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Hyperparathyroidism

(Overactive Parathyroid)

Definition

Hyperparathyroidism is when the body makes too much parathyroid hormone (PTH). PTH is made in the parathyroid gland. It helps to balance calcium levels in the blood. High PTH causes too much calcium in the blood.

There are different types of hyperparathyroidism based on cause. They may be primary, secondary, or tertiary.

Causes

Primary hyperparathyroidism may be caused by:

  • Noncancerous tumor in the parathyroid gland—most common cause
  • Familial hyperparathyroidism
  • Multiple endocrine neoplasia (MEN)
  • Parathyroid cancer—rare

Secondary hyperparathyroidism may be caused by:

  • Low levels of vitamin D—may be caused by problems in the diet, lack of sun exposure, or problems absorbing nutrient like celiac disease
  • Kidney failure or other medical problems that make the body less reactive to parathyroid hormone

Tertiary hyperparathyroidism is caused by an enlargement of the parathyroid. It can happen in those with long term kidney failure and dialysis.

Risk Factors

Hyperparathyroidism is more common in women after menopause. It is also more common in people older than 50 years of age. Other things that may increase the chances of hyperparathyroidism are:

  • Multiple endocrine neoplasia
  • Specific factors in genes
  • Radiation therapy to the head or neck during childhood

Symptoms

Symptoms are caused by changes in calcium levels. Primary hyperparathyroidism may cause:

  • Constipation
  • Nausea
  • Vomiting
  • Belly pain
  • Headache
  • Loss of interest in eating
  • Thirst
  • Frequent and sometimes painful urination due to kidney stones
  • Fatigue
  • Muscle weakness
  • Joint pain
  • Memory loss
  • Heartburn
  • Back pain

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. Testing may include:

Treatment

Treatment will be based on the cause. Examples include:

  • Surgery may be done to remove growth.
  • Medicine may improve vitamin D levels.
  • Kidney disease will be managed.

Medicine can also help to manage side effects or keep calcium levels in a normal range.

Blood calcium levels may need to be checked on a regular basis. It can help to find problems early. Other tests can also help to look for related problems such as bone density tests.

Prevention

Healthy amounts of calcium and vitamin D may prevent hyperparathyroidism in women. A healthy diet can help.

RESOURCES:

Hormone Health Network—Endocrine Society
http://www.hormone.org

The American Association of Endocrine Surgeons
http://endocrinediseases.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

The Canadian Society of Endocrinology and Metabolism
http://www.endo-metab.ca

REFERENCES:

Duan K, Gomez Hernandez K, Mete O. Clinicopathological correlates of hyperparathyroidism. J Clin Pathol. 2015 Oct;68(10):771

Hyperparathyroidism. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/hyperparathyroidism. Updated January 18, 2018. Accessed March 13, 2020.

Jamal SA, Miller PD. Secondary and tertiary hyperparathyroidism. J Clin Densitom. 2013 Jan-Mar;16(1):64.

Primary hyperparathyroidism. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/primary-hyperparathyroidism. Updated October 10, 2019. Accessed March 13, 2020.

Secondary hyperparathyroidism. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/secondary-hyperparathyroidism. Updated June 26, 2017. Accessed March 13, 2020.

Silverberg SJ, Bilezikian JP. The diagnosis and management of asymptomatic primary hyperparathyroidism. Nat Clin Pract Endocrinol Metab. 2006;2(9):494-503.

Tertiary hyperparathyroidism. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/tertiary-hyperparathyroidism. Updated March 19, 2018. Accessed March 13, 2020.

11/26/2012 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113972/Primary-hyperparathyroidism: Paik J, Curhan G, Taylor EN. Calcium intake and risk of primary hyperparathyroidism in women: prospective cohort study. BMJ. 2012;345:e6390.

Last reviewed March 2020 by EBSCO Medical Review Board Monica Zangwill, MD, MPH  Last Updated: 3/13/2020