| Hyperparathyroidism is an endocrine disorder in which any of the four glands located next to the thyroid gland near the front of the neck (parathyroid) release an excessive amount of parathyroid hormone. Increased parathyroid hormone (the substance that keeps calcium levels in check) results in an increased calcium level in the blood (hypercalcemia) and urine (hypercalciuria). Too much calcium in the urine can cause kidney stones.
Hyperparathyroidism is generally subdivided into primary, secondary, and tertiary. Primary hyperparathyroidism is usually the result of small benign tumors, or adenomas, on the parathyroid glands. Hyperparathyroidism can also be due to an enlargement of