Hyperparathyroidism is a disease that occurs when the parathyroid glands produce too much parathyroid hormone.
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The parathyroid glands are four small glands located behind the thyroid gland in the front of the neck. They produce parathyroid hormone which maintains the optimum balance of calcium in the bloodstream. In hyperparathyroidism, too much parathyroid hormone is produced which causes the calcium to be moved out of bone and into the bloodstream causing high levels of calcium in the blood (hypercalcemia).
There are two main types of hyperparathyroidism, primary and secondary. In primary hyperparathyroidism, one or more of the parathyroid glands becomes enlarged causing overproduction of parathyroid hormone which leads to high calcium levels in the blood. Secondary hyperparathyroidism occurs when a health condition causes calcium loss, triggering the parathyroid glands to produce more parathyroid hormone as a compensation.
Primary hyperparathyroidism is caused most commonly by a single non-cancerous (benign) tumour called an adenoma on one of the parathyroid glands. Two or more adenomas or multiple enlarged parathyroid glands (hyperplasia) or cancer of a parathyroid gland are less common causes of primary hyperparathyroidism.
Hyperparathyroidism can affect anyone of any age and sex but women over the age of 60 are at the highest risk of developing the condition.
Conditions that cause lower calcium levels, triggering secondary hyperparathyroidism include chronic kidney failure, severe vitamin D deficiency, and severe calcium deficiency.
Early-stage hyperparathyroidism may produce no symptoms or symptoms may be very mild. In more severe cases symptoms can be more obvious.
Classic symptoms of hyperparathyroidism include:
Hyperparathyroidism is diagnosed via a blood test that looks for high levels of parathyroid hormone, high blood calcium and low levels of phosphorus. An ultrasound of the kidney may identify kidney calcification and a DEXA scan (Dual-energy X-ray absorptiometry) measures bone density and may detect bone loss due to low calcium levels.
In the past, mild cases of hyperparathyroidism were not treated and the condition was simply monitored over time. Medications called bisphosphonates may be recommended to help lower calcium levels and protect the bones. However, it is now recognised that medical management alone is usually not in the patient’s best interest.
Therefore nearly all patients are offered surgery to remove the errant parathyroid glands.
For those unable to have surgery with high calcium levels, a medication called cinacalcet can bring down the blood calcium level.
If severe vitamin D deficiency is the cause of secondary hyperparathyroidism taking a vitamin D supplement may be helpful.
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