Hyperparathyroidism

Description

Hyperparathyroidism is when your parathyroid glands create large amounts of parathyroid hormone in the bloodstream. These glands, which are located behind the thyroid gland in the lower part of your neck, are the size of a grain of rice.

The gland hormone produced by the thyroid gland helps to maintain the balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning. This is especially important for nerve and muscle function, as well as the health of the bones.

There are two types of hyperparathyroidism. In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes the overproduction of the parathyroid hormone. This causes high levels of calcium in the blood, which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism.

Secondary hyperparathyroidism occurs due to other illness that the first cause of low levels of calcium in the body. Over time, increased parathyroid hormone levels occur as the body struggles to maintain the level of calcium in the standard range. This is common in kidney disease, and after certain surgeries or intestinal diseases.

Symptoms

Primary hyperparathyroidism is often diagnosed before signs or symptoms of the disease occur. This is usually due to a high level of calcium is found in routine blood tests. When symptoms occur, they are the result of damage to or dysfunction of other organs or tissues. This damage or dysfunction is due to the high levels of calcium in the blood and in the urine or very little calcium in the bones.

The symptoms may be so mild and nonspecific that does not seem to be related to parathyroid function, or they may be severe. The range of signs and symptoms include:

  • The weakness of the bones that break easily (osteoporosis)
  • Stones in the kidney
  • Excessive urination
  • Stomach (abdominal) pain
  • Tiring easily or weakness
  • Depression or forgetfulness
  • Bone and joint pain
  • Frequent complaints of illness with no clear cause
  • Nausea, vomiting or loss of appetite

When to see a doctor

Consult your health care provider if you have signs or symptoms of hyperparathyroidism. These symptoms can be caused by many disorders, including some with serious complications. It is important to receive a message, an accurate diagnosis and appropriate treatment.

Causes

The hyperparathyroidism is caused by factors that increase the production of parathyroid hormone.

The parathyroid glands maintain proper levels of calcium and phosphorus in the body by turning the release of parathyroid hormone on or off. This is similar to how a thermostat controls a heating system to maintain a constant air temperature. Vitamin D is also involved in the control of the amount of calcium in your blood.

Normally, this balancing act works well.

  • When the levels of calcium in the blood to drop too low, your parathyroid glands release enough of the parathyroid hormone to restore the balance. This hormone increases calcium levels by releasing calcium from bones, increasing the amount of calcium that is absorbed from the small intestine and decreased the amount of calcium lost in the urine.
  • When blood calcium levels are too high, the parathyroid glands produce less of the parathyroid hormone.

Calcium is best known for his role in keeping your teeth and bones healthy. But calcium also helps in the transmission of signals in nerve cells. And participates in muscle contraction. Phosphorous, another mineral, works together with calcium in these areas.

Sometimes, one or more of the parathyroid glands produce a large amount of parathyroid hormone. These high levels of the hormone may be the body to respond adequately to maintain the calcium in the standard range, or may be inappropriately raise the calcium in the blood. Which one depends on the underlying problem.

The hyperparathyroidism can occur due to primary hyperparathyroidism or secondary hyperparathyroidism.

Primary hyperparathyroidism

Primary hyperparathyroidism occurs due to a problem with one or more of the four parathyroid glands:

  • A non-cancerous growth (adenoma) in a gland is the most common cause.
  • Enlargement (hyperplasia) of two or more parathyroid glands accounts for the majority of the other cases.
  • A cancerous tumor is a rare cause of primary hyperparathyroidism.

One or more of the parathyroid glands produces high amounts of parathyroid hormone. This leads to elevated levels of calcium and low levels of phosphorus in the blood. Primary hyperparathyroidism usually occurs randomly. But some people inherit a gene that causes the disorder.

Secondary hyperparathyroidism

Secondary hyperparathyroidism is the result of another condition which reduces the calcium in the blood, which then affects the gland of the function. This causes the parathyroid glands to overwork and produce large amounts of parathyroid hormone to maintain or restore the level of calcium to the standard range. The factors that can result in secondary hyperparathyroidism include:

  • Severe calcium deficiency. Your body cannot get enough calcium in your diet, often because their digestive system doesn't absorb calcium from food. This is common after intestinal surgery, including weight-loss surgery.
  • Severe deficiency of vitamin D. vitamin D helps to maintain calcium levels in the blood. It also helps your digestive system absorb calcium from the food. Your body produces vitamin D when the skin is exposed to sunlight. You also get a bit of vitamin D in food. If you do not get enough vitamin D, then calcium levels may decrease.
  • Chronic renal failure.Your kidneys convert vitamin D into a form that the body can use. If your kidneys do not work well, usable vitamin D may lower the calcium levels drop. This causes parathyroid hormone levels to go up. Chronic renal failure is the most frequent cause of secondary hyperparathyroidism. In some people with long-term secondary hyperparathyroidism, usually from the end-stage of kidney disease, parathyroid glands enlarge. They begin to release the parathyroid hormone on their own. The level of the hormone decreases with the medical treatment and the calcium in the blood is too high. This is called tertiary hyperparathyroidism, and people with this condition can require surgery to remove parathyroid tissue.

