Health Encyclopedia

Primary hyperparathyroidism

Definition

Primary hyperparathyroidism is an endocrine disorder in which the parathyroid glands in the neck produce too much parathyroid hormone (PTH).

Alternative Names

Parathyroid-related hypercalcemia; Hyperparathyroidism - primary

Causes, incidence, and risk factors

The parathyroid glands are located in the neck, near or attached to the back side of the thyroid gland. They produce parathyroid hormone, which controls calcium, phosphorus, and vitamin D levels within the blood and bone.

When calcium levels are too low, the body responds by increasing production of parathyroid hormone. This increase in parathyroid hormone causes more calcium to be taken from the bone and more calcium to be reabsorbed by the intestines and kidney. When the calcium level returns to normal, parathyroid hormone production slows down.

Primary hyperparathyroidism is caused by swelling of one or more of the parathyroid glands. This leads to the release of too much parathyroid hormone, which raises the level of calcium in the blood. The term "hyperparathyroidism" generally refers to primary hyperparathyroidism.

Rarely, the disease is caused by parathyroid cancer.

The disease is most common in people over 60, but can also be seen in younger adults. Hyperparathyroidism in childhood is very unusual.

Women are more likely to be affected than men. Radiation to the head and neck increases your risk.

Symptoms

Decreased height
Depression
Fatigue
Fractures
Increased urination
Kidney stones
Loss of appetite
Muscle weakness and pain
Nausea
Personality changes
Upper abdominal pain
Stupor and possibly coma

Signs and tests

Blood tests will be done to check for increased levels of parathyroid hormone (PTH), calcium, and alkaline phosphatase, and lower levels of phosphorus.

Bone x-rays and a bone mineral density test can help detect bone loss, fractures, or bone softening.

X-rays, ultrasound, or CT scans of the kidneys or urinary tract may show calcium deposits or a blockage.

Treatment

Treatment depends upon the severity and cause of the condition.

If you have mildly increased calcium levels due to primary hyperparathyroidism and no symptoms, you may just need regular check ups with your doctor.

However, you need treatment if:

Your kidneys do not work correctly
You have calcium loss from your bones
Kidney stones develop

If treatment is needed, it may include:

Drinking more fluids to prevent the formation of kidney stones
Movement and exercise
Avoiding thiazide-type diuretics ("water pills")
Using estrogen therapy (for postmenopausal women)

If symptoms are present or your calcium level is very high, surgery may be needed to remove the parathyroid gland that is overproducing the hormone. Surgery is also recommended for patients less than 50 years of age.

Treatment for severe symptoms may also include:

Fluids given through a vein (IV)
Medications such as bisphosphonates and calcitonin, which bring down calcium levels quickly

Expectations (prognosis)

The outlook is good for those with mild symptoms. Most cases of primary hyperparathyroidism are mild.

Complications

Complications may include:

Bone damage
Increased risk of fractures
Pancreatitis
Pseudogout
Urinary tract infection due to kidney stones and blockage

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of hyperparathyroidism.

References

Wysolmerski JJ. Insogna KL. The Parathyroid Glands, Hypercalcemia, and Hypocalcemia. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008: chap. 266.

Bringhurst FR, Demay MB, Kronenberg HM. Disorders of Mineral Metabolism. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008: chap. 27.

AACE/AAES Task Force on Primary Hyperparathyroidism. The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract. 2005 Jan-Feb;11(1):49-54.

Review Date:7/15/2008
Reviewed By:Robert Cooper, MD, Endocinology Specialist and Chief of Medicine, Holyoke Medical Center, Assistant Professor of Medicine, Tufts University School of Medicine, Boston MA Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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