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Hyperparathyroidism

What is hyperparathyroidism?

Hyperparathyroidism is a medical condition characterised by excess secretion of parathyroid hormone (PTH) into the blood stream due to overactivity of one or more of your body’s parathyroid glands. Parathyroid glands are 4 small pea-sized endocrine glands located on the outer borders of the thyroid gland in your neck area. Parathyroid hormones help to maintain the correct balance of calcium, phosphorus, and vitamin D in your body-, required for proper body functioning. Hyperparathyroidism mostly affects people in the age group of 50 to 60 with women being affected more than men by 3 to 4 times.

Types of hyperparathyroidism

There are mainly two types of hyperparathyroidism, namely:

  • Primary hyperparathyroidism: This type of hyperparathyroidism occurs because of abnormality of the parathyroid glands themselves, causing increased levels of calcium in the bloodstream (hypercalcaemia).
  • Secondary hyperparathyroidism: This type of hyperparathyroidism occurs because of a medical condition occurring elsewhere in the body, such as kidney failure, causing parathyroid glands to secrete too much hormone.

Causes of hyperparathyroidism

Some of the causes of hyperparathyroidism include:

  • Hyperplasia or enlargement of the parathyroid glands.
  • A benign or noncancerous parathyroid tumour called adenoma.
  • A rare cancerous parathyroid gland.
  • Chronic kidney disease.
  • Rare inherited conditions that affects the parathyroid glands such as familial hypocalciuric hypercalcaemia or multiple endocrine neoplasia type 1.

Symptoms of hyperparathyroidism

Some of the common symptoms of hyperparathyroidism include:

  • Fatigue
  • Loss of appetite
  • Depression
  • Lack of concentration
  • Joint pain
  • Muscle weakness
  • Increased thirst and urination
  • Nausea or vomiting
  • Confusion
  • Memory loss
  • Constipation

Risk factors for hyperparathyroidism

You are at increased risk of developing hyperparathyroidism if you:

  • Have a history of calcium or vitamin D deficiency.
  • Have a history of radiation treatment in which your neck has been exposed to radiation.
  • Have a history of taking the drug lithium that is given for the treatment of bipolar disorder.
  • Have a history of rare inherited disorders known to affect parathyroid glands.
  • Are a woman who has gone through menopause.
  • Are of advanced age.

Complications of hyperparathyroidism

Some of the complications associated with hyperparathyroidism include:

  • Kidney stones: The presence of excess calcium in the blood results in the formation of small, calcified deposits in your kidneys called kidney stones - that usually cause significant pain in the urinary tract.
  • Cardiovascular disease: High levels of calcium in the bloodstream is associated with cardiovascular diseases, such as hypertension and certain kinds of heart disorders.
  • Osteoporosis: Loss of calcium from bones results in fragile bones and more likelihood of fractures.
  • Neonatal hypoparathyroidism: A condition in which dangerously deficient levels of calcium are noted in newborns of affected women.

Diagnosis of hyperparathyroidism

Some of the diagnostic tests employed for the diagnosis of hyperparathyroidism include:

  • Blood tests: A sample of blood is taken for evaluation in which levels of parathyroid hormone and calcium are measured. High levels of calcium and parathyroid hormone indicates hyperparathyroidism.
  • Urine tests: Urine test is performed to determine the severity of the hyperparathyroidism and helps to differentiate primary hyperparathyroidism from hyperparathyroidism caused by a kidney disease. The test can also rule out rare inherited conditions as a cause of hyperparathyroidism.
  • DEXA scan or bone mineral density test: This test helps to measure the health of the bone in which special X-ray devices are employed to measure the levels of calcium and other minerals in a segment of bone. This test helps to detect osteoporosis or fractures.
  • Imaging tests: Your doctor may order imaging tests such as neck ultrasound, Sestamibi or 4D CT scans, of localise hyperactive gland/s.

Treatment for hyperparathyroidism

Treatment for hyperparathyroidism involves both conservative methods as well as surgery, including:

  • Watchful waiting: This method of treatment is employed when mild elevation of calcium is noted in the blood and your bone density and kidney functions are normal. During this method, your physician monitors your condition annually and evaluates your blood calcium level biannually. Your physician also monitors the level of vitamin D and calcium that you obtain through your diet.
  • Surgery: The most employed treatment for primary hyperparathyroidism is surgery that has been successful in treating around 95 percent of all cases. During the surgery, your surgeon removes a specific enlarged or tumorous (adenoma) parathyroid gland or all the 4 parathyroid glands that are enlarged or tumorous. This surgery is known as parathyroidectomy. It is mostly performed under general anaesthetic as an inpatient procedure that allows you to go home the next day.
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