Definition

The parathyroid glands are responsible for the secretion of parathyroid hormone. This hormone regulates the calcium and phosphorus levels in your body and maintains the regular function of calcium-dependent tissues. This hormone affects bone health, muscle function, and nerve transmission. There are four parathyroid glands behind the thyroid gland.

Hyperparathyroidism is a medical disorder characterized by the excessive secretion of parathyroid hormone due to the overactivity of one or more parathyroid glands. Hyperparathyroidism is classified into:

• Primary hyperparathyroidism

Primary hyperparathyroidism is characterized by the enlargement of one or more parathyroid glands resulting from excessive parathyroid hormone synthesis. This leads to an elevation in blood calcium levels, which might result in severe complications.

• Secondary hyperparathyroidism

Secondary hyperparathyroidism results from other factors that lead to a decrease in calcium levels. Gradually, parathyroid hormone levels elevate in response to maintaining calcium levels within the normal range.

Causes

Primary hyperparathyroidism results from hyperactivity of the parathyroid glands, resulting in the overproduction of parathyroid hormone. Causes of primary hyperparathyroidism include the following:

• Adenoma, which is a benign tumor, leads to hyperactivity of the gland and results in the overproduction of parathyroid hormone
• Hyperplasia, or enlargement of two or more parathyroid glands, results in an excessive production of hormones
• Cervical radiation treatment
• Multiple endocrine neoplasia type 1, a hereditary disorder
• Parathyroid cancer

Kidney diseases and a prior history of digestive surgery might lead to secondary hyperparathyroidism.

Risk Factor

Hyperparathyroidism may become more prevalent in:

• Postmenopausal women
• Chronic vitamin D and calcium deficiencies
• Uncommon medical condition or familial predisposition
• Multiple endocrine neoplasia type 1
• Cervical radiation therapy
• Intake of lithium

Symptoms

Mild hyperparathyroidism may be asymptomatic. Several symptoms of moderate hyperparathyroidism include the following:

• Arthralgia (pain in joint)
• Muscle weakness
• Fatigue
• Depression
• Lack of focus
• Unpassionate

In severe hyperparathyroidism, symptoms may include:

• Nausea and vomiting
• Disorientation and amnesia
• Polydipsia and polyuria
• Constipation
• Ostealgia

Diagnosis

The diagnosis of hyperparathyroidism requires an examination due to its insignificant symptoms. Blood tests will be performed to determine this condition. Primary hyperparathyroidism causes elevated calcium and parathyroid hormone levels in blood tests.

The doctor might conduct a sestamibi examination to identify parathyroid gland enlargement. Additional diagnostic examinations suggested to assess the complications of hyperparathyroidism include the following:

• Vitamin D levels
• Bone mass density
• Kidney stone screening with ultrasound or other imaging
• 24-hour urine test for calcium and other components
• Kidney function

Management

If you are diagnosed with moderate hyperparathyroidism, your doctor may choose to delay initiating medication. Your doctor will monitor calcium levels and blood pressure every 6 months, monitor your kidney function annually, and evaluate your bone density every 1–3 years.

If your doctor declares that hyperparathyroidism does not require immediate treatment, it is important to follow these procedures:

• Stay hydrated
• Maintain an active lifestyle and exercise to help maintain optimal bone strength
• Thiazide and lithium diuretics might raise blood calcium levels; therefore, it is important to see a doctor before using these medications
• Consult your physician for vitamin D supplementation

If you have a severe hyperthyroidism condition, your doctor may advise surgery to remove the enlarged or abnormal parathyroid glands. The success rate of hyperparathyroidism surgery is approximately 95%.

Cinacalcet has been approved as a therapeutic intervention for secondary hyperparathyroidism. The medicine functions by transmitting a signal to the parathyroid glands, causing an inhibition in the synthesis of parathyroid hormone. Doctors may prescribe this therapy for primary and secondary hyperparathyroidism.

Bisphosphonates are another type of medication that can be administered. Decreasing calcium loss from the bones may reduce your risk of fractures and osteoporosis. After menopause, the doctor may also prescribe hormone replacement treatment to prevent osteoporosis.

Complications

The most prevalent complications of hyperparathyroidism result from prolonged, inadequate calcium levels in the skeletal system and excessive levels in the blood circulation. The following complications are involved:

• Osteoporosis

Osteoporosis, characterized by decreased bone calcium levels, typically leads to bone fragility and an increased risk of fractures.

• Kidney stone

Excessive levels of calcium in the bloodstream may lead to an excessive amount of calcium in the urine. This may result in the accumulation of calcium in the form of kidney stones. Kidney stones typically induce pain as they pass through the kidney and urinary tract.

• Cardiovascular disease

While the specific correlation remains unknown, elevated calcium levels have been associated with cardiovascular diseases, including hypertension and other diseases.

• Neonatal hypoparathyroidism

Severe hyperparathyroidism in pregnant women indicates a risk due to the possibility of low calcium levels in newborns.

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Prevention

It is not possible to prevent hyperparathyroidism. The primary objective of hyperparathyroidism prevention is to prevent the progression of the disease and its complications.

When to see a doctor?

If surgery is not necessary to treat your condition, you may:

• Keep track of your vitamin D and calcium intake
• Stay hydrated
• Exercise regularly, especially strength training
• Stop smoking
• Avoid elevating calcium medications

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