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Diseases & Conditions

Hyperparathyroidism

What is hyperparathyroidism?

Hyperparathyroidism is a condition in which one or more of the parathyroid glands become overactive and secrete too much parathyroid hormone (PTH). This causes the levels of calcium in the blood to rise, a condition known as hypercalcemia.

What are the parathyroid glands?

The parathyroid glands secrete PTH to help control the levels of calcium and phosphorous in the body. There are usually four parathyroid glands, located on the outside borders of the thyroid gland in the front of the neck.

How does hyperparathyroidism occur?

There are two types of hyperparathyroidism, primary and secondary:

  • In primary hyperparathyroidism, the parathyroid glands spontaneously produce an excessive amount of PTH, which causes the level of calcium in the blood to rise.
  • In secondary hyperparathyroidism, the overactivity of the parathyroid glands occurs in a condition such as kidney failure where calcium levels tend to be low, and the parathyroid overactivity is an attempt on the body’s part to keep the calcium levels normal.

The cause of primary hyperparathyroidism isn’t fully understood. In most cases, a benign (noncancerous) growth called an adenoma forms on a single parathyroid gland and causes it to become overactive. Another cause is a condition called hyperplasia, in which two or more of the parathyroid glands become enlarged.

Approximately 100,000 people develop hyperparathyroidism in the United States every year. Older women who are postmenopausal are at the highest risk for the disease.

What are the symptoms of hyperparathyroidism?

In many instances, a person who has hyperparathyroidism doesn’t have any symptoms. A person who has mild hyperparathyroidism may have some of the following symptoms:

  • joint pain
  • muscle weakness
  • fatigue
  • depression
  • trouble concentrating
  • loss of appetite

More severe cases of hyperparathyroidism may produce these symptoms:

  • nausea and vomiting
  • confusion
  • increased thirst and need to urinate

Other problems associated with a severe case of hyperparathyroidism include:

  • reduced kidney function, which affects a kidney’s ability to filter blood
  • kidney stones
  • thinning bones (osteoporosis)

High blood pressure occurs more commonly in people with hyperparathyroidism and may need to be treated whether or not specific treatment is recommended for the hyperparathyroidism.

How is hyperparathyroidism diagnosed?

Because the symptoms of hyperparathyroidism can be overlooked, the disease is often discovered through a blood test that is ordered for another condition. In the case of primary hyperparathyroidism, the blood test shows that the person has higher-than-normal levels of calcium and parathyroid hormone. Because of the risk of osteoporosis, the doctor may also order a bone density test to see if there is any bone loss. Other tests might include an ultrasound of the kidneys to check for stones, and measurement of calcium in the urine.

How is hyperparathyroidism treated?

If you have mild hyperparathyroidism (no symptoms, blood calcium levels only slightly elevated), then your doctor may advise that you do not need to treat it. Instead, the doctor will monitor your blood calcium levels (every six months), blood pressure (every six months), kidney function (every year) and bone density (every two years).

If the doctor feels that the hyperparathyroidism does not need immediate treatment, you should take certain measures, including the following:

  • Drink more water
  • Keep active and get more exercise.
  • Do not take thiazide diuretics or lithium because these drugs can increase the level of calcium in the blood.

If you have more severe hyperparathyroidism, your doctor may recommend that you have surgery to remove the enlarged parathyroid gland (or glands). If surgery is needed, be sure to go to a well-experienced surgeon. The cure rate is very good—often around 95%.

A group of drugs known as calcimimetics has been approved by the Food and Drug Administration for the treatment of both primary and secondary hyperparathyroidism. These drugs work by stopping the production of PTH by the parathyroid glands. Although calcimimetics are intended for secondary hyperparathyroidism, some physicians prescribe them for primary hyperparathyroidism.

What is the prognosis for people who have hyperparathyroidism?

Surgery will cure nearly all cases of hyperparathyroidism. If you have surgery, your doctor may want to check your calcium and PTH levels six weeks after surgery, and then on a yearly basis. You may also have a bone density test every year, as well.

References:

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/14/2013…#14454