Hyperparathyroidism: Symptoms, Causes, Diagnosis, Treatment

The parathyroid glands are located just behind the thyroid gland in the front of the neck.

The function of the parathyroid glands is to produce a hormone called parathyroid hormone, which helps regulate calcium and phosphate in the body.

Hyperparathyroidism occurs when the parathyroid glands produce too much parathyroid hormone (PTH).

The parathyroid glands are four endocrine glands the size of a pea located on your neck, near or attached to the back of your thyroid.

The endocrine glands secrete hormones necessary for the normal functioning of the body.

Despite having similar names and being adjacent to your neck, the parathyroid and thyroid glands are very different organs. PTH helps regulate the levels of calcium, vitamin D and phosphorus in your bones and blood.

Some people with this condition do not experience any symptoms and do not need treatment. Others have mild or severe symptoms that may require surgery.

 

What are the types of hyperparathyroidism?

There are three types of hyperparathyroidism: primary, secondary and tertiary.

Primary hyperparathyroidism

This type of hyperparathyroidism occurs when you have a problem with at least one of your parathyroid glands.

Common causes of parathyroid problems include benign growths in the gland and enlargement of at least two glands.

In rare cases, a cancerous tumor causes this condition. There is also an increased risk of developing primary hyperparathyroidism in people who:

It has certain inherited disorders that affect several glands throughout the body, such as multiple endocrine neoplasia.
It has a long history of deficiencies of calcium and vitamin D.
They have been exposed to radiation treatment of cancer.
He has taken a medicine called lithium, which mainly treats bipolar disorder.

Secondary hyperparathyroidism

This type occurs when you have an underlying condition that causes your calcium levels to be abnormally low.

Most cases of secondary hyperparathyroidism are due to chronic renal failure resulting in low levels of vitamin D and calcium.
Tertiary hyperparathyroidism

This type occurs when the parathyroid glands continue to produce too much PTH after their calcium levels return to normal. This type usually appears in people with kidney problems.

Symptoms of hyperparathyroidism

Frequently, there are no obvious symptoms or suspected hyperparathyroidism, and it is diagnosed for the first time when a patient is discovered to be hypercalcemic during a routine blood chemistry profile.

When symptoms are present, they can include the development of gastric ulcers or pancreatitis due to high levels of calcium, inflammation and pain in the lining of the stomach and pancreas.

The majority of the symptoms of hyperparathyroidism are those present due to the result of hypercalcemia, such as kidney stones, osteoporosis and muscle weakness.

Rarely, the symptoms are presented by alterations in the central nervous system such as depression, psychomotor and personality disorders, including coma.

Patients may also experience heartburn, nausea, constipation or abdominal pain.

In secondary hyperparathyroidism, patients may show signs of calcium imbalance such as deformities of long bones.

 

Causes

Most commonly, hyperparathyroidism occurs as a result of a single adenoma, or benign tumor, in one of the parathyroid glands.

They will grow to a size much larger than that of the parathyroid glands, usually up to the size of a walnut.

Genetic disorders or multiple endocrine tumors can also cause hyperparathyroidism.

Diagnosis of hyperparathyroidism

The diagnosis of hyperparathyroidism is given by a blood test that specifically measures the amount of parathyroid hormone.

X-ray examinations can be performed to look for areas of diffuse bone demineralization, bone cysts, external bone absorption and erosion of the long bones of the fingers and toes.

Hypercalcemia is mild or intermittent in some patients, but it is an excellent indicator of primary hyperparathyroidism.

Dual X-ray absorptiometry is a tool used to diagnose and measure osteoporosis, which is used to show the reduction of bone mass for patients with primary hyperparathyroidism.

Once a diagnosis is made, the doctor will probably order more tests to evaluate the complications. For example, abdominal x-rays may reveal kidney stones.

 

Treatment

Usually in most cases the patient refers to an endocrinologist, a doctor specializing in hormonal problems, or a nephrologist, who specializes in kidney and mineral disorders.

Patients with mild cases of hyperparathyroidism may not need immediate treatment if they have only slight elevations in the level of calcium in the blood, kidneys and bones.

These patients should be monitored regularly every six months, by means of a physical examination and the measurement of renal function and calcium levels.

A measurement of bone densitometry should be done every one or two years

Patients with more advanced hyperparathyroidism usually have all or half of the affected parathyroid glands, which must be surgically removed.

This surgery is relatively safe and effective.

The main risks are those related to general anesthesia. There are some cases in which surgery can be performed with the patient under regional anesthesia.

Often studies such as ultrasound before surgery help identify the affected areas.

 

Treatments based on the type of hyperparathyroidism

 

Primary hyperparathyroidism

You may not need treatment if your kidneys are working well, if your calcium levels are only a little high, or if your bone density is normal.

In this case, your primary care provider can monitor your condition once a year and your blood calcium levels twice a year.

Your primary care provider will also recommend that you see the amount of calcium and vitamin D that you get in your diet. You should also drink plenty of water to reduce the risk of kidney stones.

You should exercise regularly to strengthen your bones.

If treatment is necessary, surgery is the commonly used treatment. Surgical procedures consist of removing enlarged parathyroid glands or tumors in the glands.

Complications are infrequent and include damaged nerves of the vocal cords and long-term low calcium levels.

Calcimimetics, which act like calcium in the blood, are another treatment. These drugs can trick your glands into producing less PTH.

Primary care providers prescribe this in some cases if the surgery is unsuccessful or not an option.

Bisphophonates, which prevent your bones from losing calcium, can help reduce the risk of osteoporosis.

Hormone replacement therapy can help bones retain calcium.

This therapy can treat postmenopausal women with osteoporosis, although there are risks related to prolonged use. These include an increased risk of some cancers and cardiovascular diseases.

Secondary hyperparathyroidism

The treatment involves returning to normalize your PTH level by treating the underlying cause.

Treatment methods include prescribing vitamin D for severe deficiencies and calcium and vitamin D for chronic kidney failure.

You may also need medication and dialysis if you have chronic kidney failure.

 

What are the complications associated with hyperparathyroidism?

If you suffer from hyperparathyroidism, you may also have a condition called osteoporosis, which is sometimes also called “thinning” of the bone.

Common symptoms include bone fractures and loss of height due to fractures of the vertebral body (spine).

This can develop when excess PTH production causes an excessive loss of calcium in your bones, which weakens them.

Osteoporosis usually occurs when you have too much calcium in your blood and there is not enough calcium in your bones for a prolonged period.

Osteoporosis puts you at a higher risk of bone fractures. Your primary care provider can look for signs of osteoporosis by taking bone x-rays or by performing a bone mineral density test.

This test measures the mineral levels of calcium and bone using special X-ray devices.

 

What is the long-term perspective?

According to the Cleveland Clinic, surgery can cure most cases of hyperparathyroidism.

If you and your primary care provider chose to control your condition instead of treating it, making several healthy lifestyle choices can help you fight the symptoms.

Drink plenty of water and exercise regularly. You should also control the amount of calcium and vitamin D that you consume.