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Hyperparathyroidism

(Overactive Parathyroid)

Definition

Hyperparathyroidism is when the body makes too much parathyroid hormone (PTH). The parathyroid glands make PTH which help to keep calcium levels in balance. When PTH levels are too high it causes too much calcium in the blood.
Hyperparathyroidism may be:
  • Primary—a benign tumor of the parathyroid gland that makes too much PTH (most common form)
  • Secondary—occurs in people with long-standing kidney failure or a vitamin D deficiency
  • Tertiary—occurs in people with long-standing kidney failure and dialysis
Thyroid and Parathyroid Glands
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Causes

Primary hyperparathyroidism may be caused by:
  • Noncancerous tumor in the parathyroid gland—most common cause
  • Familial hyperparathyroidism
  • Multiple endocrine neoplasia (MEN)
  • Parathyroid cancer—rare
Secondary hyperparathyroidism may be caused by:
  • Vitamin D deficiency due to inadequate dietary intake, lack of sunlight exposure, or malabsorption condition like celiac disease
  • Kidney failure or other medical problems that make the body resistant to the action of the parathyroid hormone
Enlargement of the parathyroid gland is the main risk factor for tertiary hyperparathyroidism.

Risk Factors

Hyperparathyroidism is more common in women, especially after menopause. It is also more common in people older than 50 years of age. Other factors that may increase the chances of hyperparathyroidism:
  • Multiple endocrine neoplasia
  • Having specific genetic factors that increase your risk
  • Radiation therapy to the head or neck during childhood

Symptoms

The level of calcium in the blood will determine the symptoms. Symptoms occasionally seen with primary hyperparathyroidism include:
  • Constipation
  • Nausea
  • Vomiting
  • Abdominal pain
  • Headache
  • Loss of appetite
  • Thirst
  • Frequent and sometimes painful urination due to kidney stones
  • Fatigue
  • Muscle weakness
  • Joint pain
  • Memory loss
  • Heartburn
  • Back pain

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Testing may include:

Treatment

Treatment will be based on the type of hyperparathyroidism. Options may include the following:
  • If a growth is causing the problems, surgery may be done to remove the growth
  • Hyperparathyroidism due to a vitamin D deficiency may be treated with medications
  • Treating underlying causes
  • Medication to manage possible side effects or keep calcium levels more normal

Monitoring of Blood Calcium Levels

Your doctor may choose to regularly check your blood calcium levels and monitor you for possible complications. This may include regular bone density tests every 1-2 years.

Prevention

Adequate calcium and vitamin D intake may play a role in preventing hyperparathyroidism in women. Try to get recommended levels of calcium through dietary choices and supplements.

RESOURCES

Hormone Health Network—Endocrine Society
http://www.hormone.org
The American Association of Endocrine Surgeons
http://endocrinediseases.org

CANADIAN RESOURCES

Health Canada
https://www.canada.ca
The Canadian Society of Endocrinology and Metabolism
http://www.endo-metab.ca

References

Hyperparathyroidism. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/hyperparathyroidism. Updated January 18, 2018. Accessed March 26, 2018.
Primary hyperparathyroidism. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113972/Primary-hyperparathyroidism. Updated June 28, 2017. Accessed March 26, 2018.
Secondary hyperparathyroidism. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T914924/Secondary-hyperparathyroidism. Updated June 26, 2017. Accessed March 26, 2018.
Silverberg SJ, Bilezikian JP. The diagnosis and management of asymptomatic primary hyperparathyroidism. Nat Clin Pract Endocrinol Metab. 2006;2(9):494-503.
Tertiary hyperparathyroidism. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T914925/Tertiary-hyperparathyroidism. Updated March 19, 2018. Accessed March 26, 2018.
Taniegra E. Hyperparathyroidism. Am Fam Physician. 2004;69(2):333.
11/26/2012 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113972/Primary-hyperparathyroidism: Paik J, Curhan G, Taylor EN. Calcium intake and risk of primary hyperparathyroidism in women: prospective cohort study. BMJ. 2012;345:e6390.

Revision Information

  • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
  • Review Date: 03/2018
  • Update Date: 02/17/2016
Article written by McCoy K