About Hyperparathyroidism

Overview

Hyperparathyroidism is an endocrine disorder where the parathyroid glands in the neck produce too much parathyroid hormone (PTH). These glands are located behind the thyroid gland, near the base of the neck, and are about the size of a grain of rice. Their main job is to help control the levels of calcium and phosphorus in your blood. They work like a thermostat, turning hormone production on or off to keep these levels balanced.

There are two main types of hyperparathyroidism: primary and secondary. Primary hyperparathyroidism originates in the parathyroid glands themselves, usually due to a non-cancerous growth called a parathyroid adenoma. Secondary hyperparathyroidism, on the other hand, is typically caused by another condition, such as kidney disease or certain intestinal disorders and surgeries.

Excessive hormone production in hyperparathyroidism can lead to high calcium levels in the blood, which may cause serious health problems if left untreated. Symptoms of hyperparathyroidism can vary and may include weakness, fatigue, depression, aches and pains, loss of appetite, nausea, vomiting, constipation, confusion or impaired thinking and memory, increased thirst and urination, and thinning of the bones.

Causes and Risk Factors

The root causes of primary hyperparathyroidism include:

• Benign tumor on one of the parathyroid glands (parathyroid adenoma)
• Enlargement of multiple parathyroid glands (hyperplasia)
• Parathyroid cancer (rare)

The root causes for secondary hyperparathyroidism include:

• Severe calcium deficiency
• Severe vitamin D deficiency
• Chronic kidney disease

Non-modifiable risk factors for hyperparathyroidism cannot be changed or controlled. These include:

• Gender: Women are three times more likely to develop this condition than men.
• Age: It is most common between the ages of 50 and 60 years.

Modifiable risk factors for hyperparathyroidism can be influenced or changed. These include:

• Nutritional deficiencies: Vitamin D or calcium deficiencies may result in secondary hyperparathyroidism.
• Certain medications: Some drugs, such as lithium, can cause elevated levels of calcium in the blood and result in primary hyperparathyroidism.
• Radiation therapy: People receiving radiation therapy to treat neck cancer may develop primary hyperparathyroidism.

It is important to note that these risk factors increase the chances of developing hyperparathyroidism but do not guarantee its occurrence. It is always recommended to consult with a healthcare professional for personalized advice and guidance.

Symptoms

Early symptoms of hyperparathyroidism may not be obvious, but as the condition progresses, mild to moderate symptoms may develop. These early symptoms may include:

• Bone pain
• Joint pain
• Fatigue
• Muscle weakness

In more severe cases or as the condition progresses, additional symptoms may occur, such as:

• Confusion
• Constipation
• Extreme thirst
• Nausea and vomiting

It's important to note that some people with hyperparathyroidism may not experience any noticeable symptoms. Without treatment, hyperparathyroidism can lead to more severe complications over time, including osteoporosis and fractures. Additionally, mental health complications, such as depression, anxiety, cognitive dysfunction, and memory loss, can occur in some individuals with persistent high calcium levels. If you are experiencing any concerning symptoms or have questions about hyperparathyroidism, it's best to consult with your healthcare professional for a proper evaluation and guidance.

Diagnosis

To diagnose hyperparathyroidism, the following examinations, tests, and procedures are commonly performed:

• Physical exam: The healthcare provider checks for signs like bone pain, muscle weakness, or kidney problems. They may also look for symptoms such as fatigue, confusion, or unusual thirst that could suggest high calcium levels in the blood.
• Lab tests: Specific blood tests may be recommended to measure levels of calcium, parathyroid hormone (PTH), and other related hormones.
• Imaging studies: X-rays or MRI (magnetic resonance imaging) scans may be used to visualize the parathyroid glands and detect any abnormalities.
• Bone density test: This test evaluates bone strength and can help determine if hyperparathyroidism has led to bone loss or osteoporosis.

To determine the severity of hyperparathyroidism, additional examinations, tests, and procedures may include:

• Kidney function tests: These tests assess how well the kidneys are functioning and if hyperparathyroidism has affected kidney health.
• 24-hour urine collection: This test measures the amount of calcium excreted in urine over a 24-hour period.
• DEXA scan: Dual-energy X-ray absorptiometry (DEXA) is a type of bone density scan that provides detailed information about bone mineral density.
• Genetic testing: In some cases, genetic testing may be recommended to identify any inherited causes of hyperparathyroidism.

It's important to note that these examinations, tests, and procedures should be recommended and interpreted by a healthcare professional. They will consider your individual situation and provide personalized guidance.

Treatment Options

The goals of treatment for hyperparathyroidism are to reduce the levels of parathyroid hormone (PTH) in the blood and to address any complications associated with the condition. Here are the various treatment options and how they work:

• Medication types:
  • Calcimimetics: Medications like cinacalcet mimic circulating calcium, tricking the parathyroid glands into releasing less PTH.
  • Bisphosphonates: These medications slow or prevent bone calcium loss and may lessen osteoporosis symptoms.
  • Hormone replacement therapy (HRT): HRT may help reduce bone calcium loss for postmenopausal individuals with osteoporosis.
• Therapeutic procedures:
  • Surgery: If there are growths on the parathyroid glands or if they are overactive, surgery to remove one or more of the abnormal glands is recommended. This helps reduce PTH levels and addresses complications like osteoporosis.
• Self-care and health behavior changes:
  • Regular monitoring of PTH levels and levels of circulating calcium, phosphorous, and vitamin D
  • Taking daily supplements of calcium carbonate and vitamin D for hypoparathyroidism

Each treatment option aims to lower PTH levels, prevent further complications, and improve overall health. However, it's important to consult with a healthcare professional for personalized advice and guidance.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.