Primary Hyperparathyroidism

What is primary hyperparathyroidism?

Key points

  1. Hyperparathyroidism is when the parathyroid glands produce too much parathyroid hormone (PTH).
  2. This results in too much calcium in your blood, a condition called hypercalcemia.
  3. Treatment involves lifestyle changes, medications, or surgery.

The parathyroid glands are four small glands located near or on the back of the thyroid gland below the Adam’s apple. Yes, women do have an Adam’s apple; it’s just smaller than a man’s. These glands produce parathyroid hormone (PTH).

The parathyroid glands control the levels of calcium and phosphorus and vitamin D in the body. The main trigger for the release or production of PTH is the level of calcium in the blood. PTH helps regulate the amount of calcium in the body. If your calcium level becomes too low, PTH helps bring more calcium into your blood. It does this by increasing the reabsorption of calcium from the intestines. This reduces the amount of calcium lost in the urine and prevents the body from taking calcium from your bones.

Your parathyroid glands are normally very small. They are generally about the size of a single grain of rice. Sometimes, one or more of the glands becomes enlarged. It then produces too much PTH. In other cases, a growth on one of these glands can cause it to produce increased amounts of PTH.

Too much PTH leads to too much calcium in your blood. This condition is called hypercalcemia. It can cause a variety of symptoms including:

  • frequent urination
  • stomach problems
  • confusion
  • fatigue


What are the symptoms of primary hyperparathyroidism?

Primary hyperparathyroidism often has no symptoms. If symptoms are present, they are often very mild. Primary hyperparathyroidism is especially found in postmenopausal women, according to research published in the International Journal of Endocrinology. High blood pressure often accompanies hyperparathyroidism. When you treat your hyperparathyroidism, often your blood pressure comes down.

Symptoms that occur with hyperparathyroidism are often nonspecific. This means they’re not exclusive to this condition. For example, you might experience:

  • muscle weakness
  • lethargy
  • fatigue
  • pain in your muscles
  • depression

If your condition is more severe, you might also experience:

  • kidney stones, due to increased calcium
  • frequent urination
  • abdominal, or stomach, pain
  • nausea and vomiting
  • confusion
  • impaired memory
  • personality changes
  • constipation
  • bone thinning and fractures
  • coma (in rare cases)


What causes primary hyperparathyroidism?

Primary hyperparathyroidism occurs when your parathyroid glands produce too much of the parathyroid hormone. A variety of conditions can result in hyperparathyroidism, such as the following.


An adenoma is a noncancerous tumor on one of these glands. These tumors are the most common cause of primary hyperparathyroidism.

Parathyroid gland enlargement

In other cases, enlargement of at least two of your parathyroid glands can lead to hyperparathyroidism. Doctors often don’t know what causes this enlargement.

Parathyroid cancer

In rare cases, parathyroid cancer may cause enlargement of one or more of the parathyroid glands. These tumors can cause hyperparathyroidism.



How is primary hyperparathyroidism diagnosed?

Primary hyperparathyroidism is generally diagnosed through blood tests. Signs of this condition include:

  • elevated PTH
  • elevated blood calcium
  • elevated alkaline phosphatase, a protein found in bone and liver
  • low levels of phosphorus

When your doctor suspects hyperparathyroidism, they will probably check your bone density. Having too much PTH raises the levels of calcium in your blood. Your body draws this calcium from your bones. X-rays can help your doctor identify bone problems, such as fractures and thinning.



How is primary hyperparathyroidism treated?

The severity of primary hyperparathyroidism can vary greatly. There is no single course of treatment suitable for all cases. Your doctor will work with you to figure out what is best for your individual case.

If you don’t have any symptoms, you may not need immediate treatment. Instead, your doctor might simply monitor your condition to make sure it doesn’t get worse. They may monitor:

  • calcium levels
  • kidney function
  • bone density
  • whether you have begun to develop kidney stones

If you do need treatment, surgery is not always required. Sometimes, just drinking more water and getting more exercise can help. You may have to avoid taking certain medications, such as diuretics, which are commonly used to treat high blood pressure. These medications can cause an increase in blood calcium.

There are medications that do not treat the underlying condition, but can help your symptoms. These medications include the following:

  • Bisphosphonates, such as alendronate (Fosamax), help decrease bone turnover.
  • Cinacalcet (Sensipar) helps normalize calcium levels in the blood.
  • Estrogen therapy has been prescribed for postmenopausal women.

Your doctor might suggest surgery if:

  • your calcium level is more than 1 milligram per deciliter (mg/dL) above the normal range of 8.5–10.2 mg/dL, even without symptoms.
  • your bone density is an issue
  • your symptoms are severe
  • you are under 50 years of age


The takeaway

Hyperparathyroidism is a condition when your parathyroid glands produce too much parathyroid hormone in your body. This causes your calcium levels to rise, which can lead to bone thinning and fractures, abdominal problems, and depression. Often, there are no early symptoms. Treatment involves lifestyle changes, medications, or surgery.

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