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Hyperparathyroidism
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Hyperparathyroidism

En Español (Spanish Version)

Definition

Hyperparathyroidism is a disorder in which too much parathyroid hormone (PTH) is secreted from the parathyroid glands, resulting in abnormally high levels of calcium in the blood (hypercalcemia). Hyperparathyroidism is further classified as being primary, secondary, and tertiary.

Primary hyperparathyroidism is more common than either secondary or tertiary hyperparathyroidism, which occurs in patients with kidney failure or a severe vitamin D deficient state. The parathyroid glands are four pea-sized glands located next to the thyroid gland in the neck; they secrete PTH, which regulates the level of calcium in the blood.

Thyroid and Parathyroid Glands: Posterior (Back) View

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© 2008 Nucleus Medical Art, Inc.

Causes

In most cases of hyperparathyroidism, the exact cause is not known. Factors that may contribute to hyperparathyroidism include:

  • Adenoma (benign tumor) in the parathyroid gland (accounting for 85% of primary hyperparathyroidism)
  • Hyperplasia (enlargement) of the parathyroid glands (accounting for over 80% of secondary or tertiary hyperparathyroidism)
  • Parathyroid cancer
  • Familial hyperparathyroidism
  • Vitamin D deficiency (due to malabsorption, lack of sunlight exposure, inadequate dietary intake)
  • Radiation therapy to head or neck during childhood
  • Multiple endocrine neoplasia (MEN)
  • Kidney failure or other medical problems that make the body resistant to the action of the parathyroid hormone (called secondary hyperparathyroidism)

Risk Factors

The following factors increase your chance of developing hyperparathyroidism. If you have any of these risk factors, tell your doctor:

  • Sex: female (Hyperparathyroidism is three times more common in women, especially after menopause .)
  • Age: older than 60 years
  • Multiple endocrine neoplasia (an inherited disorder that affects the endocrine glands)
  • Genetics that make you more likely to have hyperparathyroidism

Symptoms

If you experience any of these symptoms, do not assume it is due to hyperparathyroidism. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.

The degree of hypercalcemia, as well as how rapidly the disease progresses, will determine both the type and severity of the symptoms. Symptoms commonly seen with primary hyperparathyroidism include the following:

  • Loss of appetite
  • Thirst
  • Frequent and sometimes painful urination
  • Lethargy
  • Fatigue
  • Muscle weakness
  • Joint pain
  • Constipation
  • Nausea
  • Vomiting
  • Abdominal pain
  • Memory loss
  • Depression
  • Heartburn
  • Back pain

Symptoms and clinical signs common to those patients with secondary or tertiary hyperparathyroidism include the following:

  • Bone pain
  • Fracture
  • Muscle weakness
  • Symptoms related to kidney failure or intestinal diseases such as malabsorption

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. You may be referred to a doctor who specializes in hormone disorders (endocrinologist) or a surgeon who specializes in endocrine surgery.

Tests may include the following:

  • Blood tests—to measure calcium, phosphorus, alkaline phosphatase, vitamin D, and/or PTH
  • Urine test—a 24-hour urine collection to measure calcium excretion and kidney function
  • Abdominal x-ray—a test that uses radiation to take a picture of the structures inside the body. This test can show kidney stones caused by high calcium levels
  • Bone density test—a test to measure bone loss and risk of fractures
  • Neck ultrasound—a test that uses sound waves to examine the body. This test is used to detect a large parathyroid tumor (adenoma).
  • Magnetic resonance imaging (MRI) or technetium 99m sestamibi scan—a test that uses magnetic waves to make pictures of structures inside the body. These scans are used to locate a single parathyroid adenoma.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Medications

  • 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
  • Paricalcitol (a vitamin D analog)—for the prevention and treatment of secondary hyperparathyroidism associated with chronic kidney failure
  • Ergocalciferol (a vitamin D analog)—for treating secondary hyperparathyroidism due to deficiency of vitamin D
  • Estrogen (hormone replacement therapy) for postmenopausal women

Surgery

A very effective treatment is the surgical (partial or complete) removal of the parathyroid adenoma in primary hyperparathyroidism or parathyroid gland tissue in secondary or tertiary hyperparathyroidism. This procedure is called partial or complete parathyroidectomy.

In primary hyperparathyroidism, parathyroidectomy results in a 95% cure rate with normalization of serum calcium and increase in bone density with reduced risk of kidney stones. In secondary hyperparathyroidism due to chronic renal failure, parathyroidectomy is often performed in those patients who fail medical treatment.

Monitoring of Blood Calcium Levels

If the hyperparathyroidism is not causing symptoms, your doctor may choose to regularly check your blood calcium levels and monitor you for possible complications of hyperparathyroidism. This may include regular bone density tests.

Prevention

There are no guidelines for preventing hyperparathyroidism.

RESOURCES:

American Association of Clinical Endocrinologists
http://www.aace.com

The Hormone Foundation
http://www.hormone.org

National Institute of Diabetes and Digestive and Kidney Disorders
http://www2.niddk.nih.gov/

CANADIAN RESOURCES:

Canada Health Portal
http://chp-pcs.gc.ca/CHP/index_e.jsp

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

References:

Bilezikian JP, Potts JT Jr, Fuleihan Gel-H, et al. Summary statement from a work shop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endo Metab . 2002;37:5353-5361.

Cannella G, Messa P. Therapy of secondary hyperparathyroidism to date: vitamin d analogs, calcimimetics or both? J Nephrol . 2006;19:399-402.

Clark OH. How should patients with primary hyperparathyroidism be treated? (Editorial). J Clin Endocrinol Metab . 2003;88:3011-3014.

Hyperparathyroidism. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at: http://www.niddk.nih.gov/health/endo/pubs/hyper/hyper.htm .

Information for patients about primary hyperparathyroidism. National Institutes of Health Osteoporosis and Related Bone Diseases, National Resource Center website. Available at: http://www.osteo.org/newfile.asp?doc=p112i&doctitle=Primary+Hyperparathyroidism&doctype=HTML+Fact+Sheet . Accessed July 4, 2005.

Messa P, Macario F, Yaqoob M, et al. The OPTIMA study: assessing a new cinacalcet (Sensipar/Mimpara) treatment algorithm for secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2008;3:36-45.

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

Taniegra ED. Hyperparathyroidism. Am Fam Physician . 2004; 69:333-340.

Torpy JM. Glass RM, ed. Hyperparathyroidism. JAMA . 2005;293(14).



Last reviewed March 2008 by David Juan, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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