ABOUT THE DISEASE

Parathyroid disorders lead to abnormal levels of calcium in the blood that can cause brittle bones, kidney stones, fatigue, weakness, and other problems.

The parathyroid glands are four tiny glands, located in the neck, that control the calcium level of body. Each gland is about the size of a grain of rice (weighs approximately 30 milligrams and is 3-4 millimeters in diameter). The parathyroids produce a hormone called parathyroid hormone (PTH). PTH raises the blood calcium level by:
• breaking down the bone (where most of the body`s calcium is stored) and causing calcium release
• increasing the ability of body to absorb calcium from food
• increasing the ability of kidney to hold on to calcium that would otherwise be lost in the urine.

Normal parathyroid glands work like the thermostat in homes to keep blood calcium levels in a very tightly controlled range. When the blood calcium level is too low, PTH is released to bring the calcium level back up to normal. When the calcium level is normal or gets a little too high, normal parathyroids will stop releasing PTH. Proper calcium balance is crucial to the normal functioning of the heart, nervous system, kidneys, and bones.

However, hyperparathyroidism occurs when the parathyroid glands produce too much PTH. Excess parathyroid hormone can lead to negative effects on the body such as osteoporosis which can lead to fractures, kidney stones, decreased kidney function, heart disease, pancreatitis, increased acid secretion in the stomach and ulcers. On the other hand, hypoparathyroidism occurs when the parathyroid glands do not produce enough PTH. This leads to a low blood calcium level and can adversely affect muscle, nerve and other functions.

SYMPTOMS

Hyperparathyroidism is often diagnosed before signs or symptoms of the disorder are apparent. When symptoms do occur, they are the result of damage or dysfunction in other organs or tissues due to high calcium levels circulating in the blood and urine or too little calcium in bones.

Symptoms may be so mild and nonspecific that they do not seem at all related to parathyroid function, or they may be severe. The range of signs and symptoms include:

• • Fragile bones that easily fracture (osteoporosis)
• • Kidney stones
• • Excessive urination
• • Abdominal pain
• • Tiring easily or weakness
• • Depression or forgetfulness
• • Bone and joint pain
• • Frequent complaints of illness with no apparent cause
• • Nausea, vomiting or loss of appetite

CAUSES

Hyperparathyroidism is caused by factors that increase the production of parathyroid hormone. It is of two types: Primary and Secondary

Primary hyperparathyroidism occurs because of some problem with one or more of the four parathyroid glands such as:
• A noncancerous growth (adenoma) on a gland. This is the most common cause.
• Enlargement (hyperplasia) of two or more parathyroid glands. This accounts for most other cases.
• A cancerous (malignant) tumor. This is a rare cause.
Primary hyperparathyroidism usually occurs randomly, but some people inherit a gene that causes the disorder.

Secondary hyperparathyroidism is the result of some other condition that lowers calcium levels, causing the parathyroid glands to become over active. The parathyroid glands therefore, overwork to compensate for the loss of calcium. Factors that may contribute to secondary hyperparathyroidism include:
• Severe calcium deficiency. When body may not get enough calcium from the diet, often because the digestive system does not absorb the calcium from it.
• Severe vitamin D deficiency. Vitamin D helps maintain appropriate levels of calcium in the blood, and it helps the digestive system absorb calcium from the food. Human body produces vitamin D when skin is exposed to sunlight, and one consumes some vitamin D in food. If one does not get enough vitamin D, then calcium levels may drop.
• Chronic kidney failure. Kidneys convert vitamin D into a form that your body can use. If kidneys function poorly, usable vitamin D may decline and calcium levels drop. Chronic kidney failure is the most common cause of secondary hyperparathyroidism.

DIAGNOSIS

- Physical Examination
- Blood Investigations
- Additional diagnostic tests including bone mineral density test (bone densitometry), urine tests, imaging tests of kidneys, ultrasound

TREATMENT METHODS

Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in about 95 percent of all cases. A surgeon will remove only those glands that are enlarged or have a tumor (adenoma).

Medications to treat hyperparathyroidism include:
• Calcimimetics
• Hormone replacement therapy
• Bisphosphonates

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Hyperparathyroidism
Hypoparathyroidism
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