Severe deficiency of vitamin D. vitamin D helps to maintain calcium levels in the blood. It also helps your digestive system absorb calcium from the food.

Your body produces vitamin D when the skin is exposed to sunlight. You also get a bit of vitamin D in food. If you do not get enough vitamin D, then calcium levels may decrease.

Chronic renal failure. Your kidneys convert vitamin D into a form that the body can use. If your kidneys do not work well, usable vitamin D may lower the calcium levels drop. This causes parathyroid hormone levels to go up. Chronic renal failure is the most frequent cause of secondary hyperparathyroidism.

In some people with long-term secondary hyperparathyroidism, usually from the end-stage of kidney disease, parathyroid glands enlarge. They begin to release the parathyroid hormone on their own. The level of the hormone decreases with the medical treatment and the calcium in the blood is too high. This is called tertiary hyperparathyroidism, and people with this condition can require surgery to remove parathyroid tissue.

Risk factors

You may be at a higher risk of primary hyperparathyroidism if:

  • Is a woman who has been through the menopause
  • Have had severe and prolonged calcium or vitamin D deficiency
  • You have a rare inherited disorder, such as multiple endocrine neoplasia type 1, which usually affects multiple glands
  • Have had radiation treatment for the cancer that has exposed your neck to radiation
  • Have taken lithium, a drug that is most frequently used to treat bipolar disorder

Complications

Complications of hyperparathyroidism are mainly related to the long-term effect of too little calcium in the bones and in an excess of calcium in the bloodstream. Common complications include:

  • Osteoporosis. The loss of calcium from the bones, often resulting in weak, brittle bones that break easily (osteoporosis).
  • Stones in the kidney. Too much calcium in the blood can lead to an excess of calcium in the urine. This can cause small deposits of calcium, and other substances that form in the kidneys (kidney stones). A kidney stone usually causes a big headache as it passes from the kidneys through the urinary tract.
  • Cardiovascular disease. Although the exact cause and effect is clear, high levels of calcium is associated with the heart and blood vessels (cardiovascular) conditions, such as high blood pressure and certain types of heart disease.
  • Hypoparathyroidism Neonatal. Severe, untreated hyperparathyroidism in pregnant women can cause dangerously low levels of calcium in the newborn. Primary hyperparathyroidism is not uncommon in women of childbearing age.

Hyperparathyroidism

Diagnosis

In most cases, elevated levels of calcium is found in the blood tests ordered for other reasons. For example, routine blood work or tests to find the cause of the symptoms of another disease. Your doctor can diagnose hyperparathyroidism in order:

Blood tests

If the results of the tests show that you have high levels of calcium in the blood, your doctor will likely repeat the test. This repeated the test can confirm the results after you have not eaten for a period of time.

Many conditions can increase the levels of calcium. But your health care provider can diagnose hyperparathyroidism if blood tests show that also have high levels of parathyroid hormone.

Additional tests

After the diagnosis of primary hyperparathyroidism, your health care provider will likely order more tests. These can rule out possible medical conditions that cause hyperparathyroidism, identify potential complications, and to determine the severity of the condition. These tests include:

  • Bone mineral density test.This test is done to see if they have developed osteoporosis. The most common test to measure bone mineral density by dual energy X-ray absorptiometry (DEXA). This test uses special X-ray devices to measure the amount of grams of calcium and other bone minerals are packed into a segment of bone.
  • Urine test.24-hour urine collection can provide information about how well your kidneys are working and how much calcium is passed in the urine. This test can help your provider determine the severity of hyperparathyroidism or diagnose a disorder of the kidney causing hyperparathyroidism. If a very low level of calcium in the urine, it may mean that it is a condition that does not need treatment.
  • Imaging tests of the kidneys. Your doctor may order an x-ray or other imaging tests of your abdomen to determine if you have kidney stones or other kidney problems.

Bone mineral density test. This test is done to see if they have developed osteoporosis. The most common test to measure bone mineral density by dual energy X-ray absorptiometry (DEXA).

This test uses special X-ray devices to measure the amount of grams of calcium and other bone minerals are packed into a segment of bone.

Urine test. 24-hour urine collection can provide information about how well your kidneys are working and how much calcium is passed in the urine.

