Hyperparathyroidism natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]

Overview

Primary hyperparathyroidism usually develops in the fifth decade of life, in post-menopausal women and starts as asymptomatic hypercalcemia in presence of increased parathyroid hormone. If left untreated, some of patients with primary hyperparathyroidism may commonly develop marked hypercalcemia, marked hypercalciuria, cortical bone demineralization and nephrolithiasis.

Secondary hyperparathyroidism arise in the early course of chronic renal failure. As renal failure progress, secondary hyperparathyroidism becomes more notable. If left untreated, secondary hyperparathyroidism carries an increased risk of vascular calcification with increasing age and duration of dialysis in patients.

Tertiary hyperparathyroidism usually develops in post renal transplant patients. If left untreated, tertiary hyperparathyroidism in post renal transplant patients may carry the risk of amyloid deposition, calciphylaxis, destructive or erosive spondyloarthropathy, osteonecrosis, and musculoskeletal infections.

Hyperparathyroidism leads to a variety of complications in various organ systems depending on the type of hyperparathyroidism.

Prognosis is all types hyperparathyroidism is generally good after proper treatment.

Natural History

Primary hyperparathyroidism

Secondary hyperparathyroidism

Tertiary hyperparathyroidism

Complications

Complications involving Organ system Complications of hyperparathyroidism
Primary hyperparathyroidism Secondary hyperparathyroidism Tertiary hyperparathyroidism
Cardiaovascular complications

[6][7]

--
Endocrine complications[8] -- --
Gastrointestinal complications[9] -- --
Hematologic complications[10] ---
  • Platlet function inhibition
Metabolic complications

[11][12][9][13][14][15][16]

Musculo-skeletal complications

[17][18][19][20][21][5]

Neurologic complications

[22][23]

--- --
Neuromuscular complications

[24][25]

Pregnancy related complications[26] -- --
Psychiatric complications

[27][28][29]

-- --
Renal complications

[1][30][31][32]

Rheumatologic complications

[33][34][35][36]

--
System non-specific complications

[37][5]

--
  • Metastatic calcifications
  • Amyloid deposition
  • Metastatic calcifications

Prognosis

Primary hyperparathyroidism

  • Prognosis of primary hyperparathyroidism is generally excellent after parathyroidectomy.
  • The complications of primary hyperparathyroidism resolves after the treatment.
  • Untreated complication of primary hyperparathyroidism may be fatal.[9]

Secondary hyperparathyroidism

Tertiary hyperparathyroidism

  • Prognosis of tertiary hyperparathyroidism is generally good after resection of abnormal hyperplastic gland.[38]

