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Hyperparathyroidism: Treatment, symptoms, advice and help

About hyperparathyroidism

Hyperparathyroidism is a condition in which there is excessive secretion of parathyroid hormone (PTH). PTH is a hormone which is secreted by glands located behind the thyroid gland in the neck. Increased PTH secretion leads to high calcium levels in blood.

Hyperparathyroidism: Incidence, age and sex

Primary hyperparathyroidism has an annual incidence of 4 per 100,000 population and occurs mainly in the age group of 50 to 60 years. Women are affected more frequently than men.

Signs and symptoms of hyperparathyroidism: Diagnosis

Most individuals with hyperparathyroidism do not have any symptom and are diagnosed when a routine blood test shows up increased calcium levels. Hyperparathyroidism results in increased calcium levels in blood which lead to fatigue, muscular weakness, depression, mild impairment of cognition, dyspepsia, increased urination and increased thirst. As the blood calcium level rises, there may be constipation, abdominal pain, vomiting and dehydration. Very high blood calcium levels can lead to disturbances in heart rhythm, coma and can be rapidly fatal.

Increased PTH levels leads to increased calcium resorption from bone causing osteoporosis which can present as bony pains and fractures with minor trauma.

Diagnosis is suspected by finding increased calcium levels in blood. Blood levels of PTH are measured for establishment of diagnosis. A radionuclide scan of parathyroid glands (Technetium labelled Sestamibi scan) can reveal the abnormally functioning parathyroid gland.

Causes and prevention of hyperparathyroidism

Hyperparathyroidism can be primary or secondary. Primary hyperparathyroidism is caused most commonly by a benign tumour of one of the parathyroid glands. Sometimes, multiple glands are involved and very rarely, a cancer of parathyroid may be present. Secondary hyperparathyroidism occurs when there is increased secretion of PTH to counter act low blood calcium levels because of kidney disease, intestinal malabsorption or vitamin D deficiency.

Hyperparathyroidism: Complications

Hyperparathyroidism can cause acute severe hypercalcemia which can lead to neurological symptoms, cardiac arrhythmias and the patient may lapse into coma. Chronic hypercalcemia can cause calcium deposits in soft tissues, kidney (leading to formation of stones) and cartilage. Also, primary hyperparathyroidism can lead to reduction in mineral density of bones (osteoporosis) which can predispose to fractures with minor trauma.

Hyperparathyroidism: Treatment

The individuals with mildly elevated calcium levels and without any symptoms can be followed up without any treatment. They require periodic monitoring of blood calcium levels, kidney functions, measurement of bone mineral density by a DEXA scan. They should maintain adequate hydration and should avoid thiazide diuretics.

Acute hypercalcemia is treated by administration of intravenous and diuretics (loop diuretics) to help urinary excretion of calcium. Drugs like bisphosphonates (pamidronate, zolidronic acid) and calcitonin are sometimes used to lower blood calcium levels. Corticosteroids are also given in certain conditions. In patients with primary hyperparathyroidism who fail to respond to above measures, and who have osteoporosis and kidney dysfunction, surgical removal of the tumour of parathyroid gland is required. Patients who are less than 50 years of age are also preferred candidates for surgery.