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| Hyperparathyroidism |
What is hyperparathyroidism?
If the parathyroid glands secrete too much hormone, as
happens in primary hyperparathyroidism, the balance is
disrupted: Blood calcium rises. This condition of excessive
calcium in the blood, called hypercalcaemia, is what usually
signals the doctor that something may be wrong with the
parathyroid glands. In 85 percent of people with primary
hyperparathyroidism, a benign tumor called an adenoma has
formed on one of the parathyroid glands, causing it to
become overactive. Benign tumors are noncancerous. In most
other cases, the excess hormone comes from two or more
enlarged parathyroid glands, a condition called hyperplasia.
Very rarely, hyperparathyroidism is caused by cancer of a
parathyroid gland.
This excess PTH triggers the release of too much calcium into
the bloodstream. The bones may lose calcium, and too much
calcium may be absorbed from food. The levels of calcium may
increase in the urine, causing kidney stones. PTH also lowers
blood phosphorous levels by increasing excretion of
phosphorus in the urine.
Why are calcium and phosphorous so important?
Calcium is essential for good health. It plays an important role
in bone and tooth development and in maintaining bone
strength. Calcium is also important in nerve transmission and
muscle contraction.
Phosphorous is found in all bodily tissue. It is a main part of
every cell with many roles in each. Combined with calcium,
phosphorous gives strength and rigidity to your bones and
teeth.
What causes hyperparathyroidism?
In most cases doctors don't know the cause. The vast
majority of cases occur in people with no family history of the
disorder. Only about 5 percent of cases can be linked to an
inherited problem. Familial multiple endocrine neoplasia type 1
is a rare, inherited syndrome that affects the parathyroids as
well as the pancreas and the pituitary gland. Another rare
genetic disorder, familial hypocalciuric hypercalcaemia, is
sometimes confused with typical hyperparathyroidism. Each
accounts for about 2 percent of primary hyperparathyroidism
cases.
How common is hyperparathyroidism?
In the United States, about 100,000 people develop the
disorder each year. Women outnumber men two to one, and
risk increases with age. In women 60 years and older, two out
of 1,000 will develop hyperparathyroidism each year.
What are the symptoms of hyperparathyroidism?
A person with hyperparathyroidism may have severe
symptoms, subtle ones, or none at all. Increasingly, routine
blood tests that screen for a wide range of conditions,
including high calcium levels, are alerting doctors to people
who have mild forms of the disorder even though they are
symptom-free.
When symptoms do appear, they are often mild and
nonspecific, such as a feeling of weakness and fatigue,
depression, or aches and pains. With more severe disease, a
person may have a loss of appetite, nausea, vomiting,
constipation, confusion or impaired thinking and memory, and
increased thirst and urination. Patients may have thinning of
the bones without symptoms, but with risk of fractures.
Increased calcium and phosphorous excretion in the urine may
cause kidney stones.
How is hyperparathyroidism diagnosed?
Hyperparathyroidism is diagnosed when tests show that blood
levels of calcium and parathyroid hormone are too high. Other
diseases can cause high blood calcium levels, but only in
hyperparathyroidism is the elevated calcium the result of too
much parathyroid hormone. A blood test that accurately
measures the amount of parathyroid hormone has simplified
the diagnosis of hyperparathyroidism.
Once the diagnosis is established, other tests may be done to
assess complications. Because high PTH levels can cause
bones to weaken from calcium loss, a measurement of bone
density can help assess bone loss and the risk of fractures.
Abdominal images may reveal the presence of kidney stones
and a 24-hour urine collection may provide information on
kidney damage, the risk of stone formation, and the risk of
familial hypocalciuric hypercalcaemia.
How is hyperparathyroidism treated?
Surgery to remove the enlarged gland (or glands) is the main
treatment for the disorder and cures it in 95 percent of
operations.
Calcimimetics are a new class of drug that turns off secretion
of PTH. They have been approved by the Food and Drug
Administration for the treatment of hyperparathyroidism
secondary to kidney failure with dialysis, and primary
hyperparathyroidism caused by parathyroid cancer. They have
not been approved for primary hyperparathyroidism, but
some physicians have begun prescribing calcimimetics for
some patients with this condition. Patients can discuss this
class of drug in more detail with their physicians.
