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Primary Parathyroidism

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 most often involves 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, 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’re 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:

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Symptoms

What are the symptoms of primary hyperparathyroidism?

Primary hyperparathyroidism often has no symptoms. If symptoms are present, they’re 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:

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

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Causes

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.

Adenoma

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.

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Diagnosis

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’ll 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.

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Treatment

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’s 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 the most common treatment option and leads to a cure in almost all cases. Only the glands that are affected are removed. If all four glands are enlarged, a portion of one of the glands will be left in the body so you’ll still have parathyroid tissue that is functioning.

Your doctor might suggest surgery if:

  • your calcium level is more than 1.0 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

Sometimes medications are recommended to help prevent some of the complications associated with primary hyperparathyroidism. For instance:

  • Bisphosphonates, such as alendronate (Fosamax), help decrease bone turnover.
  • Cinacalcet (Sensipar) helps normalize calcium levels in the blood.

Estrogen therapy may be prescribed for postmenopausal women.

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Takeaway

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. If treatment is medically necessary, surgery is recommended and is most often curative.

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