Hyperparathyroidism

Hyperparathyroidism, a condition affecting the parathyroid glands, can cause many symptoms that may go unnoticed for years. This disorder occurs when these glands produce too much parathyroid hormone, leading to imbalances in calcium levels throughout the body. Understanding hyperparathyroidism is crucial for early detection and effective treatment strategy. This blog will explain different types of hyperparathyroidism, its potential causes, and the risk factors associated with this condition. 

What is Hyperparathyroidism? 

Hyperparathyroidism happens when one or more of the parathyroid glands in our neck produce too much parathyroid hormone (PTH). These tiny glands, about the size of a grain of rice, play a crucial role in maintaining calcium balance in the body. They regulate calcium levels in the blood, bones, and other tissues by secreting PTH. 

However, when the parathyroid glands become overactive, they release excessive PTH. This leads to an imbalance in calcium levels, often resulting in hypercalcaemia (high blood calcium), resulting in weakened bones and other systemic symptoms. 

Types of Hyperparathyroidism 

Hyperparathyroidism has three primary forms, each with distinct causes. 

• Primary Hyperparathyroidism: It develops when a single or more than one parathyroid glands grow too large, releasing excessive PTH. This results in increased calcium levels in the blood due to increased calcitriol production and calcium release from bones. 
• Secondary Hyperparathyroidism: Secondary hyperparathyroidism develops when low calcium or vitamin D levels in the blood cause the parathyroid glands to produce more PTH to counteract the deficiency. This often happens in people with chronic kidney disease. 
• Tertiary Hyperparathyroidism: This hyperparathyroidism type occurs from long- lasting secondary hyperparathyroidism that doesn't respond to treatment. In this case, all four parathyroid glands grow and continuously produce PTH, regardless of the body's needs. This causes high calcium levels due to excessive release from bones. 

Symptoms and Signs of Hyperparathyroidism 

Hyperparathyroidism affects individuals differently, with some experiencing mild or no symptoms while others face numerous issues. The severity of symptoms doesn't always correlate with calcium levels in the blood. Some people with slightly elevated calcium levels may have noticeable symptoms, whereas others with high levels might experience few or no signs at all. 

The following are some common hyperparathyroidism symptoms: 

• Feeling tired 
• Thirsty 
• Frequent urination 
• Mood changes, like anxiety, depression, or irritability 
• Muscle weakness 
• Constipation 
• Abdominal pain 
• Loss of concentration and mild confusion 
• Frequent illnesses with no apparent cause. 

Primary hyperparathyroidism can lead to more severe symptoms, such as: 

• Weak bones that break easily (osteoporosis) 
• Kidney stones 
• Excessive urination 
• Nausea and vomiting 
• Loss of appetite 

Causes of Hyperparathyroidism 

Hyperparathyroidism has various causes, depending on its type. 

• Primary hyperparathyroidism often results from a benign tumour called an adenoma in one of the parathyroid glands. This growth stimulates the gland to produce excessive parathyroid hormone (PTH). In some cases, enlargement (hyperplasia) of two or more glands leads to overproduction of PTH. Rarely, parathyroid cancer may cause primary hyperparathyroidism. 
• Secondary hyperparathyroidism typically develops due to underlying conditions. Chronic kidney disease is a dominant cause, as it affects vitamin D metabolism and calcium levels. Severe calcium or vitamin D deficiencies can also trigger secondary hyperparathyroidism. The parathyroid glands produce more PTH to maintain optimal calcium balance in these cases. 
• Tertiary hyperparathyroidism occurs when long-standing secondary hyperparathyroidism causes the glands to become permanently overactive, regardless of the body's calcium needs. 

Risk Factors 

Many factors can make an individual susceptible to developing hyperparathyroidism, including: 

• Women, especially those who have gone through menopause 
• Age with individuals over 60 
• Prolonged, severe calcium or vitamin D deficiencies 
• Obesity and physical inactivity 
• Radiation therapy for neck cancers 
• Long-term use of specific medications, including lithium for bipolar disorder and furosemide 
• Genetic factors, such as rare inherited disorders like multiple endocrine neoplasia type 1 

Complications of Hyperparathyroidism 

Hyperparathyroidism can lead to several serious health issues. The long-term effects of excessive calcium in the bloodstream and insufficient calcium in the bones cause most complications, such as: 

• Osteoporosis (weak and brittle bones that break easily) often results from the loss of calcium from bones. 
• Kidney stones may form due to high calcium levels in the urine, causing severe pain as they pass through the urinary tract. 
• Cardiovascular problems, such as high blood pressure and certain types of heart disease, have been associated with elevated calcium levels, although the exact link remains unclear. 
• In pregnant women with severe untreated hyperparathyroidism, newborns may develop dangerously low calcium levels, a condition known as neonatal hypoparathyroidism. 
• Additionally, calcium buildup can cause skin sores and infections and potentially contribute to heart attacks and strokes. 