Some patients who have mild disease may not need immediate
treatment, according to panels convened by the National
Institutes of Health (NIH) in 2002. Patients who are
symptom-free, whose blood calcium is only slightly elevated,
and whose kidneys and bones are normal may wish to talk
with their physicians about long-term monitoring. In the 2002
recommendation, periodic monitoring would consist of clinical
evaluation, measurement of serum calcium levels, and bone
mass measurement. If the patient and physician choose
long-term follow-up, the patient should try to drink lots of
water, get plenty of exercise, and avoid certain diuretics, such
as the thiazides. Immobilization (unable to move) and
gastrointestinal illness with vomiting or diarrhea can cause
calcium levels to rise. Patients with hyperparathyroidism
should seek medical attention if they find themselves
immobilized, vomiting, or having diarrhea.
Are there any complications associated with parathyroid
surgery?
Surgery for hyperparathyroidism is highly successful with a
low complication rate when performed by surgeons
experienced with this condition. About 1 percent of patients
undergoing surgery experience damage to the nerves
controlling the vocal cords, which can affect speech. One to 5
percent of patients lose all their parathyroid tissue and thus
develop chronic low calcium levels, which may require
treatment with calcium or vitamin D. The complication rate is
slightly higher for hyperplasia than it is for adenoma since
more extensive surgery is needed.
Content Source NIDDK.NIH
If the parathyroid glands secrete too much hormone, as
happens in primary hyperparathyroidism, the balance is
disrupted: Blood calcium rises. This condition of excessive
calcium in the blood, called hypercalcaemia, is what usually
signals the doctor that something may be wrong with the
parathyroid glands. In 85 percent of people with primary
hyperparathyroidism, a benign tumor called an adenoma has
formed on one of the parathyroid glands, causing it to
become overactive. Benign tumors are noncancerous. In most
other cases, the excess hormone comes from two or more
enlarged parathyroid glands, a condition called hyperplasia.
Very rarely, hyperparathyroidism is caused by cancer of a
parathyroid gland.
This excess PTH triggers the release of too much calcium into
the bloodstream. The bones may lose calcium, and too much
calcium may be absorbed from food. The levels of calcium may
increase in the urine, causing kidney stones. PTH also lowers
blood phosphorous levels by increasing excretion of
phosphorus in the urine.
Why are calcium and phosphorous so important?
Calcium is essential for good health. It plays an important role
in bone and tooth development and in maintaining bone
strength. Calcium is also important in nerve transmission and
muscle contraction.
Phosphorous is found in all bodily tissue. It is a main part of
every cell with many roles in each. Combined with calcium,
phosphorous gives strength and rigidity to your bones and
teeth.
What causes hyperparathyroidism?
In most cases doctors don't know the cause. The vast
majority of cases occur in people with no family history of the
disorder. Only about 5 percent of cases can be linked to an
inherited problem. Familial multiple endocrine neoplasia type 1
is a rare, inherited syndrome that affects the parathyroids as
well as the pancreas and the pituitary gland. Another rare
genetic disorder, familial hypocalciuric hypercalcaemia, is
sometimes confused with typical hyperparathyroidism. Each
accounts for about 2 percent of primary hyperparathyroidism
cases.
How common is hyperparathyroidism?
In the United States, about 100,000 people develop the
disorder each year. Women outnumber men two to one, and
risk increases with age. In women 60 years and older, two out
of 1,000 will develop hyperparathyroidism each year.
What are the symptoms of hyperparathyroidism?
A person with hyperparathyroidism may have severe
symptoms, subtle ones, or none at all. Increasingly, routine
blood tests that screen for a wide range of conditions,
including high calcium levels, are alerting doctors to people
who have mild forms of the disorder even though they are
symptom-free.
When symptoms do appear, they are often mild and
nonspecific, such as a feeling of weakness and fatigue,
depression, or aches and pains. With more severe disease, a
person may have a loss of appetite, nausea, vomiting,
constipation, confusion or impaired thinking and memory, and
increased thirst and urination. Patients may have thinning of
the bones without symptoms, but with risk of fractures.
Increased calcium and phosphorous excretion in the urine may
cause kidney stones.
How is hyperparathyroidism diagnosed?
Hyperparathyroidism is diagnosed when tests show that blood
levels of calcium and parathyroid hormone are too high. Other
diseases can cause high blood calcium levels, but only in
hyperparathyroidism is the elevated calcium the result of too
much parathyroid hormone. A blood test that accurately
measures the amount of parathyroid hormone has simplified
the diagnosis of hyperparathyroidism.
