Hyperparathyroidism occurs when the parathyroid gland releases excessive parathyroid hormones. The parathyroid glands are four pea-sized endocrine glands that are located in the neck behind the thyroid gland. PTH controls the levels of vitamin D, calcium, phosphorus in our body. It can also increase the calcium levels(hypercalcemia) in the blood. If it remains untreated may cause serious health complications.

Symptoms of Hyperparathyroidism

Hyperparathyroidism causes no or few symptoms.  Symptoms may be mild or severe. The symptoms of hyperparathyroidism include:

• Depression
• Tiredness
• Muscle weakness
•  Constipation
• Mild confusion

In hypercalcemia or high blood calcium level, symptoms may include.                                    

• Vomiting
• Dehydration
• Joint pain
• Drowsiness
• Irregular heartbeat
• Hypertension

Types of Hyperparathyroidism

 The three types of hyperparathyroidism -

• Primary: it occurs when an excessive hormone secretion happens from one of the parathyroid glands due to benign growth of the tumor.

Symptoms of primary hyperparathyroidism are:

• Fatigue
•  Weakness
• Depression
• Vomiting
• Memory loss
• Kidney stones
• Secondary: the condition may occur when the calcium levels become extremely low. Secondary hyperparathyroidism causes chronic kidney failure.

Symptoms of secondary hyperparathyroidism are:

• Bones deformities
• Fractures
• Acute vitamin D deficiency.
• Tertiary: the condition occurs in patients with chronic kidney problems. In some cases, doctors may prescribe dialysis to patients due to advanced kidney failure.

Complications

In hyperparathyroidism complications may include:

• Osteoporosis: the loss of calcium in bones may cause weak and brittle bones. In such cases, fractures happen easily.
• Kidney Stones: occur due to the presence of a high level of calcium, phosphorus in the urine, trouble urinating.
• Cardiovascular Problems: high calcium leads to cardiovascular problems like high blood pressure and heart disease.
• Women tend to develop primary hyperparathyroidism than men.

Diagnosis of Hyperparathyroidism

Doctors may suggest tests include

• Blood Tests:  to check the PTH levels in the blood, high alkaline phosphatase level, phosphorus levels.
• Urine Tests: it checks the calcium levels in the urine and also checks the severity of the condition.
• Kidney Tests: to check the condition of the kidneys doctors suggest x-rays of the abdomen.

• Bone Mineral Density Test: the test can be done to check whether osteoporosis is developed or not. Dual Energy X-Ray Absorptiometry(DEXA) is used to measure bone mineral density.
• Imaging Tests of Kidneys:  doctors may suggest imaging tests to determine the abnormalities of kidneys.

Imaging test before surgery

• Sestamibi Parathyroid Scan:  it is a process to locate the hyperactive parathyroid glands. This is an authentic method to identify the abnormal parathyroid gland before surgery.
• Ultrasound: it is an imaging test, it helps in checking the size and shape of the thyroid gland.

Treatment

Doctors may suggest regular monitoring of the patients if the complications appear including:

• Calcium level is slightly raised
• Kidneys are normal with no abnormal report.
• To control primary hyperparathyroidism, avoid a high-calcium diet is necessary.
• To check the serum-creatinine level and calcium levels.
• Bisphosphonates are very useful in treating parathyroid.
• Surgery is done to remove the overactive parathyroid glands.
• Cinacalcet is used to treat tertiary hyperparathyroidism.

Surgery

 Surgery removes the parathyroid glands that have a tumor. It is a common procedure to cure parathyroid. The process is done by incisions in the neck, with local anesthesia to the affected area.

Medications

 Medications involve treating hyper parathyroid include:

• Calcimimetics: doctors suggest this drug in primary hyperparathyroidism.
• Hormone replacement theory: For women who already have menopause and have an underlying condition of osteoporosis, hormone replacement helps in gaining calcium in the bones.
• Bisphosphonates:  looks after the loss of calcium in the bones and prevents osteoporosis

SureshMaternity Hospital’s Diabetes and Endocrinology ../department

Parathyroid glands release excessive parathyroid hormones that occur in hyperparathyroidism. Hyperparathyroidism may cause diseases like osteoporosis, kidney stones.  A person who is suffering any of the symptoms should contact doctors immediately. at Suresh Hospital, we have efficient and highly qualified endocrinologists with an experienced medical team who create a caring-healing environment for the patients.