Symptoms and Causes of Hyperparathyroidism | Endocrinology

Hyperparathyroidism

What is hyperparathyroidism?

Hyperparathyroidism occurs when the parathyroid glands overproduce parathyroid hormone (PTH). The parathyroid glands are four pea-sized endocrine glands found in the neck, located behind or near the thyroid. The endocrine glands secrete hormones necessary for the normal functioning of the body.

Despite similar names and adjacent to your neck, the parathyroid and thyroid glands are very different organs. PTH helps control the levels of calcium, vitamin D, and phosphorus in the bones and blood.

Hyperparathyroidism occurs when the parathyroid glands produce too much parathyroid hormone in the bloodstream. These glands located behind the thyroid at the bottom of your neck are about the size of a grain of rice.

Symptoms

In many cases, a person with hyperparathyroidism has no symptoms. A person with mild hyperparathyroidism may have some of the following symptoms:

  • Joint pain
  • Muscular weakness
  • Fatigue
  • Depression
  • Concentration problems
  • Lack of appetite

The most severe cases of hyperparathyroidism cause these symptoms:

  • Nausea and vomiting
  • Confusion
  • Increased thirst and the need to urinate

Other complications associated with an acute case of hyperparathyroidism:

  • Decreased kidney function, which affects the kidneys’ ability to filter blood.
  • Kidney stones
  • Thin bones (osteoporosis)
  • People with hyperparathyroidism are more likely to have high blood pressure and need treatment to recommend a specific treatment for hyperparathyroidism or not.

Types

Primary hyperparathyroidism: In primary hyperparathyroidism, one or more parathyroid glands cause an overproduction of proliferative hormone. It causes high levels of calcium in the blood, which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism.

Secondary hyperparathyroidism: Secondary hyperparathyroidism is caused by another disease that causes low levels of calcium in the body. Over time, elevated levels of parathyroid hormone develop.

Causes

Hyperparathyroidism is caused by factors that increase the production of parathyroid hormone.

The parathyroid glands maintain adequate levels of calcium and phosphorus in your body by stopping or turning on the secretion of parathyroid hormone (PTH), regulating the heating system to maintain a constant air temperature like a thermostat. Vitamin D is also involved in regulating the amount of calcium in the blood.

In general, this balancing act works well. When calcium levels in the blood are very low, the parathyroid glands secrete enough PTH to restore balance. PTH increases calcium levels by releasing calcium from the bones and increasing the amount of calcium absorbed through the small intestine.

When blood calcium levels are too high, the parathyroid glands make less PTH. But sometimes one or more of these glands make too much hormone. This can lead to abnormally high levels of calcium and low levels of phosphorus in the blood.

Calcium is known for its role in the health of teeth and bones. But calcium also helps in the transmission of signals in nerve cells and participates in muscle contraction. Another mineral phosphorus works in conjunction with calcium in these areas.

Hyperparathyroidism can be caused by a problem with the parathyroid glands (primary hyperparathyroidism) or by another disease (secondary hyperparathyroidism) that affects the function of the glands.

Primary hyperparathyroidism: Primary hyperparathyroidism is caused by a problem with one or more of the four parathyroid glands:

  • The most common cause is a non-cancerous growth (adenoma) in the gland
  • The enlargement of two or more parathyroid glands (hyperplasia) can cause many other cases
  • A cancerous tumor is a very rare cause of primary hyperparathyroidism
  • Primary hyperparathyroidism usually occurs spontaneously, although some people inherit the gene that causes the disorder

Secondary hyperparathyroidism: Secondary hyperparathyroidism is the result of another condition that lowers calcium levels. Your parathyroid glands work harder to compensate for the loss of calcium. Factors that contribute to secondary hyperparathyroidism:

  • Severe calcium deficiency: Your body may not get enough calcium from your diet because your digestive system doesn’t absorb it.
  • Severe vitamin D deficiency: Vitamin D helps maintain adequate levels of calcium in the blood. It helps your digestive system absorb calcium from your diet. Your body makes vitamin D when your skin is exposed to sunlight. You should also have some vitamin D in your diet. If you don’t get enough vitamin D, your calcium levels can drop.
  • Chronic kidney failure: Your kidneys convert your body into vitamin D that our bodies can use. If your kidneys are not working properly, helpful vitamin D will decrease and calcium levels will drop, causing parathyroid hormone levels to rise. Chronic kidney failure is the most common cause of secondary hyperparathyroidism. Some medical treatments, such as vitamin D, bisphosphonates, and cinacalcet, lower pH levels.

