Hyperparathyroidism - Symptoms, causes and treatment

Hyperparathyroidism is a condition when the parathyroid glands located in the neck produce too much parathyroid hormone. High levels of parathyroid hormone cause calcium and phosphate levels in the blood to be out of balance so that it 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 that the body needs to build strong bones and teeth, clot blood after injury, and support muscle and nerve work. 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, these hormones stop being produced. In hyperparathyroidism, parathyroid hormone continues to be produced even though blood levels of calcium and phosphate are normal.

Causes of Hyperparathyroidism

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

In hyperparathyroidism, too much parathyroid hormone is produced, causing calcium levels to rise significantly (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 disorders of one or more of the parathyroid glands. The cause can be due to 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.

A person's risk of primary hyperparathyroidism may be increased by any of 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
Taking lithium medication to treat bipolar disorder
Already menopause

Secondary hyperparathyroidism

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

Some of the 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 is resolved, but the parathyroid glands continue to 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 due to too high levels of calcium in the blood, while calcium stores in the bones decrease.

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

muscle weakness
Bone and joint pain
Tired and sleepy
Loss of appetite
Difficult to concentrate
Depression

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

Nausea and vomiting
Bones become brittle and prone to fracture
Stomach pain
Constipation or constipation
bloating
Excrete a lot of urine
Get thirsty
Confused or easy to forget
Body feels bad for no apparent reason
Dehydration
Tense muscles
Irregular heartbeat
Hypertension

In addition to symptoms due to hypercalcemia, symptoms can also arise due to decreased levels of phosphate in the body (hypophosphatemia). Although generally asymptomatic, hypophosphatemia in hyperparathyroidism can sometimes cause mild symptoms, such as:

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

When to go to the doctor

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

Keep in mind that the symptoms of hyperparathyroidism can mimic those 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 their symptoms, as well as their medical and medical history. After that, the doctor will perform a thorough physical examination.

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

To determine 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 an X-ray device, 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 sampling of the parathyroid glands using a needle, to determine the cause of hyperparathyroidism

Hyperparathyroidism Treatment

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

Outpatient

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

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

Drink lots of water, especially water, to prevent dehydration and reduce the risk of kidney stones
Exercise regularly to keep bones strong
Don't smoke, because smoking can cause bone strength to decrease
Avoid drugs that increase calcium levels, such as lithium or diuretic
Pay attention to the intake of calcium and vitamin D that is allowed by the doctor according to the patient's condition

Operation

The most common treatment for hyperparathyroidism, especially in cases of primary hyperparathyroidism, is surgical removal of an enlarged or tumorous gland. This procedure is called a parathyroidectomy.

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

Sestamibi parathyroid scan uses radioactivity, to determine which parathyroid glands are abnormal
Ultrasound, to produce an image of the location of the parathyroid gland and surrounding tissue

Drugs

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

Calcimimetics
This drug mimics the action of calcium in the blood so that the parathyroid glands can reduce the production of parathyroid hormone. Calcimimetics usually given to patients with chronic kidney failure or patients with parathyroid cancer whose surgery failed or could not undergo surgery.

Hormone replacement therapy
Hormone replacement therapy aims to maintain calcium in the bones in women 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 treat, especially those caused by chronic renal failure.

Complications of Hyperparathyroidism

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