Overactive Parathyroid Glands (hyperparathyroidism)

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Overactive parathyroid glands

If the parathyroid glands overfunction (hyperparathyroidism, HPT), too much parathyroid hormone is given off, for example due to various diseases. The parathyroid glands produce this hormone, which has a major influence on the calcium balance.

Parathyroid hormone is increased when there is a calcium deficiency. The calcium concentration in the blood increases as a result. This happens on the one hand through increased bone breakdown, on the other hand through reduced excretion of calcium via the kidneys and increased absorption in the intestine.

Calcium is essential for many processes in the body. In addition to bones, it is necessary for teeth and for a number of biological functions such as muscle contraction (heart activity), excitability of the nerves and much more.

The four approximately lentil-sized parathyroid glands (Parathyroideae) are located on the back of the thyroid gland (glandula thyroidea). This in turn lies in the throat just below the larynx on the front wall of the trachea.

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• What are the causes of overactive parathyroid glands?
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What are the causes of overactive parathyroid glands?

Overactive parathyroid glands can have various causes:

• Primary hyperparathyroidism (pHPT). There is a disorder of the function of the parathyroid glands due to a disease of the parathyroid glands. The parathyroid glands make too much parathyroid hormone and the level of calcium in the blood is increased (hypercalcaemia). Often the reason is, for example, a benign new tissue formation (solitary adenoma) of the parathyroid glands, malignant tumors are less common. It is also rare because of a certain hereditary syndrome (MEN, multiple endocrine neoplasia). PHPT can occur spontaneously or in families.
• Secondary hyperparathyroidism (sHPT). The adrenal glands respond to an existing calcium deficiency due to a disease with increased production of parathyroid hormone. Most often this occurs with vitamin D deficiency and disorders of kidney function. Less common in inflammatory bowel disease.
• Tertiary hyperparathyroidism. This develops after a secondary HPT that has existed for years. The constant overstimulation of the parathyroid glands leads to tertiary HPT. Mostly in dialysis patients due to years of renal insufficiency.

Note One speaks of pseudohypoparathyroidism in the case of certain diseases in which there is resistance to parathyroid hormone (disruption of the parathyroid hormone receptor or reduced activity in the metabolism).

Very rarely there is a drug-induced form that can occur with lithium therapy. Lithium therapy is used, for example, for bipolar disorders.

What are the symptoms?

Symptoms of primary hyperparathyroidism are often non-specific. Today this can be detected early through blood tests, so that there are no or slight symptoms. The general symptoms include:

• frequent urination (polyuria),
• increased thirst, excessive drinking (polydipsia),
• Nausea,
• Vomit,
• Loss of appetite,
• Constipation,
• Lack of drive, depression,
• Muscle weakness,
• easy fatigue,
• Increase in blood pressure,
• Heart failure as well
• A headache.

As the disease progresses, stones (eg kidney stones) can form and the resulting pain (stone pain). There are disorders of kidney function (such as kidney failure) and bone metabolism (osteoporosis, broken bones, bone pain). In addition, the overactive function and the calcium excess have an effect in the gastrointestinal area. However, these signs are very rare.

With secondary hyperparathyroidism, the following can occur:

• Symptoms of the underlying disease
• Bone pain, broken bones

Tertiary hyperparathyroidism

• Symptoms of secondary hyperparathyroidism
• Calcifications

How is the diagnosis made?

The clarification is often based on a routine laboratory test, which shows, for example, an increased calcium level. The doctor clarifies possible causes for the changes.

Certain laboratory tests are essential for the diagnosis: calcium, phosphate and parathyroid hormone levels as well as recognizing the causes of the hyperfunction, the severity of the disorder and any damage. Various tests can be carried out for this, including:

• Ultrasonic
• Parathyroid scintigraphy
• Check kidney function
• rarely CT, MRI
• X-ray etc.

Further information on examinations.

How is the treatment carried out?

The treatment is intended to normalize the level of calcium in the blood. Depending on the individual situation of the person affected and the cause of the hyperfunction, this is done using:

• In primary hyperparathyroidism, often surgical intervention, possibly taking calcimimetics, administration of drugs that inhibit bone loss (bisphosphonates, selective estrogen receptor modulators)
• Treatment of secondary damage such as osteoporosis (mostly bisphosphonates)
• In secondary hyperparathyroidism, treatment of the underlying disease, vitamin D supplementation, calcium supplementation if necessary.
• Follow-up checks on blood calcium levels

Whom can I ask?

Contact points are:

• Family doctor
• Specialist in internal medicine (specializing in endocrinology)
• in the hospital institutes or departments of internal medicine (endocrinology)

Other specialists can be involved.