Diagnosis for hyperparathyroidism 

To diagnose hyperparathyroidism, doctors may perform the following diagnostic measures: 

• Blood Tests: To measure the Calcium and PTH levels in the blood 
• Bone Mineral Density Test: To see if you have developed osteoporosis, The most commonly performed test to measure bone mineral density is dual-energy X-ray absorptiometry (DEXA). 
• 24-hour Urine Analysis: Measures how well kidneys are working and how much calcium is passed in your urine. 
• Imaging Tests: Doctors may perform ultrasound, sestamibi scans, or CT scans to locate overactive parathyroid glands or parathyroid tumours. 

Hyperparathyroidism Treatment 

Treatment options for hyperparathyroidism depend on the type and severity of the condition. 

• Surgical Intervention: Surgery is the most common and effective treatment for primary hyperparathyroidism, offering a cure in most cases. A surgeon removes only the enlarged or tumorous glands, leaving some functioning parathyroid tissue. 
• Monitoring: Medical management is an alternative for those who can't undergo surgery. This includes watchful waiting with regular monitoring of calcium levels and bone density. 
• Medical Treatment of Hyperparathyroidism: Medications like calcimimetics can help manage symptoms by reducing parathyroid hormone production. Hormone replacement therapy may benefit postmenopausal women with osteoporosis, while bisphosphonates can prevent calcium loss from bones. 
• Vitamin D: In secondary hyperparathyroidism, treatment focuses on controlling underlying conditions and may involve vitamin D supplements and medications to balance calcium and phosphorus levels. 

When to See a Doctor 

If you experience symptoms of hyperparathyroidism or have high blood calcium levels, it's crucial to consult a doctor. They may recommend further tests, such as a 24-hour urine collection, to determine the cause. For those with other health conditions that increase the risk of hyperparathyroidism, discussing potential symptoms with a doctor is essential. 

Prevention 

While primary hyperparathyroidism cannot be entirely prevented, specific measures can effectively manage the condition and reduce the risk of complications, including: 

• Individuals should monitor their calcium and vitamin D intake, aiming for the recommended daily amounts. 
• Staying hydrated by drinking an optimal quantity of water helps diminish the risk of kidney stones. 
• Regular exercise, particularly strength training, maintains strong bones. 
• Quitting smoking is crucial, as it can increase bone loss. 

Conclusion 

Hyperparathyroidism significantly influences overall health, affecting calcium levels throughout the body. While often overlooked, this condition can lead to numerous complications if left untreated. Understanding its types, symptoms, and causes is crucial to spot early signs and seek timely medical attention. The treatment options, ranging from surgery to medication, offer hope for managing this disorder effectively. 

FAQ's 

1. What is the leading cause of hyperparathyroidism? 

The leading cause of primary hyperparathyroidism is usually an enlargement or benign tumour (adenoma) in one or more parathyroid glands. This leads to the overproduction of parathyroid hormone. Secondary hyperparathyroidism often results from chronic kidney disease, which affects vitamin D metabolism and calcium levels. 

2. What is the difference between hyperthyroidism and hyperparathyroidism? 

Hyperparathyroidism involves high blood calcium levels due to overactive parathyroid glands, while hyperthyroidism causes elevated thyroid hormones, speeding up bodily functions. 

3. How can I reduce hyperparathyroidism? 

To manage hyperparathyroidism, maintain proper hydration and ensure adequate vitamin D intake. For mild cases, doctors may recommend watchful waiting with regular monitoring. Treatment options include surgery to remove affected glands, medications to reduce parathyroid hormone production and hormone replacement therapy for postmenopausal women with osteoporosis. 

4. Who is at greatest risk for hyperparathyroidism? 

Women, especially those who have gone through menopause, face a higher risk of hyperparathyroidism. Other risk factors include age over 60, prolonged severe calcium or vitamin D deficiencies, obesity, and certain genetic disorders. Individuals who have undergone radiation therapy for neck cancers or long-term use of lithium for bipolar disorder are also at increased risk. 

5. Should I avoid calcium with hyperparathyroidism? 

Contrary to what one might expect, restricting calcium intake is not recommended for people with hyperparathyroidism. Adults aged 19-50 and men 51-70 should aim for 1,000 mg of calcium daily, while women over 51 and men over 71 need 1,200 mg. 

6. What is the normal range for hyperparathyroidism? 

The normal parathyroid hormone (PTH) range is 10 to 55 picograms per millilitre (pg/mL). 

Dr. Sandeep Kharkar

MBBS, MD (Int Med),PGCC (Rheumatology)
Ganga CARE Hospital Limited, Nagpur

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