References

  1. ↑ 1.0 1.1 Peacock M (2002). "Primary hyperparathyroidism and the kidney: biochemical and clinical spectrum". J. Bone Miner. Res. 17 Suppl 2: N87–94. PMID 12412783.
  2. ↑ Silverberg SJ, Shane E, de la Cruz L, Dempster DW, Feldman F, Seldin D, Jacobs TP, Siris ES, Cafferty M, Parisien MV (1989). "Skeletal disease in primary hyperparathyroidism". J. Bone Miner. Res. 4 (3): 283–91. doi:10.1002/jbmr.5650040302. PMID 2763869.
  3. ↑ Nikodimopoulou M, Liakos S (2011). "Secondary hyperparathyroidism and target organs in chronic kidney disease". Hippokratia. 15 (Suppl 1): 33–8. PMC 3139677. PMID 21897756.
  4. ↑ 4.0 4.1 Cunningham J, Locatelli F, Rodriguez M (2011). "Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options". Clin J Am Soc Nephrol. 6 (4): 913–21. doi:10.2215/CJN.06040710. PMID 21454719.
  5. ↑ 5.0 5.1 5.2 Jevtic V (2003). "Imaging of renal osteodystrophy". Eur J Radiol. 46 (2): 85–95. doi:10.1016/S0720-048X(03)00072-X. PMID 12714225.
  6. ↑ Stefenelli T, Abela C, Frank H, Koller-Strametz J, Globits S, Bergler-Klein J, Niederle B (1997). "Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up". J. Clin. Endocrinol. Metab. 82 (1): 106–12. doi:10.1210/jcem.82.1.3666. PMID 8989242.
  7. ↑ Strózecki P, Adamowicz A, Nartowicz E, Odrowaz-Sypniewska G, Włodarczyk Z, Manitius J (2001). "Parathormon, calcium, phosphorus, and left ventricular structure and function in normotensive hemodialysis patients". Ren Fail. 23 (1): 115–26. PMID 11256521.
  8. ↑ Bai HX, Giefer M, Patel M, Orabi AI, Husain SZ (2012). "The association of primary hyperparathyroidism with pancreatitis". J. Clin. Gastroenterol. 46 (8): 656–61. doi:10.1097/MCG.0b013e31825c446c. PMC 4428665. PMID 22874807.
  9. ↑ 9.0 9.1 9.2 Corlew DS, Bryda SL, Bradley EL, DiGirolamo M (1985). "Observations on the course of untreated primary hyperparathyroidism". Surgery. 98 (6): 1064–71. PMID 3878002.
  10. ↑ Remuzzi G, Benigni A, Dodesini P, Schieppati A, Livio M, Poletti E, Mecca G, de Gaetano G (1981). "Parathyroid hormone inhibits human platelet function". Lancet. 2 (8259): 1321–3. doi:10.1016/S0140-6736(81)91343-X. PMID 6118720.
  11. ↑ Fitzpatrick LA, Bilezikian JP (1987). "Acute primary hyperparathyroidism". Am. J. Med. 82 (2): 275–82. PMID 3812520.
  12. ↑ Ahmad S, Kuraganti G, Steenkamp D (2015). "Hypercalcemic crisis: a clinical review". Am. J. Med. 128 (3): 239–45. doi:10.1016/j.amjmed.2014.09.030. PMID 25447624.
  13. ↑ Lips P (2001). "Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications". Endocr Rev. 22 (4): 477–501. doi:10.1210/edrv.22.4.0437. PMID 11493580.
  14. ↑ Saab G, Whaley-Connell A, Bombeck A, Kurella Tamura M, Li S, Chen SC, McFarlane SI, Sowers JR, Norris K, Bakris GL, McCullough PA (2011). "The Association between Parathyroid Hormone Levels and the Cardiorenal Metabolic Syndrome in Non-Diabetic Chronic Kidney Disease". Cardiorenal Med. 1 (2): 123–130. doi:10.1159/000327149. PMC 3101512. PMID 22258399.
  15. ↑ Hjelmesæth, Jøran; Hofsø, Dag; Aasheim, Erlend T; Jenssen, Trond; Moan, Johan; Hager, Helle; Røislien, Jo; Bollerslev, Jens (2009). "Parathyroid hormone, but not vitamin D, is associated with the metabolic syndrome in morbidly obese women and men: a cross-sectional study". Cardiovascular Diabetology. 8 (1): 7. doi:10.1186/1475-2840-8-7. ISSN 1475-2840.
  16. ↑ Barbur MA, Kurjak M, Becker K (1997). "[Systematic calciphylaxis in chronic renal failure: fulminant course after kidney transplantation]". Pathologe (in German). 18 (6): 453–8. PMID 9451734.
  17. ↑ Bandeira F, Cusano NE, Silva BC, Cassibba S, Almeida CB, Machado VC, Bilezikian JP (2014). "Bone disease in primary hyperparathyroidism". Arq Bras Endocrinol Metabol. 58 (5): 553–61. PMC 4315357. PMID 25166047.
  18. ↑ Mazzuoli GF, D'Erasmo E, Pisani D (1998). "Primary hyperparathyroidism and osteoporosis". Aging (Milano). 10 (3): 225–31. PMID 9801732.
  19. ↑ Spaulding CM, Young G (1997). "Osteitis fibrosa cystica and chronic renal failure". J Am Podiatr Med Assoc. 87 (5): 238–40. doi:10.7547/87507315-87-5-238. PMID 9158318.
