Parathyroid
- All
- Background
- Diagnosis and Imaging
- Normocalcemic Hyperparathyroidism
- Parathyroid Cancer
- Parathyroid FAQ
- Parathyroid Surgery
- Secondary Hyperparathyroidism
- Signs and Symptoms
- Treatment
Signs and Symptoms of Hyperparathyroidism
Calcium is required in the body for a number of cellular and extra-cellular functions. Thus, it is not surprising that the disturbance of calcium homeostasis associated with primary hyperparathyroidism may lead to a wide range of signs and symptoms. The “bones, stones, moans, and groans” mnemonic recited by medical trainees year after year has served…
Secondary Hyperparathyroidism
In secondary hyperparathyroidism, there is a physiologically appropriate increase in parathyroid hormone secretion in response to a decrease in extracellular calcium. The most common cause of secondary hyperparathyroidism is renal failure. Less common causes are long term lithium usage, vitamin D deficiency, gastrointestinal malabsorption syndromes (when the intestines do not absorb vitamins and minerals properly),…
Parathyroid Surgery
Surgery is the only definitive treatment available for primary hyperparathyroidism. Surgical management is clearly indicated in symptomatic patients. In addition, the consensus guidelines of the 4th international workshop provide indications for surgery in “asymptomatic“ patients. These include: 1) significant elevation in serum calcium (>1.0 mg/dL above the upper limit of normal); 2) significant skeletal manifestations demonstrated…
Parathyroid Function
The parathyroid glands are located in the neck immediately adjacent, on or even rarely within the thyroid. Each parathyroid gland is approximately 3x4x5 millimeters and typically weighs 25-40 milligrams. Parathyroid glands produce the peptide hormone PTH, which plays a crucial role in calcium homeostasis. There are typically four parathyroid glands (a superior and inferior gland on each side…
Parathyroid Frequently Asked Questions
What causes primary hyperparathyroidism? Primary hyperparathyroidism is caused by a condition that affects one or more parathyroid glands causing exaggerated release of its hormone (parathyroid hormone, or PTH). This condition could be a benign tumor of the parathyroid gland called an adenoma, benign enlargement affecting multiple glands (hyperplasia), or very rarely carcinoma (malignant tumor). The…
Parathyroid Cancer
Parathyroid cancer is extremely rare (almost 1 in 2 million). Cases of parathyroid cancer make up less than 1% of the total number of patients with primary hyperparathyroidism. Patients are usually older than 30, and it affects men and women equally. Patients with parathyroid cancer typically have a very high calcium level (greater than 14…
Normocalcemic Primary Hyperparathyroidism
Easy reading Patients with an elevated parathyroid hormone (PTH) level and normal calcium levels can have one of two problems. Most often, the parathyroid glands are responding to a different problem elsewhere in the body. Problems with low vitamin D levels, not taking in enough calcium in the diet or putting out too much calcium…
Incidence and Risk Factors
In primary hyperparathyroidism, one or more of the parathyroid glands produces PTH in excess with some degree of autonomy from the regular negative feedback loop inhibition (i.e. the thermostat remains on despite the temperature being high). In[AH1] more than 80% of cases, a single gland is the source of excess PTH. These are termed single adenomas. In…
Hyperparathyroidism Treatment
Surgery represents the only potential definitive/curative treatment for primary hyperparathyroidism. Parathyroidectomy, like all surgery, is associated with some risks, but morbidity is relatively low and the success rate in the hands of an experienced parathyroid surgeon is excellent (95-98% cure). Patients not undergoing parathyroidectomy may be observed or receive medications. Medical treatment is focused on…
Hyperparathyroidism Diagnosis
The most common presentation of primary hyperparathyroidism in developed countries is asymptomatic hypercalcemia often found on routine biochemical screening. Advanced clinical bone and renal disease that characterized initial presentation in the past has become rare with the availability of serum calcium (and subsequently) PTH measurement. As with all diseases, a thorough history is an important…
Age and Parathyroid Surgery
All patients with primary hyperparathyroidism should be considered for surgery regardless of age. Primary hyperparathyroidism is most common in patients in their 60’s or younger, but it can occur in patients in their 70’s, 80’s and even 90’s. Unfortunately, many elderly are missing an opportunity to be cured of primary hyperparathyroidism with a low-risk operation.…
