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Hyperparathyroidism

You have four tiny parathyroid glands, one located on each of the four corners of another gland the thyroid, which is located at the base of your neck. But in spite of the similarity in name and location, the parathyroid glands and thyroid gland are separate glands with separate functions.

Your thyroid gland, for example, helps regulate nearly every aspect of your metabolism, from how quickly your heart beats to the rate at which you burn calories. The parathyroids, on the other hand, produce a hormone that helps maintain the proper balance of calcium and phosphorus in your body. When the glands sense that blood calcium levels are either too low or too high, they secrete just enough parathyroid hormone (PTH) to restore the levels to normal. Sometimes, however, the glands produce too much PTH a condition known as hyperparathyroidism. This leads to consistently high levels of calcium in your blood (hypercalcemia).

Each year, approximately 100,000 Americans develop what's known as primary hyperparathyroidism, when one or more parathyroid glands become overactive. Secondary hyperparathyroidism is less common. It occurs when another medical condition particularly kidney failure causes your parathyroid glands to secrete too much PTH.

Left untreated, hyperparathyroidism can cause additional health problems, such as kidney damage and a loss of calcium from your bones, leading to osteoporosis.

If you have mild hyperparathyroidism, you may not need any treatment, although your blood-calcium levels, kidney function and bone health will need to be regularly checked. When your kidneys or bones are affected, or you have bothersome symptoms, surgery may be the best option.

Signs and symptoms
More than half the people with hyperparathyroidism have no symptoms. In those who do, the symptoms frequently come on slowly and are usually subtle, such as a feeling of weakness or fatigue, or vague aches and pains. But more severe signs and symptoms can develop over time, including:

  • Increased thirst and urination due to increased excretion of calcium in the urine (hypercalciuria)
  • Kidney stones
  • Heartburn or abdominal pain from peptic ulcer disease or pancreatitis
  • Nausea, vomiting or loss of appetite
  • Thinning bones, leading to an increased risk of fractures
  • Confusion or poor memory
  • Muscle weakness or fatigue

Causes
Calcium is the most abundant mineral in your body. It's essential for the development and health of your teeth and bones. Calcium also helps your blood clot, aids in the transmission of signals in nerve cells and plays a role in muscle contraction. Another mineral, phosphorus, works in conjunction with calcium in these areas.

The parathyroid glands maintain proper levels of both calcium and phosphorus in your body by turning the secretion of parathyroid hormone (PTH) off or on, much as a thermostat controls a heating system to maintain a constant air temperature. Vitamin D also is involved in regulating the amount of calcium in your blood.

Normally, this balancing act works well. When calcium levels in your blood fall too low, your parathyroid glands secrete the right amount of PTH to restore the balance. PTH raises calcium levels by releasing calcium from your bones and increasing the amount of calcium absorbed from your small intestine. When blood-calcium levels are too high, the parathyroids produce less PTH. But sometimes one or more parathyroid glands produce too much hormone, leading to abnormally high levels of calcium and low levels of phosphorus in your blood.

In more than 80 percent of people with hyperparathyroidism, the cause is a benign growth (adenoma) on one of the parathyroid glands. Most other cases result from excess hormone that's produced when two or more parathyroids become enlarged a condition known as hyperplasia.

Secondary hyperparathyroidism occurs when another medical condition, such as kidney failure, causes your parathyroid to produce too much PTH. Infants and children who have rickets a disease caused by severe vitamin D deficiency also may develop secondary hyperparathyroidism. In rare cases, hyperparathyroidism may be caused by cancer of one of the parathyroid glands.

Risk factors

Twice as many women as men develop primary hyperparathyroidism, and risk increases with age. Two out of every 1,000 women age 60 and older will develop the disease.

Infants or adults with vitamin D deficiency also are at greater risk of developing secondary hyperparathyroidism. Most children and adults get sufficient amounts of vitamin D from food especially eggs, fish, green vegetables and fortified milk products and from exposure to sunlight, which changes a chemical in the skin into an active form of vitamin D. But several factors have caused a resurgence of vitamin D deficiency among some infants and children.

Chief among these are breast-feeding and the use of sunscreen. Although breast milk is a baby's ideal food, it doesn't contain vitamin D. If your baby is breast-fed only, talk to your pediatrician about a vitamin D supplement. In addition, children who live in northern or cloudy climates or who consistently use sunscreen may not receive enough sunlight to manufacture vitamin D in their skin.

Also at increased risk are people with familial endocrine neoplasia type I a rare inherited syndrome that affects the parathyroids as well as the pancreas and pituitary gland. Having familial hyperparathyroidism hyperparathyroidism that runs in families also puts you at risk.

Screening and diagnosis

You may not realize you have hyperparathyroidism because early symptoms tend to be vague or nonexistent. When symptoms do develop, they frequently resemble those of other conditions. That's why doctors rely on blood tests to diagnose hyperparathyroidism.

Your doctor may be alerted to the disease when high levels of calcium show up on routine blood tests, or on tests that screen for a number of conditions. But because other diseases and certain medications also can increase the amount of calcium in your blood, you'll receive a diagnosis of hyperparathyroidism only if blood tests show high levels of both calcium and parathyroid hormone.

Once hyperparathyroidism is diagnosed, your doctor may recommend tests to check for complications. These may include bone density tests to assess bone loss, and a 24-hour collection of urine to provide information on your kidney function.

If your doctor suspects you have kidney stones, he or she may also suggest an abdominal X-ray or an ultrasound, a diagnostic technique that combines high-frequency radio waves and computer processing to view your kidneys.

Sometimes you and your doctor may choose not to treat hyperparathyroidism right away, especially if your blood calcium is only mildly elevated. If so, your doctor will likely want to check your calcium levels and kidney function every six months and may also recommend an annual abdominal X-ray and a bone density test every one to two years. If the disease doesn't become worse over time, you may not need to have these tests as often.

Complications
Having too much PTH can lead to several serious complications, including:

  • Osteoporosis. Hyperparathyroidism poses a long-term threat to your bones the more PTH your parathyroids produce, the more calcium your bones lose. The result is weak, brittle bones that are prone to fractures.
  • Kidney damage or kidney stones. Because your body tries to compensate for excess calcium by excreting more of the mineral in your urine, you're at increased risk of kidney damage or kidney stones small hard masses that form in your kidneys.
  • Peptic ulcers. High blood levels of calcium stimulate your stomach to produce more acid, making you more prone to develop peptic ulcers.
  • High blood pressure. High calcium levels in your blood can raise your blood pressure.

Treatment
In general, treatment depends on the presence of complications or symptoms and the type of hyperparathyroidism you have.

Primary hyperparathyroidism
If you don't have symptoms and your kidneys and bones are healthy, you and your doctor may choose a wait-and-see approach. Sometimes this may be all you need, although your kidney function, bone health and calcium levels will need to be monitored on a regular basis.

If your symptoms are moderate to severe, or you have complications, or your calcium level is more than mildly elevated, even if you don't have symptoms your doctor will likely recommend surgery to remove one or more parathyroid glands (parathyroidectomy). In cases where the problem is an adenoma, just the one gland is removed. If all four glands are enlarged, your surgeon will likely remove three of them and sometimes part of the fourth.

Traditionally, this surgery has involved a long incision, exploration on both sides of the neck and general anesthesia. But a newer technique, known as minimally invasive radioguided parathyroidectomy may offer a safer and less invasive approach for some people. In this procedure, doctors use a radioisotope scan (sestamibi scan) to help locate a tumor or abnormal parathyroid gland before surgery.

For the scan, you're given a very small dose of a radioactive material that's absorbed only by the overactive parathyroid gland not healthy ones. During the operation, the surgeon uses the sestamibi scan results as a map to locate the abnormal gland. In some cases, a probe that detects radioactivity, much as a Geiger counter does, is used to confirm the location.

The entire operation can usually be performed through a 1-inch incision in your neck. It takes less than an hour and often requires local rather than general anesthesia. If local anesthesia is used, you likely can go home a few hours after surgery.

Still, all surgery poses some risks. About 1 percent of people undergoing parathyroid surgery experience damage to the nerves controlling their vocal cords. Between 1 percent and 5 percent develop chronically low calcium levels, requiring treatment with calcium and vitamin D. In addition, although it's usually very effective, hyperparathyroid surgery won't cure the problem in every case.

For women who have gone through menopause and have signs of osteoporosis but no other symptoms, hormone replacement therapy (HRT) may be an alternative to surgery. But taking oral estrogen and progestin may increase your risk of breast cancer, stroke and dementia. Work with your doctor to evaluate the risks and benefits to help you decide what's best for you.

Secondary hyperparathyroidism
In cases of secondary hyperparathyroidism, the first goal is to treat the underlying problem. For many adults, that problem is chronic kidney failure. Because treatments that are used to manage kidney failure won't cure hyperparathyroidism, you'll likely need vitamin D hormone replacement therapies to reduce the production of PTH.

Self-care
If you and your doctor have chosen to monitor, rather than treat, your hyperparathyroidism, the following suggestions can help prevent complications:

bullet Drink plenty of fluids, especially water. Drinking lots of fluids can help prevent kidney stones from forming.
bullet Exercise. This is one of the best ways to build strong bones and slow bone loss. Try to combine strength training with weight-bearing exercises. Strength training builds muscles and bones in your arms and upper spine. Weight-bearing exercises such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports mainly affect the bones in your legs, hips and lower spine. If you're new to exercise, start out slowly and build up gradually. Aim for at least 30 minutes of exercise on most days.
bullet Get adequate amounts of vitamin D. Premenopausal women and postmenopausal women who use HRT should consume at least 400 international units (IU) of vitamin D every day. Postmenopausal women not using HRT should get 800 IU of vitamin D daily. Although baking in the sun makes you more likely to develop skin cancer, exposing your arms or legs to sunlight for about 10 minutes every day can increase vitamin D levels without increasing your cancer risk.
bullet Don't smoke. Smoking has been shown to increase bone loss as well as to dramatically increase your risk of a number of serious health problems, including cancer. Talk to your doctor about the best ways to quit.
bullet Be alert for conditions that may increase your calcium levels. Certain conditions, such as a gastrointestinal illness with vomiting and diarrhea, can cause your blood-calcium levels to rise. Call your doctor if you develop any of these conditions.
 
   

Young People Get Osteoporosis Too Organization
Copyright 2001  All rights reserved.
Revised: 11/09/06.