Hyperparathyroidism

Written by Amanda Delgado | Published on June 21, 2012
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

What Is Hyperparathyroidism?

Hyperparathyroidism occurs when the parathyroid glands make too much parathyroid hormone (PTH). The parathyroid glands are four pea-sized endocrine glands located in your neck, near or attached to the back of your thyroid. Endocrine glands are glands that secrete hormones necessary for the normal function of the body.

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

Some people with this condition don’t experience any symptoms and don’t need treatment. Others have mild or severe symptoms that might require surgery.

What Causes Hyperparathyroidism?

In hyperparathyroidism, one or more of your parathyroid glands becomes overactive and makes excess PTH. This could be caused by a tumor, gland enlargement, or other structural problems of the parathyroid glands.

When your calcium levels are too low, your body will respond by increasing the production of PTH by your parathyroid glands. This causes your kidneys and intestines to absorb a larger amount of calcium. It also results in more calcium being removed from your bones. PTH production returns to normal when your calcium level goes up again.

Types of Hyperparathyroidism

Primary Hyperparathyroidism

This type occurs when you have a problem with at least one of your parathyroid glands. Common causes of parathyroid problems include benign growths on the gland and enlargement of at least two glands. In rare cases, a cancerous tumor causes this condition. According to the National Institutes of Health, primary hyperparathyroidism is more likely in people over the age of 60 and occurs most often in women (NIH). An increased risk of developing primary hyperparathyroidism also occurs in people who:

  • have certain inherited disorders that affect several glands throughout the body, such as multiple endocrine neoplasia
  • have a long history of calcium and vitamin D deficiencies
  • have been exposed to radiation from cancer treatment

have taken a drug called lithium that is mainly used to treat 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 caused by chronic kidney failure that result in low vitamin D and calcium levels.

Tertiary Hyperparathyroidism

This type occurs when your parathyroid glands keep making too much PTH even when your calcium levels return to normal. This type usually occurs in people with kidney problems.

What Are the Symptoms of Hyperparathyroidism?

Primary Hyperparathyroidism

Some patients don’t have any symptoms. If you do have symptoms, they can range from mild to severe. Milder symptoms include:

  • fatigue
  • weakness
  • depression
  • body aches

More severe symptoms include:

  • appetite loss
  • constipation
  • vomiting
  • nausea
  • excessive thirst
  • increased urination
  • confusion
  • memory problems
  • kidney stones because of too much calcium and phosphorus in the urine

Secondary Hyperparathyroidism

With this type, you may have skeletal abnormalities, such as fractures, swollen joints, and bone deformities. Other symptoms depend on the underlying cause, such as chronic kidney failure or severe vitamin D deficiency.

Osteoporosis and Hyperparathyroidism

If you suffer from hyperparathyroidism, you might also have a bone-thinning condition called osteoporosis. Common symptoms include bone fractures and height loss due to vertebral body (spinal column) fractures. This can develop when excess PTH production causes too much calcium to be pulled from your bones, making them weak. Osteoporosis typically occurs when you have too much calcium in your blood and not enough calcium in your bones for a prolonged period.

Osteoporosis puts you at a higher risk of bone fractures. Your doctor can check for signs of osteoporosis by taking bone X-rays or doing a bone mineral density test. This test measures calcium and bone mineral levels using special X-ray devices.

How Is Hyperparathyroidism Diagnosed?

Your doctor might suspect that you have hyperparathyroidism if routine blood tests show high levels of calcium in your blood. In order to confirm this diagnosis, your doctor will need to perform other tests.

Blood Tests

Additional blood tests can help your doctor make a more accurate diagnosis. Your doctor will check your blood for high PTH levels, high alkaline phosphatase levels, and low levels of phosphorus.

Urine Tests

A urine test can help your doctor determine how severe your condition is and whether kidney problems are causing it. Your doctor will check your urine to see how much calcium it contains.

Kidney Tests

Your doctor might take X-rays of your abdomen to check for kidney stones or other kidney abnormalities.

What Are Your Treatment Options?

Primary Hyperparathyroidism

You might not need treatment if your kidneys are working fine, if your calcium levels are only slightly high, or if your bone density is normal. In this case, your doctor might just have monitoring tests done once a year and your blood-calcium levels checked twice a year.

Dietary Changes

Your doctor will also recommend watching how much calcium and vitamin D you get in your diet. You’ll also need to drink plenty of water to reduce your risk of kidney stones and get regular exercise to strengthen your bones.

Surgery

If treatment is required, surgery is the commonly used treatment. It cures hyperparathyroidism about 95 percent of the time, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Surgical procedures involve removing enlarged parathyroid glands or tumors on the glands. Risks are rare and include damaged vocal cord nerves and long-term low levels of calcium.

Drugs and Medication

Calcimimetics, which act like calcium in the blood, can be prescribed. The use of these drugs can trick your glands into making less PTH. In some cases they are prescribed if surgery doesn’t work or if you can’t have surgery.

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

Hormone replacement therapy can help bones hold on to calcium. This therapy can be used to treat postmenopausal women with osteoporosis, although there are risks involved with prolonged use. These include an increased risk of some cancers and cardiovascular disease.

Secondary Hyperparathyroidism

Treatment involves bringing your PTH level back to normal by treating the underlying cause. Methods of treatment include taking prescription vitamin D for severe deficiencies and calcium and vitamin D for chronic kidney failure. You might also need medication and dialysis if you have chronic kidney failure.

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