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Hyperparathyroidism: Causes, Symptoms and Treatment

Hyperparathyroidism is a condition in which the parathyroid glands produce too much parathyroid hormone, leading to elevated calcium levels in the blood.

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Things worth knowing about "Hyperparathyroidism"

Hyperparathyroidism is a condition in which the parathyroid glands produce too much parathyroid hormone, leading to elevated calcium levels in the blood.

What is Hyperparathyroidism?

Hyperparathyroidism is a disorder of the parathyroid glands -- four small glands located behind the thyroid gland in the neck. These glands produce parathyroid hormone (PTH), which regulates calcium and phosphate levels in the body. In hyperparathyroidism, excessive PTH is released, causing elevated blood calcium levels (hypercalcemia) and reduced phosphate levels.

Types of Hyperparathyroidism

Primary Hyperparathyroidism

Primary hyperparathyroidism originates within the parathyroid glands themselves. The most common cause is a benign tumor called an adenoma affecting one of the glands. Less frequently, all four glands may be enlarged (hyperplasia), or -- rarely -- a malignant parathyroid carcinoma may be responsible.

Secondary Hyperparathyroidism

Secondary hyperparathyroidism occurs as a compensatory response to chronically low calcium levels in the blood. Common underlying causes include chronic kidney disease, severe vitamin D deficiency, and malabsorption syndromes. The parathyroid glands work overtime to correct the calcium imbalance.

Tertiary Hyperparathyroidism

Tertiary hyperparathyroidism develops from longstanding secondary hyperparathyroidism. The glands become autonomous and continue to overproduce PTH even after the original trigger -- such as kidney failure -- has been resolved.

Causes

Benign parathyroid adenoma (most common cause of primary hyperparathyroidism)
Hyperplasia of all four parathyroid glands
Chronic kidney disease (most common cause of secondary hyperparathyroidism)
Vitamin D deficiency
Malabsorption (e.g., in celiac disease or Crohn's disease)
Genetic syndromes such as Multiple Endocrine Neoplasia (MEN type 1 or 2)

Symptoms

Many patients initially experience no or only nonspecific symptoms, and the condition is often discovered incidentally during routine blood tests. Common symptoms include:

Kidney stones (nephrolithiasis) due to excess calcium in the urine
Bone pain and increased bone fragility (osteoporosis)
Fatigue, weakness, and general malaise
Nausea, vomiting, and loss of appetite
Constipation
Increased urination and thirst (polyuria and polydipsia)
Depression, difficulty concentrating, and cognitive changes
In severe cases: hypercalcemic crisis with altered consciousness

Diagnosis

Diagnosis is typically established through blood tests. Key laboratory findings include:

Elevated PTH in serum
Elevated calcium in the blood (hypercalcemia)
Low phosphate levels in the blood
Increased calcium excretion in a 24-hour urine sample

Imaging techniques are used to localize affected glands, including ultrasound, scintigraphy (sestamibi scan), and CT or MRI scans.

Treatment

Surgical Treatment

For primary hyperparathyroidism, parathyroidectomy -- surgical removal of the affected gland -- is the treatment of choice and leads to a permanent cure in the vast majority of cases.

Medical Management

When surgery is not appropriate or necessary, the following options are available:

Calcimimetics (e.g., cinacalcet): Reduce PTH levels by increasing the sensitivity of the parathyroid gland to calcium.
Bisphosphonates: Help protect bones from further loss of density.
Adequate hydration and dietary modifications to reduce calcium intake in mild cases.

Treatment of Secondary Hyperparathyroidism

Management focuses on treating the underlying condition. In patients with kidney disease, vitamin D analogues (e.g., alfacalcidol, calcitriol) and phosphate binders are commonly prescribed.

Prognosis

With timely diagnosis and appropriate treatment, the prognosis for hyperparathyroidism is generally favorable. Following successful surgery, calcium and PTH levels typically normalize quickly. If left untreated, the condition can lead to serious complications including kidney failure, osteoporosis, and cardiovascular disease.

References

Bilezikian JP et al. - Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism, 2022.
Insogna KL - Primary Hyperparathyroidism. New England Journal of Medicine, 2018.
Goodman WG, Quarles LD - Development and progression of secondary hyperparathyroidism in chronic kidney disease. Kidney International, 2008.

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