Parathyroid hyperplasia
Parathyroid hyperplasia is the enlargement of all 4 parathyroid glands. The parathyroid glands are located in the neck, near or attached to the back side of the thyroid gland.
Causes
The parathyroid glands help control calcium absorption, use, and removal by the body. They do this by producing parathyroid hormone (PTH). PTH helps control calcium, phosphorus, and vitamin D levels in the blood and bone. It is important for healthy bones.
Parathyroid hyperplasia may occur in people without a family history of the disease, or as part of 3 inherited syndromes:
- Multiple endocrine neoplasia I (MEN I)
Multiple endocrine neoplasia I (MEN I)
Multiple endocrine neoplasia (MEN) type I is a disease in which one or more of the endocrine glands are overactive or forms a tumor. It is passed do...
Read Article Now Book Mark Article - MEN IIA
MEN IIA
Multiple endocrine neoplasia, type II (MEN II) is a disorder passed down through families in which one or more of the endocrine glands are overactive...
Read Article Now Book Mark Article - Isolated familial hyperparathyroidism
Hyperparathyroidism
Hyperparathyroidism is a disorder in which 1 or more of the parathyroid glands in your neck produce too much parathyroid hormone (PTH).
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In people with an inherited syndrome, a changed (mutated) gene is passed down through the family. You only need to get the gene from one parent to develop the condition.
- In MEN I, problems in the parathyroid glands occur, as well as tumors in the pituitary gland and pancreas.
- In MEN IIA, overactivity of the parathyroid glands occurs, along with tumors in the adrenal or thyroid gland.
Parathyroid hyperplasia that isn't part of an inherited syndrome is much more common. It occurs due to other medical conditions. The most common conditions that can cause parathyroid hyperplasia are chronic kidney disease and chronic vitamin D deficiency. In both cases, the parathyroid glands become enlarged because vitamin D and calcium levels are too low.
Symptoms
Symptoms may include:
- Bone fractures or bone pain
Bone fractures
If more pressure is put on a bone than it can stand, it will split or break. A break of any size is called a fracture. If the broken bone punctures...
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Constipation
Constipation in infants and children means they have hard stools or have problems passing stools. A child may have pain while passing stools or may ...
Read Article Now Book Mark Article - Lack of energy
Lack of energy
Fatigue is a feeling of weariness, tiredness, or lack of energy.
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- Nausea
Nausea
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
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Exams and Tests
Blood tests will be done to check levels of:
- Calcium
Calcium
The calcium blood test measures the level of calcium in the blood. This article discusses the test to measure the total amount of calcium in your blo...
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Phosphorus
The phosphorus blood test measures the amount of phosphate in the blood.
Read Article Now Book Mark Article - Magnesium
Magnesium
A serum magnesium test measures the level of magnesium in the blood.
Read Article Now Book Mark Article - PTH
PTH
The PTH test measures the level of parathyroid hormone in the blood. PTH stands for parathyroid hormone. It is a protein hormone released by the par...
Read Article Now Book Mark Article - Vitamin D
Vitamin D
The 25-hydroxy vitamin D test is the most accurate way to measure how much vitamin D is in your body. Vitamin D helps control calcium and phosphate l...
Read Article Now Book Mark Article - Kidney function (Creatinine, BUN)
A 24-hour urine test may be done to determine how much calcium is being filtered out of the body into the urine.
Bone x-rays and a bone density test (DXA) can help detect fractures, bone loss, and bone softening. Ultrasound and CT scans may be done to view the parathyroid glands in the neck.
Bone density test
A bone mineral density (BMD) test measures how much calcium and other types of minerals are in an area of your bone. This test helps your health care...
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If parathyroid hyperplasia is due to kidney disease or low vitamin D level and it is found early, your provider may recommend that you take vitamin D, vitamin D-like drugs, and other medicines.
Surgery is usually done when the parathyroid glands are producing too much PTH and causing symptoms. Usually 3 1/2 glands are removed. The remaining tissue may be implanted in the forearm or neck muscle. This allows easy access to the tissue if symptoms come back. This tissue is implanted to prevent the body from having too little PTH, which can result in low calcium levels (from hypoparathyroidism).
Outlook (Prognosis)
After surgery, high calcium level may persist or return. Surgery can sometimes cause hypoparathyroidism, which makes blood calcium level too low.
Possible Complications
Parathyroid hyperplasia can cause hyperparathyroidism, which leads to an increase in blood calcium level.
Complications include increased calcium in the kidneys, which can cause kidney stones, and osteitis fibrosa cystica (a softened, weak area in the bones).
Increased calcium in the kidneys
Nephrocalcinosis is a disorder in which there is too much calcium deposited in the kidneys. It is common in premature babies.
Read Article Now Book Mark ArticleOsteitis fibrosa cystica
Osteitis fibrosa is a complication of hyperparathyroidism, a condition in which overactive parathyroid glands cause certain bones to become abnormall...
Read Article Now Book Mark ArticleSurgery can sometimes damage the nerves that control the vocal cords. This can affect the strength of your voice.
Complications may result from the other tumors that are part of the MEN syndromes.
When to Contact a Medical Professional
Call your provider if:
- You have any symptoms of hypercalcemia
- You have a family history of a MEN syndrome
Prevention
If you have a family history of the MEN syndromes, you may want to have genetic screening to check for the defective gene. Those who have the defective gene may have routine screening tests to detect any early symptoms.
Reviewed By
Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Reid LM, Kamani D, Randolph GW. Management of parathyroid disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 123.
Thakker RV. The parathyroid glands, hypercalcemia and hypocalcemia. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 232.