  20. ↑ Eastwood JB (1977). "Renal osteodystrophy--a radiological review". CRC Crit Rev Diagn Imaging. 9 (1): 77–104. PMID 328228.
  21. ↑ Adams JE (1999). "Renal bone disease: radiological investigation". Kidney Int. Suppl. 73: S38–41. PMID 10633462.
  22. ↑ Goldstein DA, Feinstein EI, Chui LA, Pattabhiraman R, Massry SG (1980). "The relationship between the abnormalities in electroencephalogram and blood levels of parathyroid hormone in dialysis patients". J. Clin. Endocrinol. Metab. 51 (1): 130–4. doi:10.1210/jcem-51-1-130. PMID 6892917.
  23. ↑ Avram MM, Feinfeld DA, Huatuco AH (1978). "Search for the uremic toxin. Decreased motor-nerve conduction velocity and elevated parathyroid hormone in uremia". N. Engl. J. Med. 298 (18): 1000–3. doi:10.1056/NEJM197805042981805. PMID 205786.
  24. ↑ Mallette LE, Patten BM, Engel WK (1975). "Neuromuscular disease in secondary hyperparathyroidism". Ann. Intern. Med. 82 (4): 474–83. PMID 47234.
  25. ↑ Gerhardt RE, Zeitlin EL (1978). "Neuromuscular disease in tertiary hyperparathyroidism". Arch. Intern. Med. 138 (6): 1013–5. PMID 646555.
  26. ↑ Poomthavorn P, Ongphiphadhanakul B, Mahachoklertwattana P (2008). "Transient neonatal hypoparathyroidism in two siblings unmasking maternal normocalcemic hyperparathyroidism". Eur. J. Pediatr. 167 (4): 431–4. doi:10.1007/s00431-007-0528-6. PMID 17569990.
  27. ↑ Walker MD, McMahon DJ, Inabnet WB, Lazar RM, Brown I, Vardy S, Cosman F, Silverberg SJ (2009). "Neuropsychological features in primary hyperparathyroidism: a prospective study". J. Clin. Endocrinol. Metab. 94 (6): 1951–8. doi:10.1210/jc.2008-2574. PMC 2690425. PMID 19336505.
  28. ↑ Espiritu RP, Kearns AE, Vickers KS, Grant C, Ryu E, Wermers RA (2011). "Depression in primary hyperparathyroidism: prevalence and benefit of surgery". J. Clin. Endocrinol. Metab. 96 (11): E1737–45. doi:10.1210/jc.2011-1486. PMID 21917870.
  29. ↑ McAllion SJ, Paterson CR (1989). "Psychiatric morbidity in primary hyperparathyroidism". Postgrad Med J. 65 (767): 628–31. PMC 2429194. PMID 2608590.
  30. ↑ Lila AR, Sarathi V, Jagtap V, Bandgar T, Menon PS, Shah NS (2012). "Renal manifestations of primary hyperparathyroidism". Indian J Endocrinol Metab. 16 (2): 258–62. doi:10.4103/2230-8210.93745. PMC 3313745. PMID 22470864.
  31. ↑ Tassone F, Gianotti L, Emmolo I, Ghio M, Borretta G (2009). "Glomerular filtration rate and parathyroid hormone secretion in primary hyperparathyroidism". J. Clin. Endocrinol. Metab. 94 (11): 4458–61. doi:10.1210/jc.2009-0587. PMID 19808852.
  32. ↑ Kim H, Cheigh JS, Ham HW (2001). "Urinary stones following renal transplantation". Korean J. Intern. Med. 16 (2): 118–22. PMC 4531707. PMID 11590898.
  33. ↑ Michael JW, Schlüter-Brust KU, Eysel P (2010). "The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee". Dtsch Arztebl Int. 107 (9): 152–62. doi:10.3238/arztebl.2010.0152. PMC 2841860. PMID 20305774.
  34. ↑ Hochberg, Marc (2015). "204. Primary hyperparathyroidism: rheumatologic manifestations and bone disease". Rheumatology. Philadelphia, PA: Mosby/Elsevier. p. 1668. ISBN 9780323091381.
  35. ↑ Rubin MR, Silverberg SJ (2002). "Rheumatic manifestations of primary hyperparathyroidism and parathyroid hormone therapy". Curr Rheumatol Rep. 4 (2): 179–85. PMID 11890884.
  36. ↑ Adler JS, Cameron DC (1989). "Erosive spondylo-arthropathy and tertiary hyperparathyroidism". Australas Radiol. 33 (1): 90–2. PMID 2712794.
  37. ↑ 37.0 37.1 Block GA, Hulbert-Shearon TE, Levin NW, Port FK (1998). "Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study". Am. J. Kidney Dis. 31 (4): 607–17. PMID 9531176.
  38. ↑ Nichol PF, Starling JR, Mack E, Klovning JJ, Becker BN, Chen H (2002). "Long-term follow-up of patients with tertiary hyperparathyroidism treated by resection of a single or double adenoma". Ann. Surg. 235 (5): 673–8, discussion 678–80. PMC 1422493. PMID 11981213.

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