Hyperparathyroidism

In medicine (endocrinology), hyperparathyroidism is overactivity of the parathyroid glands and excess production of parathyroid hormone (PTH). Consequences are weakness of bone tissue (predisposing for fracture) and hypercalcemia (high calcium levels). more...

Etiology

• Primary hyperparathyroidism is usually the result of a benign parathyroid tumor (adenoma) that loses its sensitivity to circulating calcium levels. Usually, only one of the four parathyroid glands is affected.

• In chronic renal failure secondary hyperparathyroidism can result. Its result on bone metabolism is renal osteodystrophy.

Signs and symptoms

The rhyme "moans, groans, stones, and bones, with psychic overtones" has been used to describe the classic symptoms of hyperparathyroidism: abdominal pain, lethargy or dysphoria, kidney stones, osteoporosis (and resultant fractures), and depression.

Other symptoms include: headaches, sleep disorders, memory problems, gastroesophageal reflux, decreased sex drive, thinning hair, hypertension, and heart palpitations.

In short-lived hyperparathyroidism, hypercalcemia might be the only sign, sometimes producing such symptoms as nausea, vomiting, lethargy, depression, muscular weakness and an altered mental state.

Diagnosis

Diagnostic workup for hypercalcemia often includes testing the PTH levels. Ultrasound of the neck area may reveal enlarged glands. Occasionally, scintigraphy with MIBI is necessary to identify adenomas or hyperplastic parathyroids.

Treatment

The only definitive treatment is surgery. Surgical techniques for hyperparathyroidism now are much less invasive and much more effective than in the past. The procedure is called parathyroidectomy. Usually, the surgery will only involve one of the glands, and so a successful surgery will allow the parathyroids to go back to correctly regulating blood calcium levels.

If hypercalcemia is severe, bisphosphonates may be required to maintain bone. Hyperparathyroidism can be treated medically with cinacalcet (a calcium receptor blocker), which is very expensive.

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