Once the diagnosis is established, other tests may be done to
assess complications. Because high PTH levels can cause
bones to weaken from calcium loss, a measurement of bone
density can help assess bone loss and the risk of fractures.
Abdominal images may reveal the presence of kidney stones
and a 24-hour urine collection may provide information on
kidney damage, the risk of stone formation, and the risk of
familial hypocalciuric hypercalcaemia.
How is hyperparathyroidism treated?
Surgery to remove the enlarged gland (or glands) is the main
treatment for the disorder and cures it in 95 percent of
operations.
Calcimimetics are a new class of drug that turns off secretion
of PTH. They have been approved by the Food and Drug
Administration for the treatment of hyperparathyroidism
secondary to kidney failure with dialysis, and primary
hyperparathyroidism caused by parathyroid cancer. They have
not been approved for primary hyperparathyroidism, but
some physicians have begun prescribing calcimimetics for
some patients with this condition. Patients can discuss this
class of drug in more detail with their physicians.
Some patients who have mild disease may not need immediate
treatment, according to panels convened by the National
Institutes of Health (NIH) in 2002. Patients who are
symptom-free, whose blood calcium is only slightly elevated,
and whose kidneys and bones are normal may wish to talk
with their physicians about long-term monitoring. In the 2002
recommendation, periodic monitoring would consist of clinical
evaluation, measurement of serum calcium levels, and bone
mass measurement. If the patient and physician choose
long-term follow-up, the patient should try to drink lots of
water, get plenty of exercise, and avoid certain diuretics, such
as the thiazides. Immobilization (unable to move) and
gastrointestinal illness with vomiting or diarrhea can cause
calcium levels to rise. Patients with hyperparathyroidism
should seek medical attention if they find themselves
immobilized, vomiting, or having diarrhea.
Are there any complications associated with parathyroid
surgery?
Surgery for hyperparathyroidism is highly successful with a
low complication rate when performed by surgeons
experienced with this condition. About 1 percent of patients
undergoing surgery experience damage to the nerves
controlling the vocal cords, which can affect speech. One to 5
percent of patients lose all their parathyroid tissue and thus
develop chronic low calcium levels, which may require
treatment with calcium or vitamin D. The complication rate is
slightly higher for hyperplasia than it is for adenoma since
more extensive surgery is needed.
Content Source NIDDK.NIH
| MEDICAL NOTES |
DISEASES AND
CONDITIONS
Acidosis
Acne
Acromegaly
Addison's Disease
Adrenal Crisis
Age. macular degn
Alzheimer's disease
Autoimmune
Hepatitis
Barrett's Esophagus
Cancer
Constipation
Colon Polyps
Crohns Disease
Cushing's Syndrm.
Diabetes
Erectile Dysfunction
Fecal Incontinence
Gallstones
Gastritis
Gastroenteritis
Gastroesophageal
Reflux (GERD)
Growth Hormone
Def.
Heartburn
Hemochromatosis
Hemorrhoids
Hyperparathyroidism
Hypertension
Inflam. Bowel Dis.
Kidney Stone
Liver Cirrhosis
Migraines
Multiple Sclerosis
Obesity
Osteorithritis
Osteoporosis
Pancreatitis
Parkinson's Disease
Peyronies' Disease
Prolactinoma
Psoriasis
Sprain and Strain
Stroke
Ulcerative Colitis
Urin. Incontinence
Vitiligo
CONDITIONS
Acidosis
Acne
Acromegaly
Addison's Disease
Adrenal Crisis
Age. macular degn
Alzheimer's disease
Autoimmune
Hepatitis
Barrett's Esophagus
Cancer
Constipation
Colon Polyps
Crohns Disease
Cushing's Syndrm.
Diabetes
Erectile Dysfunction
Fecal Incontinence
Gallstones
Gastritis
Gastroenteritis
Gastroesophageal
Reflux (GERD)
Growth Hormone
Def.
Heartburn
Hemochromatosis
Hemorrhoids
Hyperparathyroidism
Hypertension
Inflam. Bowel Dis.
Kidney Stone
Liver Cirrhosis
Migraines
Multiple Sclerosis
Obesity
Osteorithritis
Osteoporosis
Pancreatitis
Parkinson's Disease
Peyronies' Disease
Prolactinoma
Psoriasis
Sprain and Strain
Stroke
Ulcerative Colitis
Urin. Incontinence
Vitiligo