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Hyperparathyroidism Overview

UW Health endocrine surgeons in Madison, Wisconsin, treat hyperparathyroidism.

 

The parathyroid glands make a hormone that tells the body how much calcium to store in the bones and how much to have in the blood.  Sometimes parathyroid glands enlarge and send out too much parathyroid hormone (PTH). This is called hyperparathyroidism. When this happens, there is too much calcium in the blood and not enough in the bones. This can cause the bones to become weak and can lead to fractures.

 

If there is too much calcium in your blood, the kidneys will try to excrete it in the urine and this may cause increased urine output, kidney stones, or even kidney damage.

 

Hyperparathyroidism occurs in about 1 percent of the general population and up to 2 percent of elderly patients. It is more common in woman than in men.

 

Forms of Hyperparathyroidism

 

There are three forms of hyperparathyroidism, which include:

  • Primary: The most common form of hyperparathyroidism. We do not know exactly why people get it. In 80-85 percent of cases, this is due to a parathyroid adenoma or enlargement of a single gland.
  • Secondary: Seen most often in people with kidney disease, gastrointestinal calcium malabsorption, and vitamin D deficiency. All four parathyroid glands are enlarged.
  • Tertiary: Occurs in people with a history of kidney disease who then receive a kidney transplant. Most patients have an enlargement of all four glands, but some may only have enlargement of one or two glands.

Symptoms of Hyperparathyroidism

 

Individuals with hyperparathyroidism may experience no symptoms, or may experience the following:

 

  • Fatigue
  • Muscle weakness
  • Palpitations
  • Bone pain
  • Joint pain
  • Difficulty concentrating
  • Difficulty sleeping
  • Memory problems
  • Feeling depressed
  • Feeling anxious
  • Abdominal pain
  • Nausea or vomiting
  • Heartburn
  • Constipation
  • Frequent urination
  • Nighttime urination
  • Kidney stones
  • Fractures
  • Thinning hair
  • Headaches

 

 

 

 

 

 

 

 

 

 

 

 

 

Asymptomatic Hyperparthyroidism

 

Surgical treatment of hyperparthyroidism is recommended for people who do not have symptoms. Rebecca Sippel, MD, prepared a presentation explaining the reasons. View Dr. Sippel's presentation on asymptomatic hyperparthyroidism (pdf).

 

Risk Factors for Hyperparathyroidism

 

Individuals with the following conditions may be at a greater risk for developing hyperparathyroidism:

  • Family history of hyperparathyroidism
  • Family history of Multiple Endocrine Neoplasia (MEN) syndromes: a genetic syndrome comprised of endocrinopathies of the pituitary, parathyroids, pancreas, and thyroid
  • Family history of familial hypocalciuric hypercalcemia (FHH)
  • Kidney disease 

Diagnosing Hyperparathyroidism

 

Hyperparathyroidism is often detected on routine blood work drawn when evaluating or monitoring other health conditions. Certain medications can cause high calcium. These medications are stopped and blood work is repeated. An elevated calcium and elevated PTH diagnose hyperparathyroidism. A calcium level in the high end of the normal range and/or a PTH level in the high end of the normal range also diagnose hyperparathyroidism.

 

 

Primary

Secondary

Tertiary

Calcium

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PTH

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Phosphate

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Urine Calcium

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The vast majority of enlarged parathyroids causing hyperparathyroidism are noncancerous (benign). Parathyroid cancer occurs in less than 1 percent of people with hyperparathyroidism.