Hyperparathyroidism
Also known as: Primary hyperparathyroidism, Overactive parathyroid
Hyperparathyroidism occurs when one or more of the four small parathyroid glands in the neck produce too much parathyroid hormone (PTH), the hormone that regulates calcium levels in the blood. In primary hyperparathyroidism, usually caused by a benign tumour (adenoma) on one gland, calcium is pulled out of the bones and retained by the kidneys, leading to high blood calcium, weakened bones and kidney stones. Secondary hyperparathyroidism happens when the glands work overtime in response to low calcium or vitamin D, most often in chronic kidney disease. Primary hyperparathyroidism is often discovered incidentally when a routine blood test shows high calcium. It is most common in postmenopausal women, and surgery to remove the overactive gland is curative in the great majority of cases.
At a Glance
- Common symptoms
- Often no symptoms; discovered on a routine blood test showing high calcium, Fatigue, weakness and low mood or difficulty concentrating, Bone and joint pain, and fractures from weakened bone
- Main treatments
- Surgery (parathyroidectomy) to remove the overactive gland, the only cure for primary hyperparathyroidism, recommended for symptomatic disease, very high calcium, kidney stones, bone loss or younger age, Monitoring with regular blood tests and bone density scans for mild cases without symptoms, especially in older adults, Cinacalcet, a medication that lowers calcium levels, for people who cannot have surgery
- Category
- Endocrine · Relatively common endocrine disorder, especially in postmenopausal women; often found incidentally
- See a doctor if
- A blood test shows high calcium
Symptoms
Causes
- A benign tumour (adenoma) on one parathyroid gland, the cause in most primary cases
- Enlargement of all four glands (hyperplasia)
- Rarely, parathyroid cancer
- Chronic kidney disease, which lowers active vitamin D and calcium and drives the glands to overwork (secondary hyperparathyroidism)
- Severe vitamin D deficiency or poor calcium absorption
- Inherited syndromes such as multiple endocrine neoplasia (MEN) in a minority of cases
Risk Factors
- Being a woman past menopause
- Age over 50
- Long-term vitamin D or calcium deficiency
- Chronic kidney disease
- Previous radiation treatment to the head or neck
- Long-term lithium treatment, and a family history of parathyroid disease or MEN syndromes
Diagnosis
- Blood tests showing high calcium with an inappropriately high or normal PTH level
- Vitamin D, phosphate and kidney function tests, and a 24-hour urine calcium
- Bone density scan to check for bone loss
- Kidney ultrasound or CT to look for stones
- Imaging such as sestamibi scan, ultrasound or 4D-CT to locate the overactive gland before surgery
Treatment
- Surgery (parathyroidectomy) to remove the overactive gland, the only cure for primary hyperparathyroidism, recommended for symptomatic disease, very high calcium, kidney stones, bone loss or younger age
- Monitoring with regular blood tests and bone density scans for mild cases without symptoms, especially in older adults
- Cinacalcet, a medication that lowers calcium levels, for people who cannot have surgery
- Bisphosphonates to protect bone density where surgery is not performed
- Correcting vitamin D deficiency carefully under medical supervision
- Treating the underlying kidney disease and using vitamin D analogues or phosphate binders for secondary hyperparathyroidism
- Supportive: staying well hydrated, keeping active to protect bone, and avoiding thiazide diuretics and lithium where alternatives exist
Prevention
- Primary hyperparathyroidism cannot usually be prevented, but complications can be
- Drink plenty of fluids to reduce the risk of kidney stones
- Keep active with weight-bearing exercise to protect bone
- Maintain adequate (not excessive) dietary calcium and correct vitamin D deficiency as advised
- Avoid dehydration and prolonged bed rest, which raise calcium further
- Have calcium levels checked if you have kidney stones, osteoporosis or a family history of parathyroid disease
When to See a Doctor
- A blood test shows high calcium
- Recurrent kidney stones or an unexplained fracture
- Persistent fatigue, bone pain, excessive thirst or frequent urination
- Severe nausea, vomiting, confusion or drowsiness, which can signal dangerously high calcium (seek urgent care)
- If you have chronic kidney disease and symptoms of bone pain or itching
Frequently Asked Questions
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