Hyperparathyroidism

What is Hyperparathyroidism?

Hyperparathyroidism is a condition where one or more of the four small parathyroid glands in the neck become overactive, leading to an abnormally high release of parathyroid hormone (PTH) into the bloodstream. PTH plays a crucial role in regulating the body’s calcium and phosphorus balance. Excessive PTH secretion causes too much calcium to be released from the bones into the blood (bone resorption), reduces calcium excretion by the kidneys, and increases calcium absorption from the intestines. This condition can lead to high calcium levels in the blood, known as hypercalcemia, and cause various health problems.

What Are the Causes of Hyperparathyroidism?

There are essentially two main causes of hyperparathyroidism: primary hyperparathyroidism and secondary hyperparathyroidism. Rarely, tertiary hyperparathyroidism can also occur.

Primary Hyperparathyroidism: This issue originates directly from the parathyroid glands themselves. The most common cause is a benign tumor (adenoma), which typically forms in a single parathyroid gland. Less commonly, an enlargement of multiple glands (hyperplasia) or, very rarely, parathyroid cancer can lead to primary hyperparathyroidism. Genetic factors can play a role in some familial cases of primary hyperparathyroidism.
Secondary Hyperparathyroidism: This develops when another health problem in the body stimulates the parathyroid glands to produce excessive PTH. The most common cause is chronic kidney failure. When the kidneys cannot adequately produce active vitamin D and excrete phosphorus, calcium levels drop. This prompts the parathyroid glands to release more PTH to raise calcium levels. Other causes can include severe vitamin D deficiency and calcium malabsorption disorders.
Tertiary Hyperparathyroidism: This is a condition where the parathyroid glands become autonomous due to prolonged secondary hyperparathyroidism, continuing to produce excessive PTH even after calcium levels have normalized. It usually occurs in patients with chronic kidney failure who have been on dialysis for an extended period.

What Are the Symptoms of Hyperparathyroidism?

The symptoms of hyperparathyroidism can vary depending on the level and duration of elevated blood calcium. Many people with mild hypercalcemia may experience no symptoms. However, if calcium levels rise and remain high for a prolonged period, various symptoms can occur:

Bone and Muscle-Related Symptoms:
- Bone pain
- Bone weakness and easy fractures (osteoporosis)
- Joint pain
- Muscle weakness
- Fatigue and lethargy
Kidney-Related Symptoms:
- Frequent urination (polyuria)
- Excessive thirst (polydipsia)
- Kidney stones
- Kidney failure (in advanced cases)
Gastrointestinal Symptoms:
- Abdominal pain
- Constipation
- Nausea and vomiting
- Loss of appetite
- Peptic ulcers
- Pancreatitis (in advanced cases)
Neurological and Psychological Symptoms:
- Depression
- Anxiety
- Memory problems
- Difficulty concentrating
- Sleep disturbances
- Headaches
Cardiovascular System Symptoms:
- High blood pressure (hypertension)
- Heart rhythm disturbances (in advanced cases)

How Is Hyperparathyroidism Diagnosed?

The diagnosis of hyperparathyroidism is made by Uzm. Dr. Burcu Meryem Atak Sançmış through a careful clinical assessment and a combination of various laboratory tests:

Blood Tests:
- Parathyroid Hormone (PTH) Levels: The most important test. High PTH levels indicate hyperparathyroidism.
- Calcium Levels: Repeatedly high serum calcium levels support the diagnosis.
- Phosphorus Levels: Typically low in primary hyperparathyroidism, but can be high in secondary hyperparathyroidism.
- Vitamin D Levels: Vitamin D deficiency as a contributor to secondary hyperparathyroidism is assessed.
- Kidney Function Tests: The condition of the kidneys and possible causes of secondary hyperparathyroidism are investigated.
Urine Tests: A 24-hour urine calcium excretion can be measured to assess the risk of kidney stones.
Imaging Studies (to determine the cause of primary hyperparathyroidism):
- Parathyroid Scintigraphy (Sestamibi Scan): A nuclear medicine method to locate overactive parathyroid glands.
- Ultrasound: Can be used to assess the size of the parathyroid glands and potential tumors.
- Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): Rarely needed, especially to detect ectopic (not in the normal location) parathyroid adenomas.
Bone Density Measurement (DXA): Performed to assess the effects of hyperparathyroidism on bones and determine the risk of osteoporosis.

What Are the Treatment Methods for Hyperparathyroidism?

Treatment is planned based on the underlying cause, the severity of symptoms, and the patient’s general health status.

Treatment of Primary Hyperparathyroidism:
- Surgery (Parathyroidectomy): Surgical removal of the overactive parathyroid gland(s) is the most effective and common treatment method for primary hyperparathyroidism. For a single adenoma, minimally invasive surgical techniques can often be preferred. If multiple glands are affected, a more extensive surgical procedure may be necessary.
- Observation (Non-Surgical Approach): For some elderly patients or those with severe comorbidities who do not meet criteria for surgery, have mild or no symptoms, do not have very high calcium levels, and have stable bone density, regular monitoring and observation may be recommended instead of surgery. In this process, calcium and PTH levels are regularly checked.
- Medical Treatment: Medications to lower calcium levels in primary hyperparathyroidism are generally limited and may be used as a temporary solution or to control calcium levels in patients who are not suitable for or refuse surgery. These medications include bisphosphonates and calcimimetics (such as Cinacalcet).
Treatment of Secondary Hyperparathyroidism: Focuses on treating the underlying cause:
- In patients with chronic kidney failure: Phosphate binders, active vitamin D analogs, and calcimimetics (such as Cinacalcet) can help lower PTH levels. In some cases, parathyroidectomy may be necessary.
- In patients with vitamin D deficiency: The deficiency is corrected with vitamin D supplementation.
- In patients with calcium malabsorption disorders: The underlying cause is treated, and calcium supplements may be administered.
Treatment of Tertiary Hyperparathyroidism: Is typically surgical (parathyroidectomy).

Frequently Asked Questions

What happens if hyperparathyroidism is left untreated?

Untreated hyperparathyroidism can lead to bone loss, kidney stones, kidney failure, heart problems, and other health issues.

Is hyperparathyroidism genetic?

Some rare familial types of hyperparathyroidism can be genetic, but most cases are caused by sporadic (spontaneously developed) adenomas.

Is parathyroid surgery risky?

Parathyroid surgical procedures generally lead to safe and effective results when performed by an experienced surgeon in this field. The success rate for parathyroid surgeries performed by Uzm. Dr. Burcu Meryem Atak Sançmış is also very high. As with any surgical procedure, there can be some risks associated with parathyroid surgery. The most common include temporary or, rarely, permanent hoarseness, a drop in blood calcium levels (hypocalcemia), and, though rare, bleeding. These risks are minimized thanks to Uzm. Dr. Atak Sançmış’s experience and meticulous surgical approach.

What should one pay attention to after parathyroid surgery?

After surgery, calcium levels are closely monitored, and calcium supplements are administered if necessary. Conditions such as hoarseness or difficulty swallowing are observed.

Can hyperparathyroidism recur?

In primary hyperparathyroidism, the removal of a single adenoma usually provides a permanent solution. However, if multiple glands are involved or in cases of cancer, there may be a risk of recurrence. For secondary and tertiary hyperparathyroidism, controlling the underlying disease is crucial.

Information Request Form

Fill out our Information Request Form to receive detailed information and to schedule an appointment.