больных — «пылающий» зев, энантема на мягком нёбе, катаральный тонзиллит. Язык с 3–5-х суток болезни становится «малиновым». У некоторых больных — <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боли в животе</a>, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">Тошнота</a>\"><a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a></a>, <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">Тошнота</a>\">Рвота</a>\"><a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">Тошнота</a>\">рвота</a></a> и жидкий стул.</p>\r\n<p>Период разгара составляет 3–10 дней (максимально — месяц) и характеризуется выраженностью симптомов конкретной клинической формы и интоксикации.</p>\r\n<p>Смешанная форма характеризуется сыпью, появляющейся у большинства больных на 2–7-й дни болезни. Чаще <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> скарлатиноподобная, но может быть полиморфной, эфемерной, петехиальной, мелко- и крупнопятнистой, уртикарной, эритематозной, везикулярной и в виде узловатой эритемы, иногда <a href=\"/symptom/zud/\" title=\"Перейти на страницу симптома Зуд\">зудит</a>.</p>\r\n<p>О начале периода реконвалесценции свидетельствуют улучшение самочувствия больных, постепенная нормализация температуры, восстановление аппетита, исчезновение сыпи, болей в животе и суставах. Нередко сохраняется <a href=\"/symptom/povyshennaya_temperatura_37-38/\" title=\"Перейти на страницу симптома Повышенная температура 37-38°\">субфебрильная температура</a>. На 2–3-й неделе периода реконвалесценции появляются вегетативные расстройства, которые усиливаются при затяжном течении и формировании вторично-очаговых форм.</p>\r\n<p>При всех клинических формах заболевания обострения и рецидивы чаще возникают у больных, не получавших антибактериальной терапии.</p>\r\n<p>Септический вариант смешанной формы псевдотуберкулёза встречается редко. Летальность достигает 30–40%</p>\r\n<p> </p>",
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},
{
"id": 6908,
"symptoms": [
{
"id": 3082,
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{
"name": "Боль в яичке"
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{
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{
"name": "Боли в яичке"
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{
"id": 3091,
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{
"name": "Боли в мошонке"
},
{
"name": "Болит мошонка"
}
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{
"id": 3147,
"synonyms": [
{
"name": "Кровь в сперме"
},
{
"name": "Сперма с кровью"
}
],
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