Causes

The parathyroid glands are located in the neck, near or attached to the back side of the thyroid gland. They produce parathyroid hormone, which controls calcium, phosphorus, and vitamin D levels within the blood and bone.

When calcium levels are too low, the body responds by increasing production of parathyroid hormone. This increase in parathyroid hormone causes more calcium to be taken from the bone and more calcium to be reabsorbed by the intestines and kidney. When the calcium level returns to normal, parathyroid hormone production slows down.

Primary hyperparathyroidism is caused by swelling of one or more of the parathyroid glands. This leads to the release of too much parathyroid hormone, which raises the level of calcium in the blood. The term "hyperparathyroidism" generally refers to primary hyperparathyroidism.

Rarely, the disease is caused by parathyroid cancer.

The disease is most common in people over 60, but can also be seen in younger adults. Hyperparathyroidism in childhood is very unusual.

Women are more likely to be affected than men. Radiation to the head and neck increases your risk.

Symptoms

• Decreased height
• Depression
• Fatigue
• Fractures
• Increased urination
• Kidney stones
• Loss of appetite
• Muscle weakness and pain
• Nausea
• Personality changes
• Upper abdominal pain
• Stupor and possibly coma

Exams and Tests

Blood tests will be done to check for increased levels of parathyroid hormone (PTH), calcium, and alkaline phosphatase, and lower levels of phosphorus.

Bone x-rays and a bone mineral density test can help detect bone loss, fractures, or bone softening.

X-rays, ultrasound, or CT scans of the kidneys or urinary tract may show calcium deposits or a blockage.

Treatment

Treatment depends upon the severity and cause of the condition.

If you have mildly increased calcium levels due to primary hyperparathyroidism and no symptoms, you may just need regular checkups with your doctor.

However, you need treatment if:

• Your kidneys do not work correctly
• You have calcium loss from your bones
• Kidney stones develop

If treatment is needed, it may include:

• Drinking more fluids to prevent the formation of kidney stones
• Movement and exercise
• Avoiding thiazide-type diuretics ("water pills")
• Using estrogen therapy (for postmenopausal women)

If symptoms are present or your calcium level is very high, surgery may be needed to remove the parathyroid gland that is overproducing the hormone. Surgery is also recommended for patients less than 50 years of age.

Treatment for severe symptoms may also include:

• Fluids given through a vein (IV)
• Medications such as bisphosphonates and calcitonin, which bring down calcium levels quickly

Outlook (Prognosis)

The outlook is good for those with mild symptoms. Most cases of primary hyperparathyroidism are mild.

Possible Complications

Complications may include:

• Bone damage
• Increased risk of fractures
• Pancreatitis
• Pseudogout
• Urinary tract infection due to kidney stones and blockage

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have symptoms of hyperparathyroidism.

Alternative Names

Parathyroid-related hypercalcemia; Hyperparathyroidism - primary

References

Wysolmerski JJ, Insogna KL. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008:chap. 266.

Bringhurst FR, Demay MB, Kronenberg HM. Disorders of mineral metabolism. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008:chap. 27.

AACE/AAES Task Force on Primary Hyperparathyroidism. The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract. 2005;11:49-54.

Updated: 4/31/2012

Reviewed by: Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.