Thiazide diuretics and lithium can also cause hypercalcemia, so if PTH is high in people taking either drug, they should temporarily halt drug therapy, if possible, and have repeat PTH and calcium tests two or three months later.
Other diseases, including cancer, can raise calcium levels, but few cancers are also associated with excessive PTH. An uncommon condition that can be confused with hyperparathyroidism is familial hypercalciuric hypercalcemia FHH , a genetic disorder that resembles primary hyperparathyroidism but doesn't need to be treated.
FHH is ruled out with urine tests in order to avoid unnecessary parathyroid surgery. To confirm the hyperparathyroidism diagnosis, an endocrinologist may order additional tests for blood levels of phosphorus, vitamin D, creatinine, and biomarkers of bone turnover, as well as bone density testing using standard dual energy x-ray absorptiometry scanning.
Bone loss in primary hyperparathyroidism is usually more pronounced at the forearm than at the spine or hip, but all three sites should be evaluated. When it causes kidney or bone disease or severe symptoms, primary hyperparathyroidism almost always calls for parathyroidectomy — removal of the enlarged parathyroid gland or glands.
Experts are less certain about what to do when hyperparathyroidism is asymptomatic. Asymptomatic primary hyperparathyroidism progresses to a more serious condition only about one-third of the time, so some experts favor simply monitoring most patients and, if necessary, managing the condition with lifestyle measures and medications.
Others argue that the long-term cost of such medical management may exceed that of the relatively simple operation, which is increasingly performed as an outpatient procedure. Surgery eliminates the risk of disease progression altogether and may also get rid of many of the nonspecific complaints. Experts acknowledge that medical management might be appropriate for people who don't meet the criteria for surgery see "Decision factors for surgery in asymptomatic primary hyperparathyroidism" or who can't or won't undergo the surgery.
But they also note that surgery might ultimately be recommended even for the most asymptomatic patients. Surgery is associated with a reduced lifetime risk of fractures. Sestamibi scanning is a painless technique often used before surgery to locate abnormal parathyroid glands and determine whether minimally invasive surgery is appropriate. A radiolabeled compound technetium sestamibi is injected into a vein and is taken up preferentially by the abnormal parathyroids.
The patient lies still on a table while two cameras circle the upper body, recording images from opposite sides. The abnormal glands will show up as areas of increased uptake on the scan. The standard surgery, called bilateral neck exploration, entails making a two- to five-inch incision across the front of the neck, examining all four parathyroid glands, and removing the enlarged ones. It's usually performed under general anesthesia, although local anesthesia is sometimes an option.
A single abnormal parathyroid is usually at fault, but sometimes two or more must be removed. Today, minimally invasive surgery is increasingly preferred. It involves a smaller, one- to two-inch incision, takes less time, and requires less anesthesia. This technique can be used whenever preoperative imaging indicates that there is a single abnormal parathyroid gland. The most common imaging method is sestamibi scanning, which uses a radioactive isotope called technetium sestamibi to identify the abnormal gland.
Treatment for secondary hyperparathyroidism depends on the underlying cause. Low vitamin D is the most common cause and can be corrected with oral vitamin D colecalciferol. Another common cause is kidney disease. Surgery is usually the main treatment for tertiary hyperparathyroidism that occurs in very advanced kidney failure.
Page last reviewed: 24 May Next review due: 24 May Symptoms of hyperparathyroidism Hyperparathyroidism affects people differently. Possible signs of hyperparathyroidism include: depression tiredness feeling thirsty and peeing a lot feeling sick and losing your appetite muscle weakness constipation tummy pain loss of concentration mild confusion Symptoms of hypercalcaemia If hyperparathyroidism is not treated, it can lead to high blood calcium levels hypercalcaemia , which may cause: being sick vomiting drowsiness dehydration confusion muscle spasms bone pain or tenderness joint pain irregular heartbeat high blood pressure hypertension Hypercalcaemia can also cause other complications, including: osteoporosis and bone fractures kidney stones and blockage, and kidney damage or failure stomach ulcers gastric or peptic ulcers pancreatitis inflammation of the pancreas In very severe cases of hyperparathyroidism, high calcium levels can lead to rapid kidney failure, loss of consciousness, coma , or serious life-threatening heart rhythm abnormalities.
Diagnosing hyperparathyroidism It's important that hyperparathyroidism is diagnosed as soon as possible.
Hyperparathyroidism is diagnosed after a blood test shows: high levels of parathyroid hormone high levels of blood calcium, often with low levels of phosphorus A DEXA scan a bone density X-ray can help detect bone loss, fractures or bone softening, and X-rays , CT scans or ultrasound scans may show calcium deposits or kidney stones. Types of hyperparathyroidism There are 3 types of hyperparathyroidism. Primary hyperparathyroidism is when there's a problem within the parathyroid gland itself, usually a benign non-cancerous tumour of the gland.
Secondary hyperparathyroidism is when the glands are fine but a condition, like kidney failure, lowers calcium levels and causes the body to react by producing extra parathyroid hormone. Tertiary hyperparathyroidism is when long-standing secondary hyperparathyroidism starts to behave like primary hyperparathyroidism. It typically occurs when one or more of the four parathyroid glands hypertrophy or grow an adenoma that begins to produce extra parathyroid hormone, which in turn increases the calcium levels in the bloodstream.
This calcium typically comes from the bones, which is why this can lead to osteoporosis. Hypoparathyroidism is typically a result of surgery either of the thyroid or parathyroids. Because of their close proximity, parathyroids are sometimes accidentally removed or damaged during a thyroid surgery resulting in a much lower production of parathyroid hormone and a drop in blood calcium levels. This results in muscular irritability which causes the symptoms of muscle cramps and tingling.
Typically, diagnostic testing is used to localize the parathyroid gland that is producing extra hormone and then surgical removal of that parathyroid gland is curative. However, if patients are unable to undergo surgery, there are medications and other interventions that can help lower calcium levels.
Any association is difficult to prove today, as hyperparathyroidism is usually mild due to early detection of cases through routine automated measurements of calcium. In addition, PUD is less prevalent now than before the advent of proton pump inhibitors. The presence of ulcers or ulcer symptoms may correct in some patients after parathyroidectomy, suggesting an association. The incidence of pancreatitis in patients with primary hyperparathyroidism ranges from 1.
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