ENLmedical.com: Conditions And Concerns: Medical Encyclopedia: Primary hyperparathyroidism

Primary hyperparathyroidism

Causes and Risks:
The parathyroid glands are located at the front and base of the neck at the 4 corners of the thyroid gland. The glands produce parathyroid hormone , which regulates calcium, phosphorus, and magnesium balance within the blood and normal bone mineralization. In primary hyperparathyroidism, increased secretion of parathyroid hormone occurs because of enlargement of 1 or more of the glands, or because of parathyroid adenoma . The effects of increased calcium are seen in several body systems including the skeletal, gastrointestinal, renal , muscular, and central nervous system .

The disease may occur at any age, but most frequently affects those between 30 and 50 years old. It occurs more often in women than men. The incidence is 6 out of 100,000 people.

In children, hyperparathyroidism tends to be caused by hyperplasia (increased number of cells) of all of the parathyroid glands. Hyperparathyroidism in childhood is usually familial (it occurs in families).

Prevention:
There is no known prevention.

Symptoms:

fatigue
back pain
joint pain
fractures of long bones
decreased height
increased urine output
increased thirst
upper abdominal pain
loss of appetite
nausea
muscular weakness
muscle pain
depression
personality changes
stupor and possibly coma
itching of the skin
blurred vision (because of cataracts )

Signs and Tests:

A biopsy of the parathyroid gland shows tumor or hyperplasia .
A radioimmunoassay of parathyroid hormone that shows an increased level.
Serum calcium is increased.
Serum chloride may be increased.
Serum phosphorus is decreased.
Serum alkaline phosphatase may be increased.
Bone X-ray shows bone reabsorption or fractures .
Imaging of the kidneys or ureters shows calcification or obstruction.
ECG may show abnormalities.

This disease may also alter the results of the following tests:

Treatment:
Treatment depends upon the severity and cause of the condition. Mild hypercalcemia may be followed medically unless impaired renal function, bone demineralization, or high blood pressure is present.

Treatment consists of:

forcing fluids given by mouth to prevent kidney stone formation
avoiding sedentary lifestyle or immobilization
avoiding diuretics
phosphate preparations if kidney function is good
giving estrogen therapy to women if they are postmenopausal

For symptomatic , severe hypercalcemia, hospitalization may be required. Rehydration using intravenous fluids may be started.

Surgical removal of a tumor or excess parathyroid tissue from hyperplasia is indicated if hypercalcemia is more severe or if one or more of the following complications are present: kidney stones ( nephrolithiasis ), peptic ulcer , pancreatitis , psychiatric disease, hypertension , or progressive bone deterioration.

Prognosis:
The outcome is best for a mild case. The disease is usually progressive unless the parathyroid glands are removed. Skeletal damage may heal with treatment; however, kidney damage is irreversible. Parathyroid cancer tends to spread to other nearby tissues, and repetitive resections may be indicated.

Complications:
Complications that result from excess calcium deposits within the body:

skeletal damage
urinary tract infection due to kidney stones and obstruction
peptic ulcer disease and pancreatitis
pseudogout

Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms indicate that primary hyperparathyroidism may be present.

Call your health care provider if signs of complications develop.

The endocrine system is the chemical control center of the body. The pituitary gland is often considered the master control; sending out hormones that regulate the function of the thyroid, adrenal glands, ovaries, and testis. Over- or under-production of hormones from any of these glands is associated with many different types of disease.