In some people with end-stage chronic kidney disease, the parathyroid glands dilate and begin to release PTH on their own, and PTH does not decrease with medical treatment. This is called tertiary hyperparathyroidism, and people with this condition may need surgery to remove the parathyroid tissue.

Risk factors

The risk of primary hyperparathyroidism is higher if you have:

  • The woman who went through menopause
  • Have a long-term and severe deficiency of calcium or vitamin D
  • You have a rare inherited disorder, such as multiple endocrine neoplasias, type 1, which usually affects multiple glands
  • Radiation treatment for cancer that exposes your neck to radiation
  • Lithium is a drug commonly used to treat bipolar disorder

Diagnosis

If regular blood tests show that your blood is high in calcium, your primary care provider may suspect that you have hyperparathyroidism. To confirm this diagnosis, your primary care provider may need to perform other tests.

Blood test: Additional blood tests can help your primary care provider make a more accurate diagnosis. Your primary care doctor will check your blood for high levels of PTH, high levels of alkaline phosphatase, and low levels of phosphorus.

Urine analysis: A urine test can help your primary care provider know how serious your condition is and if it is due to kidney problems. Your primary care provider will check your urine to see how much calcium it contains.

Kidney tests: Your primary care provider can take X-rays of your abdomen to check for kidney abnormalities.

Treatment

Primary hyperparathyroidism: You do not need treatment if your kidneys are working well, your calcium levels are slightly higher, or your bone density is normal. In this case, your primary care provider can monitor your condition once a year and monitor your blood calcium levels twice a year.

Your primary care provider will also recommend that you look at how much calcium and vitamin D you can get from your diet. You should drink plenty of water to reduce the risk of kidney stones. You need to exercise regularly to strengthen your bones. If treatment is needed, surgery is the most commonly used treatment. Surgical procedures involve the removal of parathyroid glands or tumors that have spread to the glands. Complications include very rare and damaged vocal cord nerves and chronic low calcium levels.

Calcimetics are another treatment that acts like calcium in the blood. These drugs can trick your glands into making low levels of PTH. Sometimes they are mentioned by primary care providers if surgery is unsuccessful or not an option. Bisphosphonates can help reduce the risk of osteoporosis by preventing the bones from losing calcium.

Hormone replacement therapy helps the bones capture calcium. This treatment can treat osteoporosis in postmenopausal women, although there are risks with long-term use. Some of these have an increased risk of cancer and cardiovascular disease.

Secondary hyperparathyroidism: Treating the underlying cause in the treatment will bring your PTH level back to normal. Treatment methods include prescribed vitamin D intake for severe deficiencies and calcium and vitamin D intake for chronic kidney failure. If you have chronic kidney failure, you may also need medicine and dialysis.

Complications

Hyperparathyroidism problems are primarily related to the long-term effect of too little calcium in the bones and too much calcium in the bloodstream. Common problems:

Osteoporosis: Weak and brittle bones can easily break due to loss of calcium (osteoporosis).

Kidney stones: Too much calcium in the blood can lead to too much calcium in the urine, which forms small, hard calcium and other substances in the kidneys. Kidney stones can cause great pain as they pass through the kidneys.

Heart disease: Although the exact cause and effect link is unclear, high calcium levels are associated with cardiovascular conditions such as high blood pressure and certain types of heart disease.

Neonatal hypoparathyroidism: Untreated severe hyperparathyroidism in pregnant women causes low calcium levels in newborns.

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