Hyperparathyroidism

Overview – Hyperparathyroidism is the condition wherein the parathyroid glands produce an excess of parathyroid hormone (parathormone). The parathyroid hormone helps maintain an appropriate balance of calcium in the blood. The excess of parathyroid hormone leads to high calcium levels.

Each parathyroid gland is about the size of a grain of rice and lies just behind the thyroid glands in the neck.

 

There are two types of hyperparathyroidism –

  • Primary hyperparathyroidism and secondary hyperparathyroidism.
  • In primary hyperparathyroidism, there is an enlargement of one or more of the parathyroid glands.
  • Secondary hyperparathyroidism occurs when another disease causes an increased level of parathyroid hormone levels.

 

Causes of primary hyperparathyroidism –

  • History of radiation exposure to head and neck.
  • Parathyroid hormone is generally secreted in response to low calcium levels in the blood. Chronically low calcium intake may increase the risk of developing primary hyperparathyroidism by causing chronic stimulation of the parathyroid gland.
  • Cancers, adenoma (non-cancerous growth) on the gland causes an excess of parathyroid hormone.
  • Familial hyperparathyroidism – multiple endocrine neoplasia (MEN)

 

Causes of secondary hyperparathyroidism –

  • Chronic kidney failure

 

Symptoms of hyperparathyroidism –

  • Kidney stones
  • Excessive urination
  • Pain in the abdomen
  • Bone and joint pain
  • Fragile bones that easily fracture

 

Complications of hyperparathyroidism –

  • Parathyroid hormone raises blood calcium levels by releasing calcium from the bones. This leads to brittle bones that fracture easily causing osteoporosis.
  • The excess calcium in the blood may lead to excess calcium in the urine, which can cause kidney stones.
  • High calcium levels are associated with heart conditions such as high blood pressure and certain types of heart disease.

 

Diagnosis of hyperparathyroidism –

  • The diagnosis of hyperparathyroidism is made when there are elevations of calcium levels and parathyroid hormone levels in the blood.
  • Additional tests such as bone mineral density test, urine test, imaging tests of kidneys are done to rule out the secondary causes, and to identify possible complications and severity.

 

Medical management of hyperparathyroidism –

  • Patients with symptoms of hyperparathyroidism such as kidney stones, fractures should generally undergo parathyroid surgery. The surgeon removes the glands that are enlarged or have an adenoma.
  • In some patients with asymptomatic disease, surgery is not done. However, surgery may be done in asymptomatic individuals at risk for disease progression, as well as those who have features of the disease that may improve after surgery.
  • Medications that are used to treat hyperparathyroidism include cinacalcet, hormone replacement therapy for women who have gone through menopause and have signs of osteoporosis, bisphosphonates.

 

Lifestyle management –

  • Talk to your doctor about the dietary guidelines that are appropriate for you including the amount of calcium and vitamin D that you need to take.
  • Physical activity minimizes bone resorption. Talk to the doctor about your exercise regimen.
  • Keep yourself hydrated and drink plenty of fluids, mostly water, to lessen the risk of kidney stones.
  • Do not smoke. Smoking may increase bone loss.
  • Talk to your doctor about all the medications that you are taking. Some medications such as lithium and diuretics can raise calcium levels.

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