Hyperparathyroidism history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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".
History and Symptoms
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:
- Kidney stones
- Bone pain
- Gastrointestinal symptoms like epigastric burning, constipation, indigestion, nausea, and vomiting
- Psychic symptoms like lethargy, fatigue, depression, memory loss, psychosis, ataxia, delirium, and coma.
Symptoms
Asymptomatic Hyperparathyroidism
Many patients presenting with hyperparathyroidism will have no signs or symptoms, with diagnosis being made on further investigation after a coincidental finding of hypercalcemia. It is, however, reported that many patients will report that they feel better after treatment for 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, depression, problems with concentration, and problems sleeping. Other manifestations of hyperparathyroidism usually involve the kidney (stones) and the skeletal system (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.
The symptoms of hyperparathyroidism can be remembered by the rhyme "moans, groans, stones, bones, and psychiatric overtones":
- "moans" (complaints of not feeling well)
- "groans" (abdominal pain, gastroesophageal reflux)
- "stones" (kidney)
- "bones" (bone pain)
- "psychiatric overtones" (lethargy, fatigue, depression, memory problems).
Other symptoms include: headaches, gastroesophageal reflux, decreased sex drive, thinning hair, 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].
Osteoporosis
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.