A condition called hyperparathyroidism occurs when the parathyroid glands produce too much parathyroid hormone (PTH). PTH controls calcium, phosphorus, and vitamin D levels in the blood and bones. Several health problems may result from this excess of PTH, such as kidney stones, osteoporosis, and cardiovascular disease, which causes calcium levels in the blood to rise when they decrease in the bones.
Hyperparathyroidism can be classified into two types: primary and secondary.
A benign tumor called an adenoma or a cancer called a carcinoma can cause primary hyperparathyroidism. These growths cause the glands to produce excess PTH, regardless of the blood calcium levels. Women are more likely to suffer from primary hyperparathyroidism than men, and people over 50 usually suffer from it. It can also be inherited, as part of a genetic syndrome, like multiple endocrine neoplasia (MEN).
In addition to chronic kidney disease, vitamin D deficiency, or malabsorption, secondary hyperparathyroidism is caused by conditions that lower the blood calcium levels. In order to restore calcium balance, the parathyroid glands produce more PTH. People with kidney failure or who do not get enough sunlight or dietary vitamin D are more likely to develop secondary hyperparathyroidism.
The symptoms of hyperparathyroidism depend on the severity of the condition and the duration of the high calcium levels in the blood. Some people may not have any symptoms, while others may experience:
Weakness, fatigue, or depression
Nausea, vomiting, or loss of appetite
Abdominal pain, constipation, or peptic ulcers
Increased thirst, urination, or dehydration
Kidney stones, infections, or damage
Bone pain, fractures, or osteoporosis
Muscle cramps, spasms, or twitching
Confusion, memory loss, or dementia
Headache, dizziness, or ringing in the ears
High blood pressure, irregular heartbeat, or chest pain
Hyperparathyroidism can affect the quality of life, the physical and mental health, and the life expectancy of the person. It can also increase the risk of other complications, such as pancreatitis, gout, or calcification of soft tissues.
In order to diagnose hyperparathyroidism, a doctor will perform a physical exam and ask about the patient's medical history, family history, and symptoms. A blood test and urine test will also be ordered by the doctor to check calcium levels, phosphorus levels, PTH levels, vitamin D levels, and kidney function. To visualize the parathyroid glands and look for abnormalities, the doctor may also order imaging tests, such as an ultrasound, CT scan, or nuclear scan.
The doctor will use the results of the tests and the history to determine the type and the cause of hyperparathyroidism, and to prescribe the appropriate treatment.
The treatment of hyperparathyroidism aims to lower the PTH levels and the calcium levels in the blood, and to prevent or treat the complications of the condition. The most common treatments are:
An effective and definitive treatment for primary hyperparathyroidism is surgery. Surgery involves the removal of the abnormal parathyroid gland or glands, which usually cures the condition. Under general anesthesia, the surgery has a high success rate and low complication rate. The individual must undergo a thorough evaluation prior to the surgery, and follow the postoperative instructions carefully following the procedure. Surgical risks and complications may include bleeding, infection, nerve damage, or hypoparathyroidism (low PTH levels).
Medications, which are used to treat secondary hyperparathyroidism, or to manage the symptoms of hyperparathyroidism, when surgery is not possible or not indicated. They include:
Calcimimetics, which mimic the action of calcium and reduce the PTH production by the parathyroid glands.
Bisphosphonates, which inhibit the bone resorption and prevent the loss of calcium from the bones.
Diuretics, which increase the urine output and lower the calcium levels in the blood.
Analgesics, which relieve the pain caused by kidney stones or bone fractures.
Lifestyle changes, which are important to support the treatment and to prevent the worsening of hyperparathyroidism. They include:
Drinking plenty of fluids, to prevent dehydration and kidney stones.
Eating a balanced diet, low in sodium and phosphorus, and high in calcium and vitamin D, to maintain the bone health and the calcium balance.
Avoiding alcohol, caffeine, and tobacco, as they can interfere with the calcium metabolism and the kidney function.
Exercising regularly, to strengthen the bones and the muscles, and to improve the mood and the energy levels.
Monitoring the blood pressure, the blood sugar, and the cholesterol levels, to prevent or control the cardiovascular disease.
The doctor will discuss the pros and cons of each treatment option and help the person make the best decision based on the person's age, the type and cause of hyperparathyroidism, their overall health, and their personal preferences.
It is impossible to prevent hyperparathyroidism, since it is largely determined by genetic and environmental factors that affect calcium metabolism and parathyroid glands. In order to protect their health and prevent complications associated with hyperparathyroidism, the person can:
Having regular check-ups, at least once a year, or more often if recommended by the doctor.
Taking the prescribed medications, and adjusting them as needed.
Following the proper hygiene and care instructions for the surgery, if applicable, and reporting any signs of infection or bleeding.
Seeking medical attention, if they notice any symptoms of hyperparathyroidism, such as bone pain, kidney stones, or confusion.
Educating themselves and their family members about hyperparathyroidism, its causes, its symptoms, its diagnosis, its treatment, and its prevention.
By understanding the causes, symptoms, diagnosis, treatment, and prevention of hyperparathyroidism, one can take control of their health and enjoy a better quality of life.
