Definition of Hyperparathyroidism.
The parathyroid glands are located just behind the thyroid gland in the front of the neck. The function of the parathyroid glands is to produce a hormone called parathyroid hormone, which helps regulate calcium and phosphate in the body. Hyperparathyroidism is the overproduction of this hormone.
Frequently, there are no apparent symptoms or suspected hyperparathyroidism, and it is diagnosed for the first time when a patient is discovered to be hypercalcemic during a routine blood chemistry profile.
When symptoms are present, they may include the development of gastric ulcers or pancreatitis due to high levels of calcium, inflammation, and pain in the lining of the stomach and pancreas.
Most of the symptoms of hyperparathyroidism are those present due to the result of hypercalcemia, such as kidney stones, osteoporosis, muscle weakness, and in rare cases, alterations in the central nervous system such as depression, and psychomotor disorders and personality disorders, including coma. Patients may also experience heartburn, nausea, constipation, or abdominal pain. In secondary hyperparathyroidism, patients may show signs of calcium imbalance, such as long bone deformities.
Most commonly, hyperparathyroidism occurs due to a single adenoma, or benign tumor, in one of the parathyroid glands.
They will grow to a size much larger than that of the parathyroid glands, usually up to the size of a walnut.
Genetic disorders or multiple endocrine tumors can also cause hyperparathyroidism.
The diagnosis of hyperparathyroidism is given by a blood test that precisely measures the amount of parathyroid hormone.
X-ray examinations can be performed to look for diffuse bone demineralization, bone cysts, external bone absorption, and erosion of the long bones of the fingers and toes.
Hypercalcemia is mild or intermittent in some patients, but it is an excellent indicator of primary hyperparathyroidism.
Dual X-ray absorptiometry is a tool used to diagnose and measure osteoporosis, which shows the reduction of bone mass in patients with primary hyperparathyroidism.
Once a diagnosis is made, the doctor will probably order more tests to evaluate the complications. For example, abdominal x-rays may reveal kidney stones.
Usually, in most cases, the patient refers to an endocrinologist, a doctor specializing in hormonal problems, or a nephrologist who specializes in kidney and mineral disorders.
Patients with mild cases of hyperparathyroidism may not need immediate treatment if they have only slight elevations in the level of calcium in the blood, kidneys, and bones. These patients should be monitored regularly every six months through a physical examination and the measurement of renal and calcium function levels.
A measurement of bone densitometry should be done every one or two years.
Patients with more advanced hyperparathyroidism usually have all or half of the affected parathyroid glands, which should be surgically removed. This surgery is relatively safe and effective.
The main risks are those related to general anesthesia. There are some cases where surgery can be performed with the patient under regional anesthesia. Often studies such as ultrasound before surgery help identify the affected areas.