#1
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Ìíîæåñòâåííûå ïåðåëîìû
Ïàöèåíòêà,74 ãîäà æàëîáû íà ìíîæåñòâåííûå ïåðåëîìû ïðè ìèíèìàëüíîé òðàâìå,ïîâîðîòå â ïîñòåëè, ïàäåíèè ñ âûñîòû ðîñòà. íàñòîÿùåå âðåìÿ ïðàêòè÷åñêè íå ïåðåäâèãàåòñÿ. àíàìíåçå ïåðåëîì ïëå÷åâîé êîñòè, ìíîæåñòâåííûå ïåðåëîìû ðåáåð, â íàñòîÿùåå âðåìÿ ïåðåëîì êîñòåé òàçà ñ ïîâðåæäåíèåì ëîííîãî ñî÷ëåíåíèÿ. Îáñëåäîâàëàñü â ãåìàòîëîãè÷åñêîì îòäåëåíèè ìèåëîìíàÿ áîëåçíü èñêëþ÷åíà .ßçâåííîé áîëåçíè è êàìíåé â ïî÷êàõ íå áûëî. Êðåàòèíèí ïåðèîäè÷åñêè ïîâûøàëñÿ äî 133.,ìåðöàòåëüíàÿ àðèòìèÿ ,êàðäèàëüíûé öèððîç ïå÷åíè.
Ïàðàòãîðìîí 184.2(15-65 ìî÷åâèíà 5.7, êðåàòèíèí-98 îáùèé áåëîê 63(57-82) êàëüöèé 2.31(2.18-2.60) êàëüöèé èîíèçèðîâàííûé 1.21(1.13-1.32) ôîñôîð1.23(0.78-1.65) Âèòàìèí Ä3 106(48-144) Ïàðàòèðåîñöèíòèãðàôèÿ ïðîâåäåííàÿ 2 ãîäà íàçàä ïàòîëîãèè íå âûÿâèëà. Ìîæíî ëè ñ÷èòàòü ïîâûøåíèå ïàðàò ãîðìîíà ñëåäñòâèåì íàðóøåíèÿ ôóíêöèè ïå÷åíè? Êàêèå ïðåïàðàòû ëó÷øå èñïîëüçîâàòü äëÿ ïðåäîòâðàùåíèÿ ïåðåëîìîâ â äàííîì ñëó÷àå? Âñåì îãðîìíîå ñïàñèáî. |
#2
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óêàæèòå,ïîæàëóéñòà,ðîñò è âåñ ïàöèåíòêè, âîçðàñò íàñòóïëåíèÿ ìåíîïàóçû,äëèòåëüíî ïðèìåíÿåìûå ïðåïàðàòû, íàñëåäñòâåííîñòü.
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#3
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164ñì, 68 êã,55 ëåò
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#4
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êðàòêîñòü êîíå÷íî ñåñòðà òàëàíòà, íî ó ìåíÿ åùå âîïðîñû:
- òàê ïîíèìàþ ÷òî ïàðàòãîðìîí óæå áûë ïîâûøåí è ðàíüøå(ðàç óæ 2 ãîäà íàçàä çàøëà ðå÷ü î ñöèíòè)- öèôðû?. Êàëüöèé â äèíàìèêå? --òàêîé 25ÎÍÄ áåç äîïîëíèòåëüíûõ íàçíà÷åíèé? Êàê òî... -àêòóàëüíûé êðåàòèíèí ñåé÷àñ? - ñóòî÷íàÿ ìî÷à íà êàëüöèé? -ïåðå÷èñëèòå âñå ïðåïàðàòû âûáîð ÿñíî ÷òî íå âåëèê: - ïåðîðàëüíûå áèñôîñôîíàòû îòïàäàþò ïî íåïîäâèæíîñòè -âíóòðèâåííûå (íþàíñ ñ êðåàòèíèíîì è àðèòìèåé) - èìõî áèâàëîñ íå óäîáåí -õóæå ñ ìèàêàëüöèêà íå áóäåò. - à îñòàëüíîå ñëèøêîì äîðîãî. |
#5
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2 ãîäà íàçàä èñêàëè ïåðâè÷íûé ãèïåðïàðàòèðåîç,íå íàøëè, ïàðàòãîðìîí áûë ïîâûøåí â 2 ðàçà,óðîâåíü êàëüöèÿ â êðîâè â äèíàìèêå -íîðìàëüíûé,êàëüöèé â ìî÷å íå äåëàëè,êðåàòèíèí ñåé÷àñ 98,ðàíåå äî 130,âèòàìèí Ä ñäåëàí íà ÷èñòîì ôîíå â ñàìîé óâàæàåìîé ëàáîðàòîðèè,(àõ êàêàÿ âåðñèÿ ïðî âòîðè÷íûé ãèïåðïàðàòèðåîç íà ôîíå íåõâàòêè âèòàìèíà Ä íàêðûëàñü)Íàçíà÷èëà êàëüöèé,è àëåíäðó ðàç â íåäåëþ(îáåùàëè ïîë ÷àñà ïîñòîÿòü):äðóãèå ïðèíèìàåìûå ïðåïàðàòû ,àñïèðèí, âåðîøïèðîí, ýíàëàïðèë,êîíêîð-êîð.
À ÷òî äðóãîå î÷åíü äîðîãî? (ó ïàöèåíòêè õîðîøèå ôèíàíñîâûå âîçìîæíîñòè). Âñåì ñïàñèáî. |
#6
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È åùå îäèí âîïðîñ - ìû-òî ïàöèåíòêó íå ÂÈÄÈÌ - Êóøèíã èñêëþ÷åí?
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#7
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Åñëè ïàöèåíòêà ïåðåíîñèò àëåíäðîíàò, òî ýòî õîðîøèé âàðèàíò è âîçìîæíî (êàê òàì ñ îæèäàåìîé ïðîäîëæèòåëüíîñòüþ æèçíè ïî ñîïóòñòâóþùèì çàáîëåâàíèÿì?) è àëüòåðíàòèâ ïîêà íå íóæíî.
Òåðèïàðàòèä - ïî ïîäõîäèò ñ òàêèì ïàðàòãîðìîíîì åùå äîñòóïåí äåíîñóìàá (Ïðîëèà) |
#8
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Âåðñèÿ ñ íåõâàòêîé âèòàìèíà ä3 íå íàêðûëàñü.Ìîæåò áûòü íîðìàëüíûé óðîâåíü25(oh)d3 ïðè ïîíèæåííîì óðîâíå 1,25(oh)2d3 - ïðîâåðüòå, êàêîé ïàðàìåòð ïðîâåðÿëñÿ.
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#9
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Öèòàòà:
25(OH)D is the major circulating form of vitamin D, with a circulating half-life of 2–3 wk, and it is the best indicator to monitor for vitamin D status (3, 8, 25, 54, 56). The circulating half-life of 1,25(OH)2D is approximately 4 h. It circulates at 1000 times lower concentration than 25(OH)D, and the blood level is tightly regulated by serum levels of PTH, calcium, and phosphate. Serum 1,25(OH)2D does not reflect vitamin D reserves, and measurement of1,25(OH)2D is not useful for monitoring the vitamin D status of patients. Serum 1,25(OH)2D is frequently either normal or even elevated in those with vitamin D deficiency, due to secondary hyperparathyroidism. Thus, 1,25(OH)2D measurement does not reflect vitamin D status. Measurement of 1,25(OH)2D is useful in acquired and inherited disorders in the metabolism of 25(OH)D and phosphate, including chronic kidney disease, hereditary phosphate-losing disorders, oncogenic osteomalacia, pseudovitamin D-deficiency rickets, vitamin D-resistant rickets, as well as chronic granuloma forming disorders such as sarcoidosis and some lymphomas. Âðîäå íè÷åãî èç âûøåïåðå÷èñëåííîãî ó ïàöèåíòêè íå ïîäîçðåâàåì. Èëè âñå-òàêè ïðîáóåì íàéòè íåôðîãåííóþ îñòåîìàëÿöèþ? |
#10
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ß áû åùå öåëèàêèþ ïîèñêàëà...Áûëè ó íàñ òàêèå ïàöèåíòû ëîìàííûå -ïåðåëîìàííûå ñ íàðóøåíèåì ýíòåðàëüíîãî âñàñûâàíèÿ íà ôîíå àòðîôè÷åñêèõ èçìåíåíèé ñëèçèñòîé îáîëî÷êè. È ïàðàòèðåîèäíûé ãîðìîí ó íèõ òîæå âûñî÷åííûé áûë (êîìïåíñàòîðíî), ÷òî ïîääåðæèâàëî êàëüöèé â ïðåäåëàõ íîðìàëüíûõ çíà÷åíèé. "Îïîðíàÿ ôóíêöèÿ ñêåëåòà ïðèíîñèòñÿ â æåðòâó ìåòàáîëè÷åñêîé"...åñëè ìîæíî òàê ñêàçàòü.
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