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Hyperparathyroidism

Hyperparathyroidism

Hyperparathyroidism occurs when the body makes too much parathyroid hormone (PTH). The parathyroid glands make PTH which help to keep calcium levels in balance.

Hyperparathyroidism may be:

  • Primary — a benign tumor of the parathyroid gland that makes too much PTH (most common form)
  • Secondary — occurs in patients with long-standing kidney failure or a vitamin D deficient state
  • Tertiary — also occurs in patients with very long-standing kidney failure and dialysis

Thyroid and Parathyroid
Thyroid and Parathyroid Glands: Posterior (Back) View
Copyright © Nucleus Medical Media, Inc.

The Causes of Hyperparathyroidism

Primary hyperparathyroidism may be caused by:

  • Noncancerous tumor in the parathyroid gland (most common cause)
  • Parathyroid cancer (very rare)
  • Familial hyperparathyroidism
  • Multiple endocrine neoplasia (MEN)

Secondary hyperparathyroidism may be caused by:

  • Vitamin D deficiency (due to inadequate dietary intake, lack of sunlight exposure or malabsorption condition like celiac disease)
  • Kidney failure or other medical problems that make the body resistant to the action of the parathyroid hormone
  • Enlargement of the parathyroid glands — common cause

Enlargement of the parathyroid gland is the main risk factor for tertiary hyperparathyroidism.

Risk Factors

Hyperparathyroidism is more common in women, especially after menopause. Other factors that may increase your chance of developing hyperparathyroidism include:

  • Age: older than 50 years
  • Multiple endocrine neoplasia
  • Having specific genetic factors that increase your risk
  • Radiation therapy to head or neck during childhood

Hyperparathyroidism Symptoms

The level of calcium in the blood will determine the symptoms. Symptoms commonly seen with primary hyperparathyroidism include:

  • Constipation
  • Nausea
  • Vomiting
  • Abdominal pain
  • Headache
  • Loss of appetite
  • Thirst
  • Frequent and sometimes painful urination due to kidney stones
  • Lethargy
  • Fatigue
  • Muscle weakness
  • Joint pain
  • Memory loss
  • Depression
  • Heartburn
  • Back pain

Diagnosing Hyperparathyroidism

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

To measure calcium levels your doctor may ask for:

  • Blood tests — to measure calcium, phosphorus, magnesium, alkaline phosphatase, vitamin D, and PTH, kidney and liver function tests
  • Urine test — a 24-hour urine collection to measure calcium excretion and kidney function (very important test)

Images of the parathyroid gland may be taken with:

  • Neck ultrasound — a test that uses sound waves, not radiation, to detect a large parathyroid tumor (adenoma)
  • Technetium 99m sestamibi scan — a nuclear medicine test that uses safe nuclear molecules to make pictures of the parathyroid glands to help locate a single parathyroid adenoma in primary hyperparathyroidism

Other tests may be done to look for other problems hyperparathyroid may cause:

  • Bone density test — a test to measure bone loss and risk of fractures
  • Abdominal X-ray — a test that uses radiation to take a picture of the structures inside the body; can show kidney stones caused by high calcium levels

Treatment for Hyperparathyroidism

Talk with your doctor about the best plan for you. Depending on the type of hyperparathyroidism treatment options include the following:

  • Primary hyperparathyroidism — surgery is curative, medicine is not indicated and will generally not help. Find out about surgery (called parathyroidectomy) at UVA.
  • Secondary hyperaparthyroidism — if due to vitamin D deficiency:
    • Ergocalciferol (vitamin D2) or cholecalciferol (vitamin D3) — for treating secondary hyperparathyroidism due to deficiency of vitamin D.
    • Calcitriol (the most active vitamin D metabolite) — helps to reduce PTH production in secondary hyperparathyroidism in chronic kidney failure
    • Cinacalcet — helps to lower PTH blood levels for secondary and tertiary hyperparathyroidism in chronic kidney disease

Monitoring of Blood Calcium Levels

Your doctor may simply choose to regularly check your blood calcium levels. The doctor will also monitor you for possible complications. This may include regular bone density tests every 1-2 years.

Prevent Hyperparathyroidism

Adequate calcium intake may play a role in preventing hyperparathyroidism in women. Try to get recommended levels of calcium through dietary choices and supplements.

 

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Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

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