Parathyroid hyperplasia

  • Definition
    • Parathyroid hyperplasia is the enlargement of all 4 parathyroid glands. The parathyroid glands are located in the neck, near or attached to the back side of the thyroid gland.

  • Alternative Names
    • Enlarged parathyroid glands; Osteoporosis - parathyroid hyperplasia; Bone thinning - parathyroid hyperplasia; Osteopenia - parathyroid hyperplasia; High calcium level - parathyroid hyperplasia; Chronic kidney disease - parathyroid hyperplasia; Kidney failure - parathyroid hyperplasia; Overactive parathyroid - parathyroid hyperplasia

  • Causes
    • The parathyroid glands help control calcium use and removal by the body. They do this by producing parathyroid hormone (PTH). PTH helps control calcium, phosphorus, and vitamin D levels in the blood and is important for healthy bones.

      Parathyroid hyperplasia may occur in people without a family history of the disease, or as part of 3 inherited syndromes:

      In people with an inherited syndrome, a changed (mutated) gene is passed down through the family. You only need to get the gene from one parent to develop the condition.

      • In MEN I, problems in the parathyroid glands occur, as well as tumors in the pituitary gland and pancreas.
      • In MEN IIA, overactivity of the parathyroid glands occurs, along with tumors in the adrenal or thyroid gland.

      Parathyroid hyperplasia that isn't part of an inherited syndrome is much more common. It occurs due to other medical conditions. The most common conditions that can cause parathyroid hyperplasia are chronic kidney disease and chronic vitamin D deficiency. In both cases, the parathyroid glands become enlarged because vitamin D and calcium levels are too low.

  • Symptoms
  • Exams and Tests
    • Blood tests will be done to check levels of:

      A 24-hour urine test may be done to determine how much calcium is being filtered out of the body into the urine.

      Bone x-rays and a bone density test (DXA) can help detect fractures, bone loss, and bone softening. Ultrasound and CT scans may be done to view the parathyroid glands in the neck.

  • Treatment
    • Surgery is usually done to treat this condition. Usually 3 1/2 glands are removed. The remaining tissue may be implanted in the forearm. This allows easy access if symptoms come back. This tissue will also help the body control calcium levels.

      If parathyroid hyperplasia is due to kidney disease or low vitamin D level and it is found early, your provider may recommend that you take vitamin D, vitamin D-like drugs, and other medicines.

  • Outlook (Prognosis)
    • After surgery, high calcium level may persist or return. Surgery can sometimes cause hypoparathyroidism, which makes blood calcium level too low.

  • Possible Complications
    • Parathyroid hyperplasia can cause hyperparathyroidism, which leads to an increase in blood calcium level.

      Complications include increased calcium in the kidneys, which can cause kidney stones, and osteitis fibrosa cystica (a softened, weak area in the bones).

      Surgery can sometimes damage the nerves that control the vocal cords. This can affect the strength of your voice.

      Complications may result from the other tumors that are part of the MEN syndromes.

  • When to Contact a Medical Professional
    • Call your provider if:

      • You have any symptoms of hypercalcemia
      • You have a family history of a MEN syndrome
  • Prevention
    • If you have a family history of the MEN syndromes, you may want to have genetic screening to check for the defective gene. Those who have the defective gene may have routine screening tests to detect any early symptoms.

  • References
    • Silverberg SJ, Bilezikian JP. Primary hyperparathyroidism. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 63.

      Thakker R. The parathyroid glands, hypercalcemia and hypocalcemia. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 245.