Hyperparathyroidism
En Español (Spanish Version)

Definition
Hyperparathyroidism is when the body makes too much parathyroid hormone (PTH). The parathyroid glands make PTH which help to keep calcium levels in balance.

Hyperparathyroidism may be:

  • Primary—a benign tumor of the parathyroid gland that makes too much PTH (most common form)
  • Secondary—occurs in patients with long-standing kidney failure or a vitamin D deficient state
  • Tertiary—also occurs in patients with very long-standing kidney failure and dialysis
Thyroid and Parathyroid Glands: Posterior (Back) View

Copyright © Nucleus Medical Media, Inc.

Causes
Primary hyperparathyroidism may be caused by:

  • Noncancerous tumor in the parathyroid gland (most common cause)
  • Parathyroid cancer (very rare)
  • Familial hyperparathyroidism
  • Multiple endocrine neoplasia (MEN)
Secondary hyperparathyroidism may be caused by:

  • Vitamin D deficiency (due to inadequate dietary intake, lack of sunlight exposure, or malabsorption condition like celiac disease)
  • Kidney failure or other medical problems that make the body resistant to the action of the parathyroid hormone
  • Enlargement of the parathyroid glands—common cause
Enlargement of the parathyroid gland is the main risk factor for tertiary hyperparathyroidism.

Risk Factors
Hyperparathyroidism is more common in women, especially after menopause . Other factors that may increase your chance of developing hyperparathyroidism include:

  • Age: older than 50 years
  • Multiple endocrine neoplasia
  • Having specific genetic factors that increase your risk
  • Radiation therapy to head or neck during childhood
Symptoms
The level of calcium in the blood will determine the symptoms. Symptoms commonly seen with primary hyperparathyroidism include:

  • Constipation
  • Nausea
  • Vomiting
  • Abdominal pain
  • Headache
  • Loss of appetite
  • Thirst
  • Frequent and sometimes painful urination due to kidney stones
  • Lethargy
  • Fatigue
  • Muscle weakness
  • Joint pain
  • Memory loss
  • Depression
  • Heartburn
  • Back pain
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done.

To measure calcium levels your doctor may ask for:

  • Blood tests—to measure calcium, phosphorus, magnesium, alkaline phosphatase, vitamin D, and PTH, kidney and liver function tests
  • Urine test—a 24-hour urine collection to measure calcium excretion and kidney function (very important test)
Images of the parathyroid gland may be taken with:

  • Neck ultrasound —a test that uses sound waves, not radiation, to detect a large parathyroid tumor (adenoma)
  • Technetium 99m sestamibi scan—a nuclear medicine test that uses safe nuclear molecules to make pictures of the parathyroid glands to help locate a single parathyroid adenoma in primary hyperparathyroidism
Other tests may be done to look for other problems hyperparathyroid may cause:

Treatment
Treatment will be based on the type of hyperparathyroidism. Options may include the following:

  • If a growth is causing the problems, surgery may be done to remove the growth. This can often result in a growth.
  • Hyperaparthyroidism due to a vitamin D deficiency may be treated with:
    • Vitamin D ergocalciferol or cholecalciferol —for treating secondary hyperparathyroidism due to vitamin D deficiency.
    • Calcitriol (the most active vitamin D metabolite)—helps to reduce PTH production in secondary hyperparathyroidism in chronic kidney failure
    • Cinacalcet —helps to lower PTH blood levels for secondary and tertiary hyperparathyroidism in chronic kidney disease or parathyroid cancer
  • Treating underlying causes
  • Medication to manage possible side effects
Monitoring of Blood Calcium Levels
Your doctor may simply choose to regularly check your blood calcium levels and monitor you for possible complications. This may include regular bone density tests every 1-2 years.

Prevention
Adequate calcium intake may play a role in preventing hyperparathyroidism in women. Try to get recommended levels of calcium through dietary choices and supplements.




RESOURCES:
American Association of Clinical Endocrinologists

The Hormone Foundation

National Institute of Diabetes and Digestive and Kidney Disorders

CANADIAN RESOURCES:
Canada Health Portal

Canadian Society of Endocrinology and Metabolism

References:
Hyperparathyroidism. American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/hyperparathyroidism/treatment.html . Updated November 2010. Accessed June 17, 2013.

Hyperparathyroidism. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated December 24, 2012. Accessed June 17, 2013.

Silverberg SJ, Bilezikian JP. The diagnosis and management of asymptomatic primary hyperparathyroidism. Nat Clin Pract Endocrinol Metab . 2006;2:494-503.

Taniegra E. Hyperparathyroidism. Am Fam Physician . 2004 Jan 15;69(2):333.

11/26/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Paik J, Curhan G, Taylor E. Calcium intake and risk of primary hyperparathyroidism in women: prospective cohort study. BMJ. 2012;345:e6390

Last Reviewed June 2013



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