What is “hyperparathyroidism”?

Hyperparathyroidism is excessive production of parathyroid hormone (PTH) by the parathyroid glands with clinical manifestations.

What are the roles of parathyroid glands in a normal person?

The parathyroid glands produce parathyroid hormone, which controls calcium,phosphorus, and vitamin D levels within the blood and bone. These are (4 in number) situated in the neck just behind the thyroid gland.
When calcium levels are low, the body responds by increasing production of parathyroid hormone. The parathyroid hormone in turn 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 also becomes normal.

What are the causes?

Primary hyperparathyroidism:
Caused by enlargement of one or more of the parathyroid glands. This leads to too much parathyroid hormone, which raises the level of calcium in the blood. The term “hyperparathyroidism” generally refers to primary hyperparathyroidism.
Secondary hyperparathyroidism
The body produces extra parathyroid hormone because the calcium levels are very low.This is seen when vitamin D levels are low or when calcium is not absorbed from theintestines. This is also commonly seen in patients with CKD (Chronic Kidney Disease).Correcting the calcium level and the underlying problem will bring the parathyroid levels in the normal range.
Tertiary hyperparathyroidism
If the parathyroid glands continue to produce too much parathyroid hormone even though the calcium level is back to normal, the condition is called “tertiary hyperthyroidism.” It occurs especially in patients with kidney problems and longstanding vitamin D deficiency.

What are the symptoms?

  • Back pain
  • Bone pain or tenderness
  • Decreased height
  • Fractures of long bones
  • Joint pains
  • Depression
  • Personality changes
  • Stupor and possibly coma
  • Fatigue
  • Increased urine output
  • Increased thirst
  • Itchy skin
  • Loss of appetite
  • Nausea
  • Muscle weakness and pain
  • Upper abdominal pain

What are the tests to be done?

Blood tests:

Calcium (high), phosphorus (low), albumin (usually normal), alkaline phosphatase (high) and parathyroid hormone (PTH). A 24-hour urine collection test can help determine how much calcium is being excreted.

Bone x-rays and 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.


CT scan of the neck:
Helps in localizing the parathyroid swelling (adenoma)


Technitium-tetrofosmin or Technitium-MIBI scan:
Functional scan which delineates which parathyroid gland is functioning excessively.


What is the 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 have to increase the fluid intake may just need regular check ups with your doctor.
If symptoms are present or your calcium level is very high, surgery is needed to remove the parathyroid swelling/adenoma.
Treatment of secondary hyperparathyroidism depends on the underlying cause.

What are the possible complications?

Complications may include:

  • Increased risk of fractures
  • Urinary tract infection due to kidney stones and blockage
  • Peptic ulcer disease
  • Pancreatitis
  • Symptoms of adrenal crisis (Abdominal pain, difficulty in breathing, reduced consciousness, low BP)

What is the prognosis?

Prognosis is usually good, if treated early and appropriately.

When to contact an Endocrinologist?

If symptoms of hyperparathyroidism are there, fragility (trivial or no trauma) fractures are happening or if the blood calcium levels are high you have to consult an Endocrinologist.

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