STORY BYHypertension. Hyperactive. Hyperthyroidism. Sound familiar, right? But have you ever heard of hyperparathyroidism?
It's not the first thing you ask about during a check-up. Remarkably, most cases are discovered while people are being treated for something else.
You've always been told that calcium is good for you. It keeps our bones strong and healthy. With primary hyperparathyroidism, the body's calcium balance is upset from too much parathyroid hormone production.
The parathyroid glands - four pea-sized glands near the thyroid gland in the neck - produce parathyroid hormone which maintains the delicate balance of calcium and phosphorus our bodies need for good health. The calcium imbalance resulting from too much parathyroid hormone can cost our bones much needed calcium and in some cases can result in kidney damage and kidney stones.
Primary hyperparathyroidism is diagnosed when the parathyroid glands overwork and make too much parathyroid hormone. This results in excess calcium absorption, retention and removal of calcium from our bones.
All this leads to high blood calcium levels.
This often shows up on a routine blood test. In nearly all cases, a benign tumor of one of the parathyroid glands triggers excess hormone production. Less commonly, all four glands overwork.
"For many patients, hyperparathyroidism is discovered during a routine blood test when a high calcium level is found incidentally," says Dr. Shahla Nader, endocrinologist and professor of internal medicine at The University of Texas Medical School at Houston. "If a patient's serum calcium is high, eventually it can lead to kidney damage. It can also be a cause of kidney stones, and eventually osteoporosis and bone fractures."
Nader says people with hyperparathyroidism may show signs of neuromuscular problems, nausea and vomiting, weakness, and increased urination and constipation. However, many people are symptom-free.
Should we get checked for the disease everytime we get a physical?
"If you have passed a kidney stone or have urinary frequency with the passage of large amounts of urine, your doctor may want to run some tests including your calcium level," Nader explains.
If the doctor says "you've got high calcium," it's time to find out the cause. While parathyroid hormone excess is a common cause, other medical problems can also lead to high blood calcium, such as taking in large amounts of vitamin D.
Surgery is usually the treatment of choice, especially for younger patients and people who have more severe cases of hyperparathyroidism. If you have a mild case of the disorder, you may not need treatment right away. Simple follow-up may be appropriate.
If you need surgery, it's a good idea to find a surgeon who specializes in neck surgery or endocrine surgery. The surgeon will find and remove the benign tumor or enlarged glands. For now, surgery is the only treatment option and fixes the problem in 95 percent of cases. Less invasive surgical techniques are now available.
According to the National Institutes of Health (NIH), patients with mild primary hyperparathyroidism probably don't need immediate treatment. It may be best to watch and wait by checking calcium levels and kidney function twice a year and checking for bone loss every one to two years.
"If your calcium levels increase and your symptoms increase, seek medical attention soon," Nader says. "It can be managed and treated."
UPDATED: 11-15-2004
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Dr. Shahla Nader is an endocrinologist and professor of internal medicine at the UT Medical School.
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