Hyperparathyroidism

(Overactive Parathyroid)

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 people with long-standing kidney failure or a vitamin D deficiency
  • Tertiary—occurs in people with long-standing kidney failure and dialysis
Thyroid and Parathyroid Glands: Posterior (Back) View
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Causes

Primary hyperparathyroidism may be caused by:
  • Noncancerous tumor in the parathyroid gland—most common cause
  • Familial hyperparathyroidism
  • Multiple endocrine neoplasia (MEN)
  • Parathyroid cancer—rare
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 gland is the main risk factor for tertiary hyperparathyroidism.

Risk Factors

Hyperparathyroidism is more common in women, especially after menopause. It is also more common in people older than 50 years of age. Other factors that may increase your chance of hyperparathyroidism include:
  • Multiple endocrine neoplasia
  • Having specific genetic factors that increase your risk
  • Radiation therapy to the 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
  • Fatigue
  • Muscle weakness
  • Joint pain
  • Memory loss
  • Heartburn
  • Back pain

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.Your bodily fluids may be tested. This can be done with:
  • Blood tests
  • Urine tests
Images may be taken of your bodily structures. This can be done with:
  • Ultrasound
  • 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:

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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
  • Hyperparthyroidism due to a vitamin D deficiency may be treated with medications
  • Treating underlying causes
  • Medication to manage possible side effects

Monitoring of Blood Calcium Levels

Your doctor may 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 and vitamin D 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 Endocrine Surgeons
http://endocrinediseases.org

Hormone Health Network—Endocrine Society
http://www.hormone.org

CANADIAN RESOURCES

Health Canada
http://www.hc-sc.gc.ca

Canadian Society of Endocrinology and Metabolism
http://www.endo-metab.ca

References

Hyperparathyroidism. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/hyperparathyroidism/treatment.html. Updated March 2014. Accessed June 4, 2014.

Hyperparathyroidism. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 28, 2014. Accessed June 4, 2014.

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;69(2):333.

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

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