This test can help your provider determine the severity of hyperparathyroidism or diagnose a disorder of the kidney causing hyperparathyroidism. If a very low level of calcium in the urine, it may mean that it is a condition that does not need treatment.

Imaging tests before the surgery

If your health care provider recommends the surgery, one of these imaging tests can be used to localize the parathyroid gland or glands that are causing problems:

  • Sestamibi parathyroid scan.Sestamibi is a radioactive compound that is absorbed by the hyperactivity of the parathyroid glands. Can be detected by a scanner that detects radioactivity. A healthy thyroid gland also absorbs sestamibi. To keep the thyroid uptake blocking the view of the absorption in a parathyroid tumor (adenoma), is given radioactive iodine. This is only absorbed by the thyroid gland. Through this process, the thyroid image digitally removed so that can't be seen. The computed tomography (CT) may be combined with the sestamibi scan in order to improve the detection of any problem with the parathyroid glands.
  • Ultrasound.The ultrasound uses sound waves to create images of your parathyroid glands and surrounding tissue. A small device that is held against your skin (transducer) sends sharp sound of the surf and the records of the sound wave echoes that are reflected in the internal structures. A computer converts the echoes into an image on a monitor.

Sestamibi parathyroid scan. Sestamibi is a radioactive compound that is absorbed by the hyperactivity of the parathyroid glands. Can be detected by a scanner that detects radioactivity.

A healthy thyroid gland also absorbs sestamibi. To keep the thyroid uptake blocking the view of the absorption in a parathyroid tumor (adenoma), is given radioactive iodine. This is only absorbed by the thyroid gland. Through this process, the thyroid image digitally removed so that can't be seen.

The computed tomography (CT) may be combined with the sestamibi scan in order to improve the detection of any problem with the parathyroid glands.

Ultrasound. The ultrasound uses sound waves to create images of your parathyroid glands and surrounding tissue.

A small device that is held against your skin (transducer) sends sharp sound of the surf and the records of the sound wave echoes that are reflected in the internal structures. A computer converts the echoes into an image on a monitor.

Treatment

Treatment options for primary hyperparathyroidism can include watchful waiting, surgery, and medications.

Watchful waiting

Your health care provider may recommend no treatment, and regular monitoring if:

  • Calcium levels are only slightly elevated
  • Your kidneys are functioning well, and you do not have stones in the kidney
  • The bone density is within the standard range or only slightly below the range
  • You do not have other symptoms that may improve with treatment

If you choose this watch and wait approach, it is likely that you will have regularly scheduled tests to monitor your blood calcium levels and bone density.

Surgery

Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in most cases. A surgeon will remove only those glands that are enlarged or have a tumor.

If all four glands are affected, a surgeon may remove only three of the glands, and perhaps a part of the room leaving some of functioning parathyroid tissue.

The surgery can be performed as an outpatient procedure, allowing you to go home the same day. In such cases, the surgery can be performed through very small cuts (incisions) in the neck. You only get local anesthesia to numb the area.

The complications of the surgery are not common. The risks include:

  • The damage to the nerves that control the vocal cords.
  • Long-term low calcium levels which required the use of calcium and vitamin D supplements due to the removal of, or damage to all parathyroid glands. This means that the body can not produce enough parathyroid hormone to maintain calcium in the standard range.

Drugs

Medications to treat hyperparathyroidism include the following:

  • Calcimimetics.A calcimimetic is a drug that mimics calcium in the circulating blood. The drug can fool the parathyroid glands in the release of less parathyroid hormone. This drug is sold as cinacalcet (Sensipar). Cinacalcet may be an option for treating primary hyperparathyroidism, especially if the surgery has not been successfully cured the disorder, or a person is not a good surgery candidate. Cinacalcet and vitamin D analogues (the prescription forms of vitamin D) are used to control secondary hyperparathyroidism in chronic kidney disease. These medicines help to maintain the balance of calcium and phosphorus, minerals, with the purpose of the parathyroid glands do not have to work hard. The most common side effects of cinacalcet, are joint and muscle pain, diarrhea, nausea, and respiratory infection.
  • The hormone replacement therapy.For the women who have gone through menopause and have signs of osteoporosis, hormone replacement therapy can help to maintain bone calcium. However, this treatment does is to treat the underlying problems with the parathyroid glands. The long-term use of hormone replacement therapy may increase the risk of blood clots and breast cancer. Work with your health care provider to assess the risks and benefits to help you decide what is best for you. Some common side effects of hormone replacement therapy include breast pain and tenderness, dizziness, and headaches.
  • The bisphosphonates. Bisphosphonates also to prevent the loss of calcium from the bones and may reduce the osteoporosis caused by hyperparathyroidism. Some side effects associated with bisphosphonates include low blood pressure, fever, and vomiting. This treatment does is to treat the underlying problems with the parathyroid glands, and the level of calcium in the blood is maintained above the standard range.

