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Hyperparathyroidism
Parathyroid-related hypercalcemia; Osteoporosis - hyperparathyroidism; Bone thinning - hyperparathyroidism; Osteopenia - hyperparathyroidism; High calcium level - hyperparathyroidism; Chronic kidney disease - hyperparathyroidism; Kidney failure - hyperparathyroidism; Overactive parathyroid
Hyperparathyroidism is a disorder in which the parathyroid glands in your neck produce too much parathyroid hormone (PTH).
Causes
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
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Kidney failure
Kidney failure
End-stage kidney disease is the last stage of chronic kidney disease. This is when your kidneys can no longer support your body's needs. End-stage k...
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- 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
Symptoms
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
Bone pain or tenderness
Bone pain or tenderness is aching or other discomfort in one or more bones.
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Depression
and forgetfulness
Depression
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...
ImageRead Article Now Book Mark Article - Feeling tired, ill, and weak
- Fragile bones of the limbs and spine that can break easily
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Increased amount of urine produced
and needing to urinate more often
Increased amount of urine produced
Excessive amount of urination means that your body makes larger than normal amounts of urine each day.
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Kidney stones
Kidney stones
A kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time.
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Nausea
and
loss of appetite
Nausea
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up is forcing the contents of the stomach ...
ImageRead Article Now Book Mark ArticleLoss of appetite
A decreased appetite is when your desire to eat is reduced. The medical term for a loss of appetite is anorexia.
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Exams and Tests
The health care provider will do a physical exam and ask about symptoms.
Tests that may be done include:
-
PTH blood test
PTH blood test
The PTH test measures the level of parathyroid hormone in the blood. PTH stands for parathyroid hormone. It is a protein hormone released by the par...
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Calcium blood test
Calcium blood test
The calcium blood test measures the level of calcium in the blood. This article discusses the test to measure the total amount of calcium in your blo...
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Alkaline phosphatase
Alkaline phosphatase
Alkaline phosphatase (ALP) is a protein found in all body tissues. Tissues with higher amounts of ALP include the liver, bile ducts, and bone. A blo...
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Phosphorus
Phosphorus
The phosphorus blood test measures the amount of phosphate in the blood.
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24-hour urine test
24-hour urine test
The urine 24-hour volume test measures the amount of urine produced in a day. The amount of creatinine, protein, and other chemicals released into t...
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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.
Treatment
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 (Prognosis)
Outlook depends on the cause of hyperparathyroidism.
Possible Complications
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.
Hypoparathyroidism
Hypoparathyroidism is a disorder in which the parathyroid glands in the neck do not produce enough parathyroid hormone (PTH).
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 RV. 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.
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Parathyroid glands - illustration
The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce pararthyroid hormone (PTH). Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.
Parathyroid glands
illustration
-
Parathyroid glands - illustration
The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce pararthyroid hormone (PTH). Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.
Parathyroid glands
illustration
Review Date: 5/2/2016
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
