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Hyperparathyroidism

Basic Information

Hyperparathyroidism is an over activity of the parathyroid glands -- the four small glands located in the neck next to the thyroid gland. But hyperparathyroidism also can involve the teeth, blood vessels, bones, kidneys and gastrointestinal track, central nervous system and skin. The excess parathyroid hormones (PTH) circulating in the blood increases the blood levels of calcium while at the same time decreasing the blood levels of phosphorus. This increased calcium absorption disrupts the calcium balance and in most cases (85%), patients with hyperparathyroidism have a benign tumor called an adenoma of one of their parathyroid glands. Others (about 20%) have an enlargement of two or more glands called hyperplasia.

Women are more likely to have hyperparathyroidism than men -- it occurs most frequently in postmenopausal women with approximately one case in one thousand.

Those most at risk are:

  • females (especially postmenopausal)
  • patients of increased age, especially over 50
  • patients with a history of the disease in the family
  • patients with Vitamin D deficiency
  • patients with recent illnesses such as endocrine disorders

Left untreated there can be serious complications including:

  • kidney damage
  • cataracts
  • peptic ulcer
  • pancreatitis

It is wise to provide a copy of your previous medical records to your current health care provider so that he or she can see when your blood calcium first became elevated.

Symptoms

Patients with this condition are asymptomatic in 50% of cases. It is often discovered "out of the blue" by your health care provider during a routine blood test.

Yet there are a plethora of symptoms in the other 50% of patients which can include:

  • chronic low back pain caused by bone softening
  • bones that have fractured easily because of the decrease of calcium
  • kidney stones
  • confusion
  • depression
  • decreased appetite
  • muscle and joint pains
  • hypertension
  • constipation
  • nausea
  • vomiting
  • ulcers

Diagnosis/Treatment

The best diagnostic test is considered the serum PTH level which is used to confirm hypercalcemia. Urine, bone X-rays, CT or MRI scans can also be useful in evaluating problem areas associated with hyperparathyroidism.

This condition can be cured by surgically removing the tumor -- i.e. removing the parathyroid tissue that is not normal, leaving the remaining tissue that is normal to continue to produce hormones. Surgery is almost always indicated for patients whose calcium levels are high, who continue to have annoying symptoms and who are suspected of having cancer. Surgery is effective in most cases involving younger patients. But elderly patients may benefit from a more conservative approach with their health care provider keeping tabs on serum calcium levels and taking note of any worsening symptoms.

There can be complications associated with surgery such as infection or bleeding, and low calcium levels may occur which may be temporary but in some cases remain permanent. Taking calcium and Vitamin D supplements before surgery may help prevent the severity of calcium deficiency in postoperative patients. Voice changes, either permanent or temporary, may result from the surgery as well. While there are possible complications involved with surgery, in cases of primary hyperparathyroidism surgery is the only truly effective treatment. And certainly necessary for those who have complications resulting from this condition.

However, different treatments may be offered both for mild cases and emergency situations.

In mild cases, treatment includes:

  • forced diuresis to eliminate excess calcium
  • limiting the dietary intake of calcium
  • forcing fluids and sodium chloride to help increase renal calcium excretion

In an emergency, when there is a need to immediately lower dangerous high calcium levels, you may need:

  • diuretics
  • intravenous fluids
  • bisphosphonates

Of course you may need to be treated for any medical condition that has been caused by hyperparathyroidism as well.

In the meantime, it is generally recommended that you:

  • drink plenty of water to prevent kidney stones and high blood calcium levels and to prevent dehydration
  • do not take medications, including calcium supplements, that have not been approved by your health care provider
  • follow-up on visits to your health care provider (if you do not have surgery) for regular blood and urine tests as well as kidney function and bone density tests
  • be certain you have selected an experienced specialist with whom you are comfortable if you do have surgery
  • should consider hormone replacement therapy if you are a postmenopausal woman

If you feel you may have hyperparathyroidism or feel you are at risk for this condition and would like a serum PTH level test please contact your health care provider.