Hyperparathyroidism occurs when your parathyroid glands create too much parathyroid hormone in the bloodstream. These glands, located behind the thyroid at the bottom of your neck, are about the size of a grain of rice.
The parathyroid glands produce parathyroid hormone. This hormone helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning
Two types of hyperparathyroidism exist.
• Primary hyperparathyroidism –
In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of the hormone. This causes high calcium levels in the blood, which can cause a variety of health problems.Sugergy in the most common treatment of this type.
• Secondary hyperparathyroidism-
This type of hyperparathyroidism occurs due to another disease such as chronic kidney failure that first causes low calcium levels in the body. Overtime, increased parathyroid hormone levels occur.
Symptoms can vary from mild to severe, depending on your type of hyperparathyroidism.
Primary hyperparathyroidism –
Milder symptoms may include-
More severe symptoms can include –
• appetite loss
• excessive thirst
• increased urination
• memory problems
• kidney stones
Secondary hyperparathyroidism –
With this type, you may have skeletal abnormalities, such as fractures, swollen joints and bone deformities. Other symptoms depend on the underlying cause, such as chronic kidney failure or severe vitamin D deficiency.
Hyperparathyroidism is caused by factors that increase the production of parathyroid hormone.
The parathyroid glands maintain proper levels of both calcium and phosphorus in your body by turning the secretion of parathyroid hormone (PTH) off or on, much like a thermostat controls a heating system to maintain a constant air temperature. Vitamin D also is involved in regulating the amount of calcium in your blood.
Normally, this balancing act works well. When calcium levels in your blood fall too low, your parathyroid glands secrete enough PTH to restore the balance. PTH raises calcium levels by releasing calcium from your bones and increasing the amount of calcium absorbed from your small intestine.
When blood-calcium levels are too high, the parathyroid glands produce less PTH, but sometimes one or more of these glands produce too much hormone. This leads to abnormally high calcium levels and low phosphorous levels in your blood.
Calcium is best known for its role is keeping your teeth and bones healthy. But calcium also aids in the transmission of signals in nerve cells and it’s involved in muscle contraction. Phosphorus works along with calcium in these areas.
Primary hyperparathyroidism occurs became of some problem with one or more of the four parathyroid glands-
• A non cancerous growth on a gland is the most common cause.
• Enlargement of two or more parathyroid glands
• Very rarely, a cancerous tumor
Secondary hyperthyroidism may occurs due to the diseases such as severe calcium deficiency, severe vitamin D deficiency, chronic kidney failure.
Risk Factors –
You may be at high risk of primary hyperparathyroidism if you :
• Are a woman who has gone through menopause
• Had prolonged, severe calcium or vitamin D deficiency
• Have a rare, inherited disorder, such as multiple endocrine neoplasia, type 1, which usually affects multiple glands
• Have had radiation treatment for cancer that has exposed your neck to radiation
• Have taken lithium, a drug most often used to treat bipolar disorder
Complications of hyperparathyroidism are mainly related to the long term effect of too little calcium in your bones and too much calcium in your bloodstream. Common complications include –
• Kidney stones
• Cardiovascular disease
• Neonatal hypoparathyroidism
Your primary care provider might suspect that you have hyperparathyroidism if routine blood tests show high levels of calcium in your blood. To confirm this diagnosis, your doctor will need to perform other tests.
Blood Tests –
Additional blood tests can help your doctor to make a more accurate diagnosis. Your doctor will check your blood for high PTH levels, high alkaline phosphatase levels and low levels of phosphorus.
Bone mineral density test –
This test is done to see if you have developed osteoporosis. The most common test to measure bone mineral density is dual energy X-ray absorptiometry (DEXA).
Urine Tests –
A urine test can help your doctor to determine how severe your condition is and whether kidney problems are the cause. Your doctor will check your urine to see how much calcium it contains.
Imaging tests of Kidneys-
Your doctor may order an X-ray or other imaging tests of your abdomen to determine if you have kidney stones or other kidney abnormalities
Yourdoctor may recommend no treatment and regular monitoring if –
• Your calcium levels are only slightly elevated
• Your kidneys are working normally and you have no kidney stones
• Your bone density is normal or only slightly below normal
• You have no other symptoms that may improve with treatment
If you choose this watch and wait approach, you will likely need periodically scheduled tests to monitor your blood calcium levels and bone density.
Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in most cases.A surgeon will remove only those glands that one enlarged or have a tumor. If all four glands are affected, a surgeon will likely remove all three glands and perhaps a portion of the fourth – leaving some functioning parathyroid tissue.
Medications to treat hyperparathyroidism incIude the following-
• Calcimimetics- It is a drug that mimics calcium circulating in the blood. The drug may trick the parathyroid glands into releasing less parathyroid hormone. This drug is sold as cinacalcet (Sensipar). Sometimes it is used to treat primary hyperparathyroidism, particularly if surgery hasn’t successfully cured the disorder or a person is not a good surgery candidate.
• Hormone replacement therapy – For women who have gone through menopause and have sign of osteoporosis, HRT may help bones retain calcium.
• Bisphosphonates – These medications also prevent the Ioss of calcium from bones and may lessen osteoporosis caused by hyperparathyroidism.
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