Calcimimetics. A calcimimetic is a drug that mimics calcium in the circulating blood. The drug can fool the parathyroid glands in the release of less parathyroid hormone. This drug is sold as cinacalcet (Sensipar).

Cinacalcet may be an option for treating primary hyperparathyroidism, especially if the surgery has not been successfully cured the disorder, or a person is not a good surgery candidate.

Cinacalcet and vitamin D analogues (the prescription forms of vitamin D) are used to control secondary hyperparathyroidism in chronic kidney disease. These medicines help to maintain the balance of calcium and phosphorus, minerals, with the purpose of the parathyroid glands do not have to work hard.

The most common side effects of cinacalcet, are joint and muscle pain, diarrhea, nausea, and respiratory infection.

The hormone replacement therapy. For the women who have gone through menopause and have signs of osteoporosis, hormone replacement therapy can help to maintain bone calcium. However, this treatment does is to treat the underlying problems with the parathyroid glands.

The long-term use of hormone replacement therapy may increase the risk of blood clots and breast cancer. Work with your health care provider to assess the risks and benefits to help you decide what is best for you.

Some common side effects of hormone replacement therapy include breast pain and tenderness, dizziness, and headaches.

Self-care

If you and your health care provider they have chosen to monitor, in place of treat, your primary hyperparathyroidism, the following suggestions may help to prevent complications:

  • Control the amount of calcium and vitamin D is obtained in the diet.The restriction of the amount of calcium that you eat or drink is not recommended for people with hyperparathyroidism. The recommended daily amount of calcium for adults between the ages of 19 to 50 and men ages 51 to 70 is 1,000 milligrams (mg) of calcium per day. That the recommendation of calcium increases to 1,200 mg daily for women age 51 and older and men age 71 and older. The recommended daily amount of vitamin D is 600 international units (Iu) of vitamin D a day for people between the ages of 1 to 70 and 800 Iu per day for adults age 71 and older. Talk with your provider about dietary guidelines that are suitable for you.
  • Drink plenty of fluids. Drink plenty of liquids, especially water, to produce nearly clear urine to decrease the risk of kidney stones.
  • Exercise regularly. Regular exercise, including strength training, helps to maintain strong bones. Talk with your doctor about what type of exercise program is best for you.
  • Do not smoke. The habit of smoking can increase the loss of bone, as well as increase the risk of several serious health problems. Talk with your provider about the best ways of quitting smoking.
  • Avoid calcium-raising drugs. Certain medications, including some of the diuretics and lithium, can increase the levels of calcium. If you take these medicines, ask your healthcare provider if another medication may be appropriate for you.

Control the amount of calcium and vitamin D is obtained in the diet. The restriction of the amount of calcium that you eat or drink is not recommended for people with hyperparathyroidism.

The recommended daily amount of calcium for adults between the ages of 19 to 50 and men ages 51 to 70 is 1,000 milligrams (mg) of calcium per day. That the recommendation of calcium increases to 1,200 mg daily for women age 51 and older and men age 71 and older.

The recommended daily amount of vitamin D is 600 international units (Iu) of vitamin D a day for people between the ages of 1 to 70 and 800 Iu per day for adults age 71 and older. Talk with your provider about dietary guidelines that are suitable for you.

Preparing for your appointment

In most cases, elevated levels of calcium is detected by the evidence of blood to your health care provider has ordered as part of a routine examination, evidence of a relationship of condition or tests to identify the cause of a very general overview of the symptoms.

Talk with your doctor about the results of the test if they show that you have high levels of calcium. Questions to ask include:

  • Do I have hyperparathyroidism?
  • What evidence do I need to confirm the diagnosis or to determine the cause?
  • You should see a specialist in disorders of the hormone (endocrine)?
  • If I have hyperparathyroidism, do you recommend surgery?
  • What alternatives do I have for the surgery?
  • I have these other health conditions. How can I best manage them together?
  • Do you have printed material on the hyperparathyroidism that I can take home?

To understand the effect of hyperparathyroidism on your general health, your doctor may ask you questions about the possible mild signs or symptoms, including:

  • Do you feel depressed?
  • Do you often feel tired, easily fatigued, or general discomfort?
  • You feel any unexplained aches and pains?
  • That is often forgetful, distracted, or unable to concentrate?
  • Has experienced an increase in thirst and excessive urination?

Your doctor may ask you more questions about what medications you are taking and what your diet is like, to help determine if you are receiving an adequate amount of calcium and vitamin D.

Symptoms and treatment of Hyperparathyroidism