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Hyperparathyroidism

Parathyroid-related hypercalcemia; Osteoporosis - hyperparathyroidism; Bone thinning - hyperparathyroidism; Osteopenia - hyperparathyroidism; High calcium level - hyperparathyroidism; Chronic kidney disease - hyperparathyroidism; Kidney failure - hyperparathyroidism; Overactive parathyroid; Vitamin D deficiency - hyperparathyroidism

Hyperparathyroidism is a disorder in which the parathyroid glands in your neck produce too much parathyroid hormone (PTH).

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Parathyroid glands

Causes

There are 4 tiny parathyroid glands in the neck, near or attached to the back side of the thyroid gland.

The parathyroid glands help control calcium 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.

When calcium level is too low, the body responds by making more PTH. This causes the calcium level in the blood to rise.

When one or more of the parathyroid glands grow larger, it leads to too much PTH. Most often, the cause is not known.

Medical conditions that cause low blood calcium or increased phosphate can also lead to hyperparathyroidism. Common conditions include:

Symptoms

Hyperparathyroidism is often diagnosed by common blood tests before symptoms occur.

Symptoms are mostly caused by damage to organs from high calcium level in the blood, or by the loss of calcium from the bones. Symptoms can include:

Exams and Tests

The health care provider will do a physical exam and ask about symptoms.

Tests that may be done include:

Bone x-rays and bone mineral density (DXA) tests can help detect bone loss, fractures, or bone softening.

X-rays, ultrasound, or CT scans of the kidneys or urinary tract may show calcium deposits or a blockage.

Ultrasound or a nuclear medicine scan of the neck (sestamibi) is used to see if a benign tumor (adenoma) in a parathyroid gland is causing hyperparathyroidism.

Treatment

If you have a mildly increased calcium level and don't have symptoms, you may choose to have regular checkups or get treated.

If you decide to have treatment, it may include:

If you have symptoms or your calcium level is very high, you may need surgery to remove the parathyroid gland that is overproducing the hormone.

If you have hyperparathyroidism from a medical condition, your provider may prescribe vitamin D, if you have a low vitamin D level.

If hyperparathyroidism is caused by kidney failure, treatment may include:

Outlook (Prognosis)

Outlook depends on the cause of hyperparathyroidism.

Possible Complications

Long-term problems that can occur when hyperparathyroidism is not well controlled include:

Parathyroid gland surgery can result in hypoparathyroidism and damage to the nerves that control the vocal cords.

Related Information

Parathyroid hormone (PTH) blood test
Renal
Central nervous system
Urinary tract infection - adults
Kidney stones
Peptic ulcer
Calcium pyrophosphate arthritis

References

Silverberg SJ, Bilezikian JP. Primary hyperparathyroidism. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 63.

Thakker RV. The parathyroid glands, hypercalcemia and hypocalcemia. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 245.

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Review Date: 5/17/2018  

Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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