Hyperparathyroidism

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 30, 2016
StartDiseasesHyperparathyroidism

Hyperparathyroidism occurs when a parathyroid gland is overactive. This causes an increase of the parathyroid hormone in the bloodstream, which then throws off the balance of calcium in the body.

Contents

Definition & Facts

Hyperparathyroidism is identified as an increase of the parathyroid hormone in the bloodstream. The condition occurs because of overactivity in the parathyroid glands, which are four glands about the size of a piece of rice that are located in the neck.

When the parathyroid gland is functioning properly, it properly regulates the levels of calcium in the bloodstream and tissues. But when the gland becomes overactive, hyperparathyroidism occurs. There are two kinds of hyperparathyroidism that can occur, known as primary hyperthyroidism and secondary hyperparathyroidism.

Primary hyperparathyroidism exists when there is an enlargement in one or more of the parathyroid glands. The enlargement causes the gland to overproduce the parathyroid hormone and increase the amount of calcium in the blood.

Secondary hyperparathyroidism usually occurs when another disease exists that lowers the amount of calcium found in the body. To make up for the decrease of calcium, the parathyroid glands work in overtime in order to increase the calcium levels.

Symptoms & Complaints

In most cases, the symptoms associated with hyperparathyroidism occur because the calcium imbalance causes damage to organs, tissues, or bones. Symptoms range vastly depending on the area of damage. Those symptoms include: osteoporosis or fragile bones, kidney stones, increased urination, bone pain or joint pain, nausea, or vomiting, decreased appetite, abdominal pain, depression, forgetfulness, weakness, or tiring easily. Other symptoms include constipation, excessive thirst, or irregular heartbeat.

Some of these symptoms are signs of more severe conditions while others may be mild. Additionally, hyperparathyroidism does not always show symptoms.

Causes

If hyperparathyroidism is of the primary classification, it occurs when there is a problem with at least one of the parathyroid glands. Possible conditions of the glands includes a noncancerous growth on the gland, an enlargement of the glands, or a cancerous tumor on the gland. Of the possible causes, a noncancerous growth is the most common.

Secondary hyperparathyroidism occurs because of a severe calcium deficiency, a severe vitamin D deficiency, or chronic kidney disease. All of these conditions lower the levels of calcium in the blood and cause the parathyroid gland to work harder than normal to make up for the loss of calcium.

While anyone can develop hyperparathyroidism, there are conditions that can make an individual more prone to developing the condition. Obesity and age are contributing factors. Most individuals who develop hyperparathyroidism are women between the ages of 50 and 60.

Diagnosis & Tests

The first step in determining if one has increased levels of calcium in the bloodstream is to have a blood test. Usually, a fast will be done before the blood test is performed to rule out high levels of calcium that result from eating high-calcium foods.

Because a number of conditions can cause high calcium levels, additional evaluations will need to be done to determine if the condition is hyperparathyroidism. Additional tests include bone mineral density tests, urine testing, or imaging tests of the kidneys. Each of these can determine if the increased levels of calcium have caused additional damage or if the patient has a condition that caused secondary hyperparathyroidism.

While there can be a number of reasons for having high calcium in the blood, it is determined to be hyperparathyroidism when that calcium increase is caused by an overproduction of the parathyroid hormone. When the parathyroid hormone is high, hyperparathyroidism can be diagnosed.

If the person has been diagnosed with hyperparathyroidism, the doctor may perform a sestamibi parathyroid scintigraphy prior to surgery in order to isolate which of the four glands is producing too much of the hormone.

Treatment & Therapy

The recommended treatment and therapy will depend on the particular condition and category of hyperparathyroidism one has. If one's calcium levels are only slightly increased and the typical side effects that occur from hyperparathyroidism have not yet appeared, treatment or therapy may not be necessary. However, it is important to still monitor one's calcium levels and bone density.

In the event of primary hyperparathyroidism, the most common form of treatment is surgery to remove the affected gland or glands. Additionally, there are drugs that can treat hyperparathyroidism, including calcimimetics, hormone replacement therapy, and bisphosphonates.

Those with hyperparathyroidism can also make lifestyle changes, including exercising regularly, not smoking, and monitoring the amount of calcium and vitamin D ingested through their diet. They should also be aware of taking drugs that could raise their calcium levels.

Prevention & Prophylaxis

Because hyperparathyroidism can occur for a number of reasons and as a side effect of other diseases, preventing the disease can be difficult. For those at risk of the disease, there are measures to take to keep their calcium levels in the desired range. Exercising regularly, avoiding stimulates such as alcohol, coffee, and tobacco, and drinking enough water can decrease an individual's risk of developing hyperparathyroidism.

Individuals at risk should also avoid refined foods, like white breads and sugar, and trans-fatty acids, like those found in cookies, crackers, French fries, and donuts. For those with secondary hyperparathyroidism, eating foods rich in calcium, such as almonds, apricots, princes, and dark leafy greens, can help reduce symptoms and decrease risk.