Hyperparathyroidism: MedlinePlus Medical Encyclopedia

P Hyperparathyroidism is a disorder in which the parathyroid glands in your neck produce too much parathyroid hormone (PTH).

T Causes
P There are 4 tiny parathyroid glands in the neck, near or attached to the back side of the thyroid gland.
P The parathyroid glands help control calcium use and removal by the body. They do this by producing parathyroid hormone (PTH). PTH helps control calcium, phosphorus, and vitamin D levels in the blood and bone.
P When calcium level is too low, the body responds by making more PTH. This causes the calcium level in the blood to rise.
P When one or both of the parathyroid glands grow larger, it leads to too much PTH. Most often, the cause is not known.
- The disease is most common in people over age 60, but it can also occur in younger adults. Hyperparathyroidism in childhood is very unusual.
- Women are more likely to be affected than men.
- Radiation to the head and neck increases the risk.
- In rare cases, the disease is caused by parathyroid cancer.
P Medical conditions that cause low blood calcium or increased phosphate can also lead to hyperparathyroidism. Common conditions include:
- Conditions that make it hard for the body to remove phosphate
- Kidney failure
- Not enough calcium in the diet
- Too much calcium lost in the urine
- Vitamin D disorders (may occur in children who do not eat a variety of foods, and in older adults who do not get enough sunlight on their skin)
- Problems absorbing nutrients from food

T Symptoms
P Hyperparathyroidism is often diagnosed before symptoms occur.
P Symptoms are mostly caused by damage to organs from high calcium level in the blood, or by the loss of calcium from the bones. Symptoms can include:
- Bone pain or tenderness
- Depression and forgetfulness
- Feeling tired, ill, and weak
- Fragile bones of the limbs and spine that can break easily
- Increased amount of urine produced and needing to urinate more often
- Kidney stones
- Nausea and loss of appetite

T Exams and Tests
P The health care provider will do a physical exam and ask about symptoms.
P Tests that may be done include:
- PTH blood test
- Calcium blood test
- Alkaline phosphatase
- Phosphorus
- 24-hour urine test
P Bone x-rays and bone mineral density (DXA) tests can help detect bone loss, fractures, or bone softening.
P X-rays, ultrasound, or CT scans of the kidneys or urinary tract may show calcium deposits or a blockage.

T Treatment
P If you have a mildly increased calcium level and don't have symptoms, you may choose to have regular checkups or get treated.
P If you decide to have treatment, it may include:
- Drinking more fluids to prevent kidney stones from forming
- Exercising
- Not taking a type of water pill called thiazide diuretic
- Estrogen for women who have gone through menopause
- Having surgery to remove the overactive glands (usually for people under age 50)
P If you have symptoms or your calcium level is very high, you may need surgery to remove the parathyroid gland that is overproducing the hormone.
P If you have hyperparathyroidism from a medical condition, your provider may prescribe vitamin D, if you have a low vitamin D level.
P If hyperparathyroidism is caused by kidney failure, treatment may include:
- Extra calcium and vitamin D
- Avoiding phosphate in the diet
- The medicine cinacalcet (Sensipar)
- Dialysis or a kidney transplant
- Parathyroid surgery, if the parathyroid level becomes uncontrollably high

T Outlook (Prognosis)
P Outlook depends on the cause of hyperparathyroidism.

T Possible Complications
P Long-term problems that can occur when hyperparathyroidism is not well controlled include:
- Bones become weak, deformed, or can break
- High blood pressure and heart disease
- Kidney stones
- Long-term kidney disease
P Parathyroid gland surgery can result in hypoparathyroidism and damage to the nerves that control the vocal cords.

T Alternative Names
P Parathyroid-related hypercalcemia; Osteoporosis - hyperparathyroidism; Bone thinning - hyperparathyroidism; Osteopenia - hyperparathyroidism; High calcium level - hyperparathyroidism; Chronic kidney disease - hyperparathyroidism; Kidney failure - hyperparathyroidism; Overactive parathyroid

T Images
- Parathyroid glands

T References
P Silverberg SJ, Bilezikian JP. Primary hyperparathyroidism. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 63.
P Thakker RV. The parathyroid glands, hypercalcemia and hypocalcemia. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 245.

T Review Date 5/2/2016
P Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

