| Hyperparathyroidism | |
|---|---|
 | |
| Thyroid and parathyroid | |
| Specialty | Endocrinology |
| Symptoms | None, kidney stones, weakness, depression, bone pains, confusion, increased urination[1][2][3] |
| Complications | Osteoporosis[2][3] |
| Usual onset | 50 to 60[2] |
| Types | Primary, secondary |
| Causes | Primary: parathyroid adenoma, multiple benign tumors, parathyroid cancer[1][2] Secondary: vitamin D deficiency, chronic kidney disease, low blood calcium[1] |
| Diagnostic method | High blood calcium and high PTH levels[2] |
| Treatment | Monitoring, surgery, intravenous normal saline, cinacalcet[1][2] |
| Frequency | ~2 per 1,000[3] |
Hyperparathyroidism is an increase in parathyroid hormone (PTH) levels in the blood.[1][4] This occurs from a disorder either within the parathyroid glands (primary hyperparathyroidism) or as response to external stimuli (secondary hyperparathyroidism).[1] Symptoms of hyperparathyroidism are caused by inappropriately normal or elevated blood calcium excreted from the bones and flowing into the blood stream in response to increased production of parathyroid hormone.[1] In healthy people, when blood calcium levels are high, parathyroid hormone levels should be low. With long-standing hyperparathyroidism, the most common symptom is kidney stones.[1] Other symptoms may include bone pain, weakness, depression, confusion, and increased urination.[1][2] Both primary and secondary may result in osteoporosis (weakening of the bones).[2][3]
In 80% of cases, primary hyperparathyroidism is due to a single benign tumor known as a parathyroid adenoma.[1][2] Most of the remainder are due to several of these adenomas.[1][2] Very rarely it may be due to parathyroid cancer.[2] Secondary hyperparathyroidism typically occurs due to vitamin D deficiency, chronic kidney disease, or other causes of low blood calcium.[1] The diagnosis of primary hyperparathyroidism is made by finding elevated calcium and PTH in the blood.[2]
Primary hyperparathyroidism may only be cured by removing the adenoma or overactive parathyroid glands.[5][1][2] In asymptomatic patients who present with mildly elevated blood calcium levels, with otherwise normal kidneys, and with normal bone density, monitoring may be all that is required.[2] The medication cinacalcet may also be used to decrease PTH levels in those unable to have surgery although it is not a cure.[2] In patients with very high blood calcium levels, treatment may include large amounts of intravenous normal saline.[1] Low vitamin D should be corrected in those with secondary hyperparathyroidism but low Vitamin D pre-surgery is controversial for those with primary hyperparathyroidism.[6] Low vitamin D levels should be corrected post-parathyroidectomy.[2]
- ^ a b c d e f g h i j k l m n Fraser WD (July 2009). "Hyperparathyroidism". Lancet. 374 (9684): 145–58. doi:10.1016/S0140-6736(09)60507-9. PMID 19595349. S2CID 208793932.
- ^ a b c d e f g h i j k l m n o p "Primary Hyperparathyroidism". NIDDK. August 2012. Archived from the original on 4 October 2016. Retrieved 27 September 2016.
- ^ a b c d Cite error: The named reference
Michels-2013was invoked but never defined (see the help page). - ^ Allerheiligen DA, Schoeber J, Houston RE, Mohl VK, Wildman KM (April 1998). "Hyperparathyroidism". American Family Physician. 57 (8): 1795–802, 1807–8. PMID 9575320.
- ^ McDow AD, Sippel RS (2018-01-01). "Should Symptoms Be Considered an Indication for Parathyroidectomy in Primary Hyperparathyroidism?". Clinical Medicine Insights. Endocrinology and Diabetes. 11: 1179551418785135. doi:10.1177/1179551418785135. PMC 6043916. PMID 30013413.
- ^ Randle RW, Balentine CJ, Wendt E, Schneider DF, Chen H, Sippel RS (July 2016). "Should vitamin D deficiency be corrected before parathyroidectomy?". The Journal of Surgical Research. 204 (1): 94–100. doi:10.1016/j.jss.2016.04.022. PMID 27451873.