Hyperparathyroidism

Hyperparathyroidism is a condition when the parathyroid glands located in the neck produce too much parathyroid hormone. High levels of parathyroid hormone cause unbalanced levels of calcium and phosphate in the blood which can cause various health problems.

The parathyroid glands produce parathyroid hormone which functions to balance calcium and phosphate levels in the bloodstream. Calcium and phosphate form calcium phosphate, a mineral the body needs to build strong bones and teeth, clot blood after injury, and support muscles and nerves. On the other hand, phosphate is also needed to produce energy.

Parathyroid hormone is released when calcium levels in the blood are low. When calcium levels return to normal, the hormone stops being produced. In hyperparathyroidism, parathyroid hormone continues to be produced even though blood calcium and phosphate levels are normal.

Causes of Hyperparathyroidism

The parathyroid gland consists of 4 small glands that function to maintain the stability of calcium and phosphate levels. This gland works by releasing or stopping the release of parathyroid hormone.

In hyperparathyroidism, too much parathyroid hormone is produced so that calcium levels increase considerably ( hypercalcemia ). Conversely, low levels of phosphate in the blood (hypophosphatemia).

Based on the cause, hyperparathyroidism can be divided into 3 types, namely:

Primary hyperparathyroidism

This condition occurs due to interference with one or several parathyroid glands. The cause can be due to the presence of a benign tumor (adenoma) in the parathyroid glands or enlargement of two or more parathyroid glands. Although rare, malignant tumors of the parathyroid glands can also cause this condition.

The risk of primary hyperparathyroidism may increase in a person with the following factors:

Genetic disorders
Lack of vitamin D and calcium for a long time
Radiation exposure while undergoing cancer therapy in the neck area
Take lithium medication to treat bipolar disorder
Already menopausal

Secondary hyperparathyroidism

Secondary hyperparathyroidism occurs when another medical condition causes low calcium levels. As a result, the work of the parathyroid glands becomes more active to replace lost calcium.

Some medical conditions that cause secondary hyperparathyroidism are:

Chronic kidney failure
Impaired absorption of food
Vitamin D deficiency

Tertiary hyperparathyroidism

Tertiary hyperparathyroidism occurs when the cause of secondary hyperparathyroidism has been treated, but the parathyroid glands still produce excess parathyroid hormone. As a result, calcium levels in the blood remain high. This type most often occurs as a result of advanced kidney failure.

Symptoms of Hyperparathyroidism

In fact, hyperparathyroidism itself rarely causes symptoms. Symptoms usually appear when organs and tissues are damaged by calcium levels in the blood that are too high, while calcium stores in the bones decrease.

Symptoms caused by high levels of calcium in the blood (hypercalcemia) depend on the severity of the hyperparathyroidism. In mild hyperparathyroidism, symptoms that may appear include:

Muscle weakness
Bone and joint pain
Tired and sleepy quickly
Loss of appetite
Difficulty concentrating
Depression

In more severe conditions, hyperparathyroidism can cause other symptoms, such as:

Nausea and vomiting
Bones become brittle and prone to fracture
Abdominal pain
Constipation or constipation
Flatulence
Lots of urine
Get thirsty
Confused or easy to forget
The body feels bad for no apparent reason
Dehydration
Stiff muscle
Irregular heartbeat
Hypertension
White lumps appear under the skin ( calcinosis cutis )

In addition to symptoms due to hypercalcemia, symptoms can also arise due to decreased levels of phosphate in the body (hypophosphatemia). Although generally not accompanied by symptoms, hypophosphatemia in hyperparathyroidism can sometimes cause mild symptoms, such as:

Body feels weak
Loss of appetite
Muscle weakness
Bone pain or disorders

When to see a doctor

Check with your doctor if you experience the symptoms of hyperparathyroidism as mentioned above, especially if there are other health conditions that increase the risk of hyperparathyroidism.

It should be noted that the symptoms of hyperparathyroidism can mimic the symptoms of other conditions. Therefore, an examination needs to be done so that the doctor can find out the cause and provide the right treatment.

Diagnosis of Hyperparathyroidism

To diagnose hyperparathyroidism, the doctor will ask the patient about the symptoms, as well as the history of the disease and medication. After that, the doctor will carry out a thorough physical examination.

Hyperparathyroidism can generally be known through blood tests. Doctors can determine hyperparathyroidism if blood tests show high parathyroid hormone and calcium levels and low phosphate levels.

To find out the cause and severity of the condition, the doctor will carry out supporting examinations which include:

Follow-up blood tests, to check the condition and function of the kidneys, pancreas, bones, and measure vitamin D levels
Urine test by collecting a urine sample for 24 hours, to assess the work of the kidneys and how much calcium is excreted through the urine
Bone density test or bone mineral densitometry (BMD) using X-rays to measure the amount of calcium and other minerals in the bones
Kidney scan using X-rays, ultrasound , or CT scans, to detect kidney disorders that can occur due to hypercalcemia, such as kidney stones
Biopsy or taking a sample of the parathyroid glands using a needle, to determine the cause of hyperparathyroidism

Treatment of Hyperparathyroidism

Treatment for hyperparathyroidism is based on the cause and severity of the condition. The following are some of the treatment methods that can be done:

Outpatient

If the calcium level is slightly increased, but the condition of the kidneys and bone density is still normal, and no other symptoms appear, the doctor will only make periodic observations and examinations.

These examinations include blood tests, as well as examination of kidney function and blood pressure. During this outpatient period, patients need to pay attention to the following:

Drink plenty, especially water, to prevent dehydration and reduce the risk of kidney stone formation
Exercise regularly to keep bones strong
Do not smoke, because smoking can cause decreased bone strength
Avoiding drugs that increase calcium levels, such as lithium or diuretics
Pay attention to the intake of calcium and vitamin D allowed by the doctor according to the patient's condition

Operation

The most common treatment step for hyperparathyroidism, especially for cases of primary hyperparathyroidism, is surgical removal of the gland that is enlarged or has a tumor. This procedure is called a parathyroidectomy.

Before undergoing a surgical procedure, the doctor will perform several scans to determine the location of the parathyroid glands. The scan is in the form of:

The sestamibi parathyroid scan uses radioactivity, to determine which parathyroid glands have abnormalities
Ultrasound, to produce an overview of the location of the parathyroid glands and surrounding tissue

Drugs

Another treatment method that can be done is the administration of drugs. Types of drugs commonly given to sufferers of hyperparathyroidism include:

Calcimimetics
These drugs mimic the action of calcium in the blood so that the parathyroid glands can reduce the production of parathyroid hormone. Calcimimetics are usually given to patients with chronic kidney failure or parathyroid cancer patients whose operations have failed or cannot undergo surgery. In addition, vitamin D analogues, such as calcitriol , can also be used to stimulate calcium absorption in the bones and kidneys. This process will automatically inhibit the production of parathyroid hormone.

Hormone replacement therapy Hormone
replacement therapy aims to maintain calcium in the bones in female patients who have gone through menopause or have osteoporosis .

Bisphophonate
Bisphosphonate can prevent calcium loss from bones and relieve osteoporosis caused by hyperparathyroidism.

Most patients with primary hyperparathyroidism recover after undergoing parathyroidectomy. However, secondary or tertiary hyperparathyroidism is quite difficult to cure, especially those caused by chronic kidney failure.

Hyperparathyroidism complications

Hyperparathyroidism complications can arise when calcium levels in the bones are too low and too much calcium circulating in the bloodstream. Some of these complications are: