Primary Hyperparathyroidism

Written by Gretchen Holm
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

What is Primary Hyperparathyroidism?

The parathyroid glands are four small glands located near or on the back of the thyroid gland below the Adam’s apple. They produce parathyroid hormone (PTH).

While 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 becomes too low, PTH helps bring more into your blood. It does this by increasing the reabsorption of calcium from the intestines, reducing the amount of calcium lost in the urine and taking calcium from the bones.

Your parathyroid glands are normally very small. They are generally about the size of a single grain of rice. However, sometimes one or more becomes enlarged. It then produces too much PTH. In other cases, a growth on one of these glands can cause increased 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 Causes Primary Hyperparathyroidism?

Primary hyperparathyroidism occurs when your parathyroid glands produce too much PTH.

This can happen if you have an adenoma—or non-cancerous tumor—on one of these glands. These tumors are the most common cause of primary hyperparathyroidism.

In other cases, enlargement of at least two of your parathyroid glands can lead to this condition. Doctors often do not understand what causes this enlargement.

In rare cases, parathyroid cancer may be the culprit. These tumors can cause hyperparathyroidism.

What Are the Symptoms of Primary Hyperparathyroidism?

Primary hyperparathyroidism often has no symptoms. Other times, the symptoms present can be very mild. According to Harvard Health, as many as 80 percent of people with primary hyperparathyroidism do not have any symptoms. (Harvard Health) Primary hyperparathyroidism seems to be more common in post menopausal women and there is increasing documentation of associated high blood pressure, pancreatitis and gall stone disease. (International Journal of Endocrinology)

When symptoms occur, they are often nonspecific. This means they are 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 suffer:

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

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 and bone)
  • low levels of phosphorus

When this disease is suspected, your doctor 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?

Primary hyperparathyroidism can vary greatly in severity. 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 does not get worse. This, however, depends on your calcium levels, whether there are signs of poor kidney function, bone loss or 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 commonly used to treat high blood pressure. These medications can cause an increase in blood calcium.

There are medications that can help lower your calcium levels and improve bone health. Bisphosphonates, such as alendronate (Fosamax), help decrease bone turnover. Cinacalcet (Sensipar) helps normalize calcium levels in the blood. However, they do not treat the underlying parathyroid problem. Estrogen therapy has been prescribed for post menopausal women.

Surgery might be necessary if your calcium level is more than 1 mg/dL (milligram per deciliter) above the normal range of 8.5-10.2 mg/dL, even without symptoms. You may also need surgery if your bone density is an issue. (Harvard Health) Surgery is more likely to be used if symptoms are severe or you are under 50 years of age.

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