Parathyroid hyperplasia
Enlarged parathyroid glands; Osteoporosis - parathyroid hyperplasia; Bone thinning - parathyroid hyperplasia; Osteopenia - parathyroid hyperplasia; High calcium level - parathyroid hyperplasia; Chronic kidney disease - parathyroid hyperplasia; Kidney failure - parathyroid hyperplasia; Overactive parathyroid - parathyroid hyperplasiaParathyroid 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 regulate calcium absorption, use, and removal by the body. They do this by producing parathyroid hormone (PTH). PTH helps regulate 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:
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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...
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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 condition 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 (variant) 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:
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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
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 ...
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Lack of energy
Lack of energy
Fatigue is a feeling of weariness, tiredness, or lack of energy.
Read Article Now Book Mark Article - Muscle pain
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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:
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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
Phosphorus
The phosphorus blood test measures the amount of phosphate in the blood.
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Magnesium
Magnesium
A serum magnesium test measures the level of magnesium in the blood.
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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...
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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 regulate calcium and phosphate ...
Read Article Now Book Mark Article - Creatinine, BUN (kidney function tests)
Kidney function tests
Kidney function tests are common lab tests used to evaluate how well the kidneys are working. Such tests include:BUN (Blood urea nitrogen) Creatinin...
Read Article Now Book Mark Article - 24-hour urine test - done to determine how much calcium is being filtered out of the body into the urine
- Alkaline phosphatase
Other tests include:
- Bone density exam
- Kidney ultrasound or CT scan (may show kidney stones or calcification)
Ultrasound
Ultrasound uses high-frequency sound waves to make images of organs and structures inside the body.
Read Article Now Book Mark ArticleCT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
Read Article Now Book Mark Article - Kidney x-rays (may show kidney stones)
x-rays
X-rays are a type of electromagnetic radiation, just like visible light. An x-ray machine sends individual x-ray waves through the body. The images...
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- Neck ultrasound
- Sestamibi neck scan (to identify the location of the parathyroid adenoma)
Treatment
If parathyroid hyperplasia is due to kidney disease or low vitamin D level and it is found early, your health care provider may recommend that you take vitamin D, vitamin D-like medicines, 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).
Hypoparathyroidism
Hypoparathyroidism is a disorder in which the parathyroid glands in the neck do not produce enough parathyroid hormone (PTH).
Read Article Now Book Mark ArticleOutlook (Prognosis)
After surgery, a high blood 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.
Hyperparathyroidism
Hyperparathyroidism is a condition in which 1 or more of the parathyroid glands in your neck produce too much parathyroid hormone (PTH).
Read Article Now Book Mark ArticleComplications 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 ArticleKidney stones
A kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time.
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
Contact your provider if:
- You have any symptoms of hypercalcemia
Hypercalcemia
Hypercalcemia means you have too much calcium in your blood.
Read Article Now Book Mark Article - 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 variant gene. Those who have the variant gene may have routine screening tests to detect any early symptoms.
References
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, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 227.
Walker MD, Bilezikian JP. Primary hyperparathyroidism. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 54.
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Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
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Parathyroid glands - illustration
The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce parathyroid hormone. Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.
Parathyroid glands
illustration
-
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
-
Parathyroid glands - illustration
The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce parathyroid hormone. Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.
Parathyroid glands
illustration
Review Date: 5/20/2024
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.