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Hyperparathyroidism

Parathyroid-related hypercalcemia

Hyperparathyroidism is a disorder in which the parathyroid glands in your neck produce too much parathyroid hormone (PTH).

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Parathyroid glands

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Causes

The parathyroid glands are located in the neck, near or attached to the back side of the thyroid gland. They produce parathyroid hormone. This hormone controls calcium, phosphorus, and vitamin D levels in the blood and bone.

When calcium levels are too low, the body responds by making more parathyroid hormone. This hormone causes calcium levels in the blood to rise, as more calcium is taken from the bone and reabsorbed by the intestines and kidney.

One or more of the parathyroid glands may grow larger. This leads to too much parathyroid hormone (a condition called primary hyperparathyroidism). Most often, the cause is not known.

Medical conditions that cause low blood calcium levels or increased phosphate levels can lead to secondary hyperparathyroidism. Common causes include:

Symptoms

Often hyperparathyroidism is diagnosed before symptoms occur.

Symptoms are mostly caused by damage to organs from high calcium levels in the blood, or by the loss of calcium from the bones. Symptoms can include:

Exams and Tests

Blood tests will be done to check for increased levels of parathyroid hormone (PTH), calcium, and alkaline phosphatase, and lower levels of phosphorous. A 24-hour urine collection test can help determine how much calcium is being removed from the body.

Bone x-rays and bone mineral density (DXA) tests can help detect bone loss, fractures, or bone softening.

X-rays, ultrasound, or CT scans of the kidneys or urinary tract may show calcium deposits or a blockage.

Treatment

If you have mildly increased calcium levels from primary hyperparathyroidism and you do not have symptoms, you may choose to have regular checkups or get treated.

If you decide to have treatment, it may include:

If you have symptoms or your calcium level is very high, you may need surgery to remove the parathyroid gland that is overproducing the hormone.

Treatment for secondary hyperparathyroidism depends on the cause. Your doctor may suggest:

Patients whose hyperparathyroidism is caused by kidney failure may be treated with:

Outlook (Prognosis)

The outlook depends on the type of hyperparathyroidism.

Long-term problems that can occur when hyperparathyroidism is not well controlled include:

Related Information

Parathyroid hormone (PTH) blood test
Renal
Central nervous system
Urinary tract infection - adults
Kidney stones
Peptic ulcer
Calcium pyrophosphate arthritis

References

Bringhurst FR, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap. 28.

Wysolmerski JJ, Insogna KL. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 253.

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Review Date: 8/5/2014  

Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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