Hyperparathyroidism
Hyperparathyroidism occurs when the parathyroid glands make too much parathyroid hormone (PTH). The parathyroid glands are four pea-sized endocrine glands located in your neck, near or attached to the back of your thyroid. Endocrine glands secrete hormones necessary for the normal functioning of the body. Despite having similar names and being adjacent in your neck, the parathyroid glands and the thyroid are very different organs. PTH helps regulate the levels of calcium, vitamin D, and phosphorus in your bones and blood.
Some people with this condition don’t experience any symptoms and don’t need treatment. Others have mild or severe symptoms that might require surgery. Older women who are postmenopausal are at the highest risk for the condition.
Causes of Hyperparathyroidism
In hyperparathyroidism, one or more of your parathyroid glands becomes overactive and makes excess PTH. This could be due to a tumor, gland enlargement, or other structural problems of the parathyroid glands. When your calcium levels are too low, your parathyroid glands respond by increasing the production of PTH. This causes your kidneys and intestines to absorb a larger amount of calcium. It also removes more calcium from your bones. PTH production returns to normal when your calcium level goes up again.
Types of Hyperparathyroidism
There are three types of hyperparathyroidism: primary, secondary, and tertiary.
Primary Hyperparathyroidism
This type occurs when you have a problem with at least one of your parathyroid glands. Common causes of parathyroid problems include benign growths on the gland and enlargement of at least two glands. In rare cases, a cancerous tumor causes this condition. An increased risk of developing primary hyperparathyroidism also occurs in people who:
- have certain inherited disorders that affect several glands throughout the body, such as multiple endocrine neoplasia
- have a long history of calcium and vitamin D deficiencies
- have been exposed to radiation from cancer treatment
- have taken a drug called lithium, which mainly treats bipolar disorder
Some patients don’t have any symptoms. If you do have symptoms, they can range from mild to severe. Milder symptoms may include:
- fatigue
- weakness
- depression
- body aches
More severe symptoms can include:
- appetite loss
- constipation
- vomiting
- nausea
- excessive thirst
- increased urination
- confusion
- memory problems
- kidney stones
Secondary Hyperparathyroidism
This type occurs when you have an underlying condition that causes your calcium levels to be abnormally low. Most cases of secondary hyperparathyroidism are due to chronic kidney failure that results in low vitamin D and calcium levels. With this type, you may
- have skeletal abnormalities, such as fractures, swollen joints, and bone deformities.
- Other symptoms depend on the underlying cause, such as chronic kidney failure or severe vitamin D deficiency.
Tertiary Hyperparathyroidism
This type occurs when your parathyroid glands keep making too much PTH after your calcium levels return to normal. This type usually occurs in people with kidney problems.
Diagnosed hyperparathyroidism
Because the symptoms of hyperparathyroidism can be nonexistent, mild or common to many other disorders, a diagnosis of hyperparathyroidism can be missed. Often, the condition is discovered through a blood test that is ordered for another condition. If you have primary hyperparathyroidism, your blood test will show a higher-than-normal levels of calcium and parathyroid hormone. Other tests may be ordered to check for complications of hyperparathyroidism. These tests may include:
- scan to check for any growths on your parathyroid glands or enlargement of the gland
- A blood test to check your vitamin D level. It’s common to have a low vitamin D level if you have hyperparathyroidism.
- A bone density test to check for bone loss.
- An ultrasound or other imaging test of your kidneys to check for kidney stones.
- A 24-hour urine collection test to measure the amount of calcium and other chemicals in your urine to help determine the cause of your hyperparathyroidism.
- Blood tests to check how well your kidneys are working.
References
https://emedicine.medscape.com/article/127351-overview#a4
https://www.healthline.com/health/hyperparathyroidism#outlook
https://my.clevelandclinic.org/health/diseases/14454-hyperparathyroidism
