Hyperparathyroidism (patient information)
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What is Hyperparathyroidism?
If the parathyroid glands secrete too much hormone, as happens in primary hyperparathyroidism, the balance is disrupted: Blood calcium rises. This condition of excessive calcium in the blood, called hypercalcemia, is what usually signals the doctor that something may be wrong with the parathyroid glands. In 85 percent of people with primary hyperparathyroidism, a benign tumor called an adenoma has formed on one of the parathyroid glands, causing it to become overactive. Benign tumors are noncancerous. In most other cases, the excess hormone comes from two or more enlarged parathyroid glands, a condition called hyperplasia. Very rarely, hyperparathyroidism is caused by cancer of a parathyroid gland.
This excess PTH triggers the release of too much calcium into the bloodstream. The bones may lose calcium, and too much calcium may be absorbed from food. The levels of calcium may increase in the urine, causing kidney stones. PTH also lowers blood phosphorus levels by increasing excretion of phosphorus in the urine.
What are the symptoms of Hyperparathyroidism?
- Back pain
- Blurred vision (because of cataracts)
- Bone pain or tenderness
- Decreased height
- Depression
- Fatigue
- Fractures of long bones
- Increased urine output
- Increased thirst
- Itchy skin
- Joint pain
- Loss of appetite
- Nausea
- Muscle weakness and pain
- Personality changes
- Stupor and possibly coma
- Upper abdominal pain
What are the causes of Hyperparathyroidism?
In most cases doctors don't know the cause. The vast majority of cases occur in people with no family history of the disorder. Only about 5 percent of cases can be linked to an inherited problem. Familial multiple endocrine neoplasia type 1 is a rare, inherited syndrome that affects the parathyroids as well as the pancreas and the pituitary gland. Another rare genetic disorder, familial hypocalciuric hypercalcemia, is sometimes confused with typical hyperparathyroidism. Each accounts for about 2 percent of primary hyperparathyroidism cases.
Who is at risk for Hyperparathyroidism?
In the United States, about 100,000 people develop the disorder each year. Women outnumber men two to one, and risk increases with age. In women 60 years and older, two out of 1,000 will develop hyperparathyroidism each year.
How to know you have Hyperparathyroidism?
- Diagnosis of hyperparathyroidism: Hyperparathyroidism is diagnosed when tests show that blood levels of calcium and parathyroid hormone are too high. Other diseases can cause high blood calcium levels, but only in hyperparathyroidism is the elevated calcium the result of too much parathyroid hormone. A blood test that accurately measures the amount of parathyroid hormone has simplified the diagnosis of hyperparathyroidism.
- Assessment of complications of hyperparathyroidism: Once the diagnosis is established, other tests may be done to assess complications. Because high PTH levels can cause bones to weaken from calcium loss, a measurement of bone density can help assess bone loss and the risk of fractures. Abdominal images may reveal the presence of kidney stones and a 24-hour urine collection may provide information on kidney damage, the risk of stone formation, and the risk of familial hypocalciuric hypercalcemia.
When to seek urgent medical care
Call for an appointment with your health care provider if you have symptoms of hyperparathyroidism.
Treatment options
Surgery to remove the enlarged gland (or glands) is the main treatment for the disorder and cures it in 95 percent of operations.
Calcimimetics are a new class of drug that turns off secretion of PTH. They have been approved by the Food and Drug Administration for the treatment of hyperparathyroidism secondary to kidney failure with dialysis, and primary hyperparathyroidism caused by parathyroid cancer. They have not been approved for primary hyperparathyroidism, but some physicians have begun prescribing calcimimetics for some patients with this condition. Patients can discuss this class of drug in more detail with their physicians.
Some patients who have mild disease may not need immediate treatment, according to panels convened by the National Institutes of Health (NIH) in 2002. Patients who are symptom-free, whose blood calcium is only slightly elevated, and whose kidneys and bones are normal may wish to talk with their physicians about long-term monitoring. In the 2002 recommendation, periodic monitoring would consist of clinical evaluation, measurement of serum calcium levels, and bone mass measurement. If the patient and physician choose long-term follow-up, the patient should try to drink lots of water, get plenty of exercise, and avoid certain diuretics, such as the thiazides. Immobilization (inability to move) and gastrointestinal illness with vomiting or diarrhea can cause calcium levels to rise. Patients with hyperparathyroidism should seek medical attention if they find themselves immobilized, vomiting, or having diarrhea.
Diseases with similar symptoms
- Familial hypocalciuric hypercalcemia
- Hypercalcemia of malignancy
- Multiple myeloma
- Familial hypocalciuric hypercalcaemia
- Sarcoidosis
- Hyperthyroidism
Where to find medical care for Hyperparathyroidism
Directions to Hospitals Treating Hyperparathyroidism
Prevention of Hyperparathyroidism
Getting the proper amount of calcium in your diet or through supplements may reduce your risk of secondary hyperparathyroidism.
What to expect (Outlook/Prognosis)
The outlook depends on the specific type of hyperparathyroidism.
Possible Complications
Complications may include:
- Increased risk of fractures
- Urinary tract infection due to kidney stones and blockage
- Peptic ulcer disease
- Pancreatitis
- Pseudogout
Surgery for hyperparathyroidism may lead to low blood calcium levels, which causes tingling and muscle twitching. This requires immediate treatment.
Sources
- http://www.nlm.nih.gov/medlineplus/ency/article/001215.htm
- http://www.wrongdiagnosis.com/h/hyperparathyroidism/misdiag.htm
- http://www.endocrine.niddk.nih.gov/pubs/hyper/hyper.htm
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