Hyperparathyroidism

Parathyroid-related hypercalcemia; Osteoporosis - hyperparathyroidism; Bone thinning - hyperparathyroidism; Osteopenia - hyperparathyroidism; High calcium level - hyperparathyroidism; Chronic kidney disease - hyperparathyroidism; Kidney failure - hyperparathyroidism; Overactive parathyroid

There are 4 tiny parathyroid glands in the neck, near or attached to the back side of the thyroid gland.

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 bone.

When calcium level is too low, the body responds by making more PTH. This causes the calcium level in the blood to rise.

When one or both of the parathyroid glands grow larger, it leads to too much PTH. Most often, the cause is not known.

• The disease is most common in people over age 60, but it can also occur 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 the risk.
• In rare cases, the disease is caused by parathyroid cancer.

Medical conditions that cause low blood calcium or increased phosphate can also lead to hyperparathyroidism. Common conditions include:

• Conditions that make it hard for the body to remove phosphate
• Kidney failure
• Not enough calcium in the diet
• Too much calcium lost in the urine
• Vitamin D disorders (may occur in children who do not eat a variety of foods, and in older adults who do not get enough sunlight on their skin)
• Problems absorbing nutrients from food

Hyperparathyroidism is often diagnosed before symptoms occur.

Symptoms are mostly caused by damage to organs from high calcium level in the blood, or by the loss of calcium from the bones. Symptoms can include:

• Bone pain or tenderness
• Depression and forgetfulness
• Feeling tired, ill, and weak
• Fragile bones of the limbs and spine that can break easily
• Increased amount of urine produced and needing to urinate more often
• Kidney stones
• Nausea and loss of appetite

The health care provider will do a physical exam and ask about symptoms.

Tests that may be done include:

• PTH blood test
• Calcium blood test
• Alkaline phosphatase
• Phosphorus
• 24-hour urine test

Bone x-rays and bone mineral density (DXA) tests 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.

If you have a mildly increased calcium level and don't have symptoms, you may choose to have regular checkups or get treated.

If you decide to have treatment, it may include:

• Drinking more fluids to prevent kidney stones from forming
• Exercising
• Not taking a type of water pill called thiazide diuretic
• Estrogen for women who have gone through menopause
• Having surgery to remove the overactive glands (usually for people under age 50)

If you have symptoms or your calcium level is very high, you may need surgery to remove the parathyroid gland that is overproducing the hormone.

If you have hyperparathyroidism from a medical condition, your provider may prescribe vitamin D, if you have a low vitamin D level.

If hyperparathyroidism is caused by kidney failure, treatment may include:

• Extra calcium and vitamin D
• Avoiding phosphate in the diet
• The medicine cinacalcet (Sensipar)
• Dialysis or a kidney transplant
• Parathyroid surgery, if the parathyroid level becomes uncontrollably high

Outlook depends on the cause of hyperparathyroidism.

Long-term problems that can occur when hyperparathyroidism is not well controlled include:

• Bones become weak, deformed, or can break
• High blood pressure and heart disease
• Kidney stones
• Long-term kidney disease

Parathyroid gland surgery can result in hypoparathyroidism and damage to the nerves that control the vocal cords.