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:
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 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 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
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
- Excrete a lot of urine
- Get thirsty
- Confused or easy to forget
- Body feels bad for no apparent reason
- Tense muscles
- Irregular heartbeat
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
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:
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
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
Another treatment method that can be done is the administration of drugs. Types of drugs commonly given to people with hyperparathyroidism include:
- CalcimimeticsThis 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 therapyHormone replacement therapy aims to maintain calcium in the bones in women who have gone through menopause or have osteoporosis.
- BisphophonateBisphosphonate 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:
- Kidney stones
- Cardiovascular diseases, such as high blood pressure and arrhythmias
- Hypoparathyroidism in newborns, if hyperparathyroidism occurs in pregnant women
- stomach ulcer
However, hyperparathyroidism can usually be diagnosed at an early stage so these complications are rare.