Hyperparathyroidism

February 2, 2017

Hyperparathyroidism is a condition in which the parathyroid glands, located in the neck, secrete too much parathyroid hormone (PTH). Parathyroid hormone regulates the amount of calcium and phosphorus (minerals necessary for strong bones and teeth) in the body, by controlling how much calcium is taken from bones, absorbed in the intestines, and lost in urine. When too much parathyroid hormone is secreted, levels of calcium in the blood and urine rise, and bones may lose calcium, leading to osteoporosis.

In the United States, about 100,000 people develop hyperparathyroidism 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.

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 phosphorus levels by increasing excretion of phosphorus in the urine.

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. Phosphorus is found in all bodily tissue. It is a main part of every cell with many roles in each. Combined with calcium, phosphorus gives strength and rigidity to the bones and teeth.

Types

Primary Hyperparathyroidism, which is usually tied to an enlargement (hyperplasia) of a parathyroid gland, a benign (non-cancerous) growth (adenoma) or (in rare cases) a malignant (cancerous) tumor. The reasons for enlargement are usually undetermined but can be hereditary.
Secondary Hyperparathyroidism, when certain medical conditions skew the levels of calcium and a related mineral, phosphate. That prompts the parathyroid glands to compensate and is caused by such problems as a vitamin D or calcium deficiency, or by kidney failure.

Causes

In most cases nobody knows. Something happens within the parathyroid gland to cause the cells to replicate over and over until the gland grows into a tumor.

Some rare causes of tumor development are –

Lithium – People who take Lithium on a daily basis for 10 or more years may develop parathyroid problems.
Radioactive iodine therapy – Radioactive iodine therapy for previous thyroid problems causes approximately 3 percent of all parathyroid problems.
Radiation therapy – Radiation treatments to the head, neck and face as a child or teenager account for 1 percent to 2 percent of all parathyroid patients.
Family history – Hereditary forms of hyperparathyroidism account for about 2 percent of all parathyroid patients.
Kidney failure – Secondary hyperparathyroidism occurs in patients who have renal failure, and almost always in patients who have been on kidney dialysis for several years.

A small number of patients will have two parathyroid adenomas while having two normal parathyroid glands. An even smaller number of patients will have an enlargement of all four parathyroid glands, a term called parathyroid hyperplasia. This is much less common but the end results on the body are identical.

Risk Factors

People are at risk if they –

Are a woman who has gone through menopause
Have had prolonged, severe calcium or vitamin D deficiency
Have a rare, inherited disorder, such as multiple endocrine neoplasia, type I, which usually affects multiple glands
Have had radiation treatment for cancer that has exposed the neck to radiation
Have taken lithium, a drug most often used to treat bipolar disorder

Symptoms

Most people who have hyperparathyroidism do not experience any symptoms. Some people may have one or more of the following symptoms –

Feeling weak or tired most of the time
General aches and pains throughout your body
Abdominal pain
Frequent heartburn (because the high calcium level in your blood causes the stomach to make too much acid)
Nausea
Vomiting
Loss of appetite
Bone and joint pain
An increase in bone fractures or breaks
Confusion and memory loss
Kidney stones
Excessive urination
High blood pressure

Complications

Osteoporosis – a weakening of the bones that can make them more susceptible to fractures
Osteopenia – a condition that often precedes osteoporosis
Kidney Stones – hard deposits that result from excess calcium getting in the urine and getting filtered by the kidneys
Cardiovascular Disease – research suggests that high-calcium levels are associated with high blood pressure (hypertension) and some types of heart disease

Treatment

Surgery –

Standard parathyroid surgery – The standard parathyroid operation begins with an anesthesiologist putting people to sleep under general anesthesia.
Minimal parathyroid surgery – Minimal parathyroid surgery (radio-guided parathyroid surgery) is dramatically changing the way surgeons treat parathyroid disease.

Medications –

Calcimimetics – A calcimimetic is a drug that mimics calcium circulating in the blood. The drug may trick the parathyroid glands into releasing less parathyroid hormone. This drug is sold as cinacalcet (Sensipar)

Hormone replacement therapy – For women who have gone through menopause and have signs of osteoporosis, hormone replacement therapy may help bones retain calcium. This treatment doesn’t address the underlying problems with the parathyroid glands.

Bisphosphonates – Bisphosphonates also prevent the loss of calcium from bones and may lessen osteoporosis caused by hyperparathyroidism. Some side effects associated with bisphosphonates include low blood pressure, fever and vomiting.

Alternative Treatment

Multivitamin – A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.

Calcium citrate is used for bone support.

Vitamin D is for immunity.

Ipriflavone (soy isoflavones) is helpful in for bone loss. Because hyperparathyroidism may lead to osteoporosis, taking ipriflavone may help treat this cause of bone loss. Ipriflavone can lower white blood cell counts and has the potential to interact with a variety of medications.

Chaste tree (Vitex agnus castus) for support of the parathyroid gland. Chaste tree extract has many possible drug interactions and can have hormone-like effects in the body.

Dandelion is used for its high mineral content.

Reference –

http://patient.info/doctor/hyperparathyroidism-pro

http://www.healthline.com/health/hyperparathyroidism

http://www.mayoclinic.org/diseases-conditions/hyperparathyroidism/basics/definition/con-20022086

https://www.nlm.nih.gov/medlineplus/ency/article/001215.htm

http://www.nhs.uk/conditions/hypoparathyroidism-hyperparathyroidism/Pages/Introduction.aspx

http://www.endocrineweb.com/conditions/hyperparathyroidism/hyperparathyroidism

http://www.uofmhealth.org/conditions-treatments/secondary-renal-and-tertiary-hyperparathyroidism

https://my.clevelandclinic.org/health/diseases_conditions/hic_hyperparathyroidism

http://radiopaedia.org/articles/hyperparathyroidism

https://www.cedars-sinai.edu/Patients/Health-Conditions/Hyperparathyroidism.aspx