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{{Hyperparathyroidism}}
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==Overview==
==Overview==
The majority of patients with primary hyperparathyroidism are asymptomatic. Asymptomatic primary hyperparathyroidism patient was expected to dvelop signs ans symptoms, but most of the patients does not becomes symptomatic with time. The hallmark of primary hyperparathyroidism is asymptomatic hypercalcemia. The classic signs and symptoms of primary hyperparathyroidism are present in a few individuals and are summarized by the mnemonic "stones, bones, abdominal groans and psychic moans".
The majority of patients with primary hyperparathyroidism are asymptomatic. Asymptomatic primary hyperparathyroidism patient is expected to develop signs and symptoms, but most of the patients does not becomes symptomatic with time. The hallmark of primary hyperparathyroidism is asymptomatic [[hypercalcemia]]. The classic signs and symptoms of primary hyperparathyroidism are present in a few individuals and are summarized by the mnemonic '''painful bones, kidney stones, abdominal groans, psychic moans, and fatigue overtones'''.
The majority of patients with secondary hyperparathyroidism have a history of either [[chronic renal failure]] or long term [[vitamin D deficiency]].
The majority of patients with tertiary hyperparathyroidism have a history of [[Kidney transplantation|renal transplantation]].


==History and Symptoms==
==History and Symptoms==
===History===
===History===
Although majority of patients with hyperparathyroidism have non-specific history, a detailed and thorough history from the patient is necessary. The patient may have a positive history of:
Although majority of patients with hyperparathyroidism have non-specific history but a detailed and thorough history from the patient is necessary. The patient may have a positive history of:<ref name="pmid8964825">{{cite journal |vauthors=Silverberg SJ, Bilezikian JP |title=Evaluation and management of primary hyperparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=81 |issue=6 |pages=2036–40 |year=1996 |pmid=8964825 |doi=10.1210/jcem.81.6.8964825 |url=https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jcem/81/6/10.1210_jcem.81.6.8964825/1/jcem2036.pdf?Expires=1503692700&Signature=ZNJlqTCdoYB5YdpmMh2WawXE72llaZteGxPuWfREgVRKpx00WZxZ-UZdwfpk6LuPTdlWsh-Elc5Alf7JEW33H8tWVcfm7I-98XhVtwcWTBJzlm1TNVCrIeJ4eHKOS7ZEXCrDbyd33oACDzrKbod5FXSntDTBDOk2wlQiFJrIoZY~qDT82PcdGRmso9OOGmCtogJWLfOPLHGc6bDwvb8zrCK~itTf5PvHhAt-VN100iBDq~NwqRCmWPpMiE3yljADv7fw8Fo58JBz~QjiVc58JWSF2fRieodJYYInHaarbeMf4atxgXh6yyET0UFtl74i4IfdFFI0RMHoZR50XfUw9g__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q}}</ref>
*Kidney stones
*[[Kidney stones]]
*Bone pain
*[[Bone pain]] and [[tenderness]]
*Gastrointestinal symptoms like epigastric burning, constipation, indigestion, nausea, and vomiting
*Fragile bones of the limbs and spine that can break easily
*Psychic symptoms like  lethargy, fatigue, depression, memory loss, psychosis, ataxia, delirium, and coma.
*Frequent and [[Polyuria|excessive urination]]
*[[Gastrointestinal]] symptoms like [[epigastric pain]], [[constipation]], [[indigestion]], [[nausea]], and [[vomiting]]
*Feeling [[Fatigue|tired]], ill, and weak
*[[Depression]] and [[Dementia|memory disturbances]]
*[[Vitamin D deficiency]]
*[[Chronic renal failure]] in case secondary hyperparathyroidism is suspected
*[[Kidney transplantation|Renal transplant]] in case tertiary hyperparathyroidism is suspected
*Use of medications including [[thiazide diuretics]] and [[lithium]].
*Neck [[radiation]]


===Symptoms===
===Symptoms===
====Asymptomatic Hyperparathyroidism====
====Asymptomatic Hyperparathyroidism====
The majority of patients with primary hyperparathyroidism are asymptomatic. Asymptomatic primary hyperparathyroidism patient was expected to dvelop signs ans symptoms, but most of the patients does not becomes symptomatic with time. The hallmark of primary hyperparathyroidism is asymptomatic hypercalcemia.
The majority of patients with primary hyperparathyroidism are asymptomatic. Asymptomatic primary hyperparathyroidism patient was expected to dvelop signs ans symptoms, but most of the patients does not becomes symptomatic with time. The hallmark of primary hyperparathyroidism is asymptomatic [[hypercalcemia]].<ref name="MarcocciCetani2011">{{cite journal|last1=Marcocci|first1=Claudio|last2=Cetani|first2=Filomena|title=Primary Hyperparathyroidism|journal=New England Journal of Medicine|volume=365|issue=25|year=2011|pages=2389–2397|issn=0028-4793|doi=10.1056/NEJMcp1106636}}</ref>


====Symptomatic Hyperparathyroidism====
====Symptomatic Hyperparathyroidism====
Of those patients that do present with symptoms, they are commonly associated with the effects of an increased level of calcium. Since calcium is involved in trans-synaptic communication within our nervous system, high blood calcium levels have a direct effect on the nervous system. Thus, most of the symptoms of parathyroid disease are "neurological" in origin. The most common symptom is fatigue and tiredness. Other very common symptoms are lack of energy, memory problems, [[Clinical depression|depression]], problems with concentration, and [[sleep disorders|problems sleeping]]. Other manifestations of hyperparathyroidism usually involve the kidney ([[kidney stone|stones]]) and the skeletal system (bone pain due to the development of [[osteoporosis]]).
A few of patients that do present with symptoms, they are commonly associated with the effects of an increased level of [[calcium]]. [[Calcium]] is involved in trans-synaptic communication within [[nervous system]] and [[Hypercalcemia|high blood calcium]] levels have a direct effect on the [[nervous system]]. As a result, most of the symptoms of [[parathyroid]] diseases are [[Neurology|neurological]]. The most common symptom is [[fatigue]]. Other symptoms include [[lethargy]], [[Dementia|memory disturbances]], [[Clinical depression|depression]], lack of concentration, and [[sleep disturbances]]. Other manifestations of hyperparathyroidism may include [[kidney stone]]s and the [[musculoskeletal]] symptoms ([[bone pain]] due to the development of [[osteoporosis]]).


Almost all patients will have symptoms if their calcium is high and the right questions are asked. Removing the parathyroid tumor which is causing the excess parathyroid hormone will eliminate the symptoms in most patients within several days or weeks. Often it is life-changing when the parathyroid tumor is removed.
=====Common symptoms=====
The symptoms of hyperparathyroidism can be remembered by the rhyme "'''painful bones, kidney stones, abdominal groans, psychic moans, and fatigue overtones'''":<ref name="pmid21369510">{{cite journal |vauthors=Elaraj DM, Clark OH |title=Current status and treatment of primary hyperparathyroidism |journal=Perm J |volume=12 |issue=1 |pages=32–7 |year=2008 |pmid=21369510 |pmc=3042336 |doi= |url=}}</ref>
*"Painful bones" ([[bone pain]])
*"Kidney stones" ([[Kidney stones]])
*"Abdominal groans" ([[abdominal pain]], [[gastroesophageal reflux disease|gastroesophageal reflux*"Psychic moans" ([[depression]], [[Dementia|memory disturbances]])
*"Fatigue overtones" (complaints of not feeling well, [[lethargy]], [[fatigue]])


The symptoms of hyperparathyroidism can be remembered by the rhyme "'''moans, groans, stones, bones, and psychiatric overtones'''":
=====Less common symptoms=====
*"moans" (complaints of not feeling well)
Less common symptoms are usually present in severe disease and includes:
*"groans" (abdominal pain, [[gastroesophageal reflux disease|gastroesophageal reflux]])
*[[Confusion]]
*"stones" (kidney)
*[[Constipation]]
*"bones" (bone pain)
*[[Decreased libido]]
*"psychiatric overtones" (lethargy, fatigue, depression, memory problems).
*[[arterial hypertension|Hypertension]]
 
*[[Headache]]s
Other symptoms include: [[headache]]s, [[gastroesophageal reflux disease|gastroesophageal reflux]], decreased sex drive, thinning hair, [[arterial hypertension|hypertension]], and heart palpitations which are often due to bouts of atrial fibrillation. Additional symptoms reported consist of an increase of thirst and urination as a result of calcium excretion in the urine, stomach ulcers, nausea, and a loss of appetite [3].
*Heart [[palpitations]] which are often due to bouts of [[atrial fibrillation]]
 
*[[gastroesophageal reflux disease|Gastroesophageal reflux]]
===Osteoporosis===
*Lack of [[concentration]]
Unfortunately, medicines are usually not useful for treating the osteoporosis associated with hyperparathyroidism until the parathyroid tumor is removed. Osteoporosis associated with hyperparathyroidism is caused by the high parathyroid hormone that is secreted by the overactive parathyroid gland(s). This excess parathyroid hormone (PTH) acts directly on the bones to remove calcium from the bones. Thus, the high calcium in the blood comes from the bones. Removing the offending parathyroid gland will usually cause a significant improvement in the osteoporosis, often reversing this process back to normal bone density over several years.
*[[Loss of appetite]]
*[[Left ventricular hypertrophy]]
*[[Nausea and vomiting]]
*[[Peptic ulcer|Peptic ulcers]]
*[[Polydipsia]]
*[[Polyuria]]
*Thinning of hair


==References==
==References==


{{Reflist|2}}
{{Reflist|2}}
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[[Category:Disease]]
[[Category:Medicine]]
[[Category:Endocrinology]]
[[Category:Parathyroid disorders]]
[[Category:Parathyroid disorders]]
[[Category:Endocrinology]]
[[Category:Up-To-Date]]

Latest revision as of 22:16, 29 July 2020

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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

The majority of patients with primary hyperparathyroidism are asymptomatic. Asymptomatic primary hyperparathyroidism patient is expected to develop signs and symptoms, but most of the patients does not becomes symptomatic with time. The hallmark of primary hyperparathyroidism is asymptomatic hypercalcemia. The classic signs and symptoms of primary hyperparathyroidism are present in a few individuals and are summarized by the mnemonic painful bones, kidney stones, abdominal groans, psychic moans, and fatigue overtones. The majority of patients with secondary hyperparathyroidism have a history of either chronic renal failure or long term vitamin D deficiency. The majority of patients with tertiary hyperparathyroidism have a history of renal transplantation.

History and Symptoms

History

Although majority of patients with hyperparathyroidism have non-specific history but a detailed and thorough history from the patient is necessary. The patient may have a positive history of:[1]

Symptoms

Asymptomatic Hyperparathyroidism

The majority of patients with primary hyperparathyroidism are asymptomatic. Asymptomatic primary hyperparathyroidism patient was expected to dvelop signs ans symptoms, but most of the patients does not becomes symptomatic with time. The hallmark of primary hyperparathyroidism is asymptomatic hypercalcemia.[2]

Symptomatic Hyperparathyroidism

A few of patients that do present with symptoms, they are commonly associated with the effects of an increased level of calcium. Calcium is involved in trans-synaptic communication within nervous system and high blood calcium levels have a direct effect on the nervous system. As a result, most of the symptoms of parathyroid diseases are neurological. The most common symptom is fatigue. Other symptoms include lethargy, memory disturbances, depression, lack of concentration, and sleep disturbances. Other manifestations of hyperparathyroidism may include kidney stones and the musculoskeletal symptoms (bone pain due to the development of osteoporosis).

Common symptoms

The symptoms of hyperparathyroidism can be remembered by the rhyme "painful bones, kidney stones, abdominal groans, psychic moans, and fatigue overtones":[3]

Less common symptoms

Less common symptoms are usually present in severe disease and includes:

References

  1. ↑ Silverberg SJ, Bilezikian JP (1996). "Evaluation and management of primary hyperparathyroidism" (PDF). J. Clin. Endocrinol. Metab. 81 (6): 2036–40. doi:10.1210/jcem.81.6.8964825. PMID 8964825.
  2. ↑ Marcocci, Claudio; Cetani, Filomena (2011). "Primary Hyperparathyroidism". New England Journal of Medicine. 365 (25): 2389–2397. doi:10.1056/NEJMcp1106636. ISSN 0028-4793.
  3. ↑ Elaraj DM, Clark OH (2008). "Current status and treatment of primary hyperparathyroidism". Perm J. 12 (1): 32–7. PMC 3042336. PMID 21369510.

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