Hyperparathyroidism

Hyperparathyroidism is a condition characterized by the overproduction of parathyroid hormone (PTH) by the parathyroid glands. This hormone regulates calcium levels in the blood, and excessive PTH can lead to elevated calcium levels (hypercalcemia), which can cause various health issues.

Types of Hyperparathyroidism

• Primary Hyperparathyroidism: This is the most common type and is usually caused by a benign tumor (adenoma) on one of the parathyroid glands. It can also result from hyperplasia of the glands or, rarely, parathyroid carcinoma.

• Secondary Hyperparathyroidism: This occurs as a response to low calcium levels, often due to chronic kidney disease or vitamin D deficiency. The parathyroid glands produce more hormone to compensate for the low calcium.

• Tertiary Hyperparathyroidism: This can develop after prolonged secondary hyperparathyroidism, where the parathyroid glands become autonomous and continue to secrete PTH even when calcium levels normalize.

  
  

Causes

• Benign parathyroid adenoma

• Parathyroid hyperplasia

• Parathyroid carcinoma

• Chronic kidney disease

• Vitamin D deficiency

• Genetic syndromes (e.g., Multiple Endocrine Neoplasia)

  
  

Symptoms

The symptoms of hyperparathyroidism can vary widely and may include:

• Bone Pain: and joint pain; Due to increased bone resorption.

• Kidney Stones: Elevated calcium can lead to stone formation.

• Fatigue and Weakness: Commonly reported by patients.

• Nausea and Vomiting: Gastrointestinal disturbances may occur.

• Increased Thirst and Urination: Hypercalcemia can lead to polyuria and polydipsia.

• Psychological Symptoms: Depression, anxiety, and cognitive changes may be present.

  
  

Diagnosis

Diagnosis typically involves:

• Blood Tests: To check levels of calcium, PTH, and vitamin D.

• Urine Tests: To assess calcium excretion.

• Imaging Studies: Ultrasound, CT scans, or nuclear medicine scans to locate abnormal parathyroid glands.

  
  

Management

Management of hyperparathyroidism depends on the type and severity of the condition:

Primary Hyperparathyroidism

• Surgery: Parathyroidectomy is the most effective treatment, especially for symptomatic patients or those with complications.

• Monitoring: Asymptomatic patients may be monitored with regular blood tests and imaging.

• Medications: Bisphosphonates or calcimimetics may be used to manage symptoms or reduce calcium levels.

  
  

Secondary Hyperparathyroidism

• Addressing Underlying Causes: Treating kidney disease or vitamin D deficiency is essential.

• Phosphate Binders: To reduce phosphate levels in patients with chronic kidney disease.

• Vitamin D Supplementation: To improve calcium absorption.

  
  

Tertiary Hyperparathyroidism

• Surgery: Parathyroidectomy may be necessary if hypercalcemia persists after kidney transplantation

Complications

If left untreated, hyperparathyroidism can lead to:

• Osteoporosis and increased fracture risk

• Kidney damage or kidney failure

• Cardiovascular issues due to vascular calcification

• Neurological complications from severe hypercalcemia

  
  

Conclusion

Hyperparathyroidism is a manageable condition with appropriate diagnosis and treatment. Surgical intervention is often the most effective option for primary hyperparathyroidism, while secondary forms require addressing underlying causes. Regular monitoring and a multidisciplinary approach are essential for optimal management.

FUNCTION OF PARATHYROID HORMONES