Hyperparathyroidism

What is Hyperparathyroidism?

Hyperparathyroidism is an endocrine disorder in which any of the four parathyroid glands (located next to the thyroid gland, near the front of the neck) release an excessive amount of parathyroid hormone. Increased parathyroid hormone (the substance that keeps calcium levels in check) results in an increased calcium level in the blood and urine known as hypercalcemia. This disorder may cause gastrointestinal problems, muscle weakness, neurological problems, kidney stones or even kidney failure. Because this condition causes the blood to reabsorb calcium from the skeleton, it can also lead to osteoporosis (brittle bones due to loss of minerals).

Primary hyperparathyroidism is usually the result of small benign tumors, or adenomas, on the parathyroid glands. Hyperparathyroidism can also be due to an enlargement of the glands, the cause of which is unknown. Secondary hyperparathyroidism may be caused by a chronic hypocalcemia (decreased level of calcium) that originates elsewhere in the body, or it can be caused by a vitamin D deficiency. Occurring in about one out of 1,000 individuals, the disease is found two to three times as often in women as in men. It occurs predominantly in women over age 50.

How is it diagnosed?

History: Individuals may be without symptoms (asymptomatic). When symptoms are present, they may include headaches, fatigue, bone and muscle pain, thirst, nausea, vomiting, abdominal pain, constipation, weight loss and increased urination. Some individuals may have pain from kidney stones that develop as a result of the high calcium levels. In rare cases, individuals may experience personality disorders, or even coma, as a result of the impact on their central nervous system.

Physical exam may reveal muscle weakness or calcium precipitate in the tissues (calciphylaxis) due to the hypercalcemia. Calcinosis (abnormal deposits of calcium) may occur in joints causing a type of arthritic inflammation known as pseudogout. Ophthalmology (eye) exam may reveal calcium precipitate in the corneas (known as "band keratopathy").

A careful search is done for physical signs that may establish the underlying cause of the condition such as a tumor or thyroid gland enlargement.

Tests: Diagnosis of hyperparathyroidism is confirmed by tests to measure the level of calcium, phosphorus, and parathyroid hormone in the blood. In about 50% of cases, individuals are unaware of the disorder and discover it only through routine multi-panel blood work that reveals high levels of calcium and parathyroid hormone, or through urinalysis that shows high calcium levels.

X-ray tests may also be used to diagnose hyperparathyroidism. X-ray films can show evidence of excess parathyroid hormone action on certain bones. Occasionally, a routine chest x-ray may reveal a parathyroid mass.

How is Hyperparathyroidism treated?

Primary hyperparathyroidism is typically treated by surgically removing the tumors or part of the gland itself (parathyroidectomy). Rehydration (including intravenous fluids) and diuresis (using diuretics to force the kidneys to pass large amounts of urine) may be used to help dilute blood calcium levels. In addition, the individual may be advised to reduce or avoid calcium in the diet, increase fluids, and continue to take diuretics to effectively flush excess calcium levels out of the body. Postmenopausal women are usually put on estrogen replacement therapy. When the hypercalcemia is severe, the individual may require the above-mentioned therapies, surgery, and medication to lower calcium levels in the blood. Treatment for secondary hyperparathyroidism focuses on addressing the underlying cause of the problem. The individual may require vitamin D therapy and, in some cases, dialysis to remove excess calcium from the blood.

Medications

• Diuretics to force sodium and calcium excretion.
• Don't take antacids that contain calcium.
• Estrogens for postmenopausal females may be prescribed.

Information	Brand	Generic	Label	Rating
	Lasix	Furosemide
	Premarin	Conjugated Estrogens
Hypercalcemia
	Deltasone	Prednisone
	Fosamax	Alendronate

Activity

Follow medical advice about returning to normal activities following surgery.

Diet

• Drink extra water to prevent kidney stones.
• Limit calcium-containing foods, such as milk and cheese.
• Avoid highly seasoned or spicy foods, especially if you have an ulcer.
• Special diet may be recommended as part of your treatment.

What might complicate it?

Individuals with hyperparathyroidism are at increased risk for fractures, urinary infections, peptic ulcers, and pancreatitis. Kidney and pancreas function may be affected. In secondary hyperparathyroidism due to renal failure, high blood levels of calcium and phosphate levels may cause calcification in the skin, soft tissues, and arteries (calciphylaxis). This can result in painful patches of tissue death (necrosis) or gangrene, abnormal heart rhythms (arrhythmias), or respiratory failure.

Predicted outcome

Hyperparathyroidism is usually a chronically progressive disease unless surgically cured. Therefore, individuals who receive medical treatment only (without surgery) must be carefully monitored. With surgery, which carries little risk, most individuals are successfully cured. Bones heal once a parathyroid tumor is removed. However, kidney or pancreas damage resulting from the hypercalcemia may persist.

Alternatives

Other conditions with symptoms similar to hyperparathyroidism include adrenal insufficiency, hyperthyroidism, excessive calcium or vitamin D ingestion, familial hypocalciuric hypercalcemia, and certain malignant tumors or myelomas.

Appropriate specialists

Endocrinologist and surgeon.

Last updated 21 December 2015