Hyperparathyroidism

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Hyperparathyroidism is an excess of parathyroid hormone in the bloodstream due to overactivity of one or more of the body's four parathyroid glands. These glands are about the size of a grain of rice and are located in your neck.

The parathyroid glands produce parathyroid hormone, which helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning.

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What are the symptoms of hyperparathyroidism?

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Hyperparathyroidism is often diagnosed before signs or symptoms of the disorder are apparent. When symptoms do occur, they're the result of damage or dysfunction in other organs or tissues due to high calcium levels circulating in the blood and urine or too little calcium in bones.

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Symptoms may be so mild and nonspecific that they don't seem at all related to parathyroid function, or they may be severe. The range of signs and symptoms include:

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• Fragile bones that easily fracture (osteoporosis)

• Kidney stones

• Excessive urination

• Abdominal pain

• Tiring easily or weakness

• Depression or forgetfulness

• Bone and joint pain

• Frequent complaints of illness with no apparent cause

• Nausea, vomiting or loss of appetite

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What are the causes of hyperparathyroidism?

The disorder can generally be divided into two types based on the cause. Hyperparathyroidism may occur because of a problem with the parathyroid glands themselves (primary hyperparathyroidism) or because of another disease that affects the glands' function (secondary hyperparathyroidism).

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PRIMARY HYPERPARATHYROIDISM

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Primary hyperparathyroidism occurs because of some problem with one or more of the four parathyroid glands:

• A noncancerous growth (adenoma) on a gland is the most common cause.

• Enlargement (hyperplasia) of two or more parathyroid glands accounts for most other cases.

• A cancerous (malignant) tumor is a rare cause of primary hyperparathyroidism.

Primary hyperparathyroidism usually occurs randomly, but some people inherit a gene that causes the disorder.

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SECONDARY HYPERTHYROIDISM

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Secondary hyperparathyroidism is the result of another condition that lowers calcium levels. Therefore, your parathyroid glands overwork to compensate for the loss of calcium. Factors that may contribute to secondary hyperparathyroidism include:

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• Severe calcium deficiency. Your body may not get enough calcium from your diet, often because your digestive system doesn't absorb the calcium from it.

• Severe vitamin D deficiency. Vitamin D helps maintain appropriate levels of calcium in the blood, and it helps your digestive system absorb calcium from your food.

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Your body produces vitamin D when your skin is exposed to sunlight, and you consume some vitamin D in food. If you don't get enough vitamin D, then calcium levels may drop.

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• Chronic kidney failure. Your kidneys convert vitamin D into a form that your body can use. If your kidneys function poorly, usable vitamin D may decline and calcium levels drop. Chronic kidney failure is the most common cause of secondary hyperparathyroidism.

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WHAT ARE THE TREATMENT OPTIONS?

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WATCHFUL WAITING

Your doctor may recommend no treatment and regular monitoring if:

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• Your calcium levels are only slightly elevated

• Your kidneys are functioning normally, and you have no kidney stones

• Your bone density is normal or only slightly below normal

• You have no other symptoms that may improve with treatment

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If you choose this watch-and-wait approach, you'll likely need periodically scheduled tests to monitor your blood-calcium levels and bone density.

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SURGERY

Watchful waiting can be considered if calcium levels are only mildly elevated, kidney function is normal, bone density is close to normal, and there are no other symptoms. Medications can also sometimes be used, including calcimimetics, hormone replacement therapy, and bisphosphonates.

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Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in about 95 percent of all cases. Typically only the gland that is enlarged or has a tumor (adenoma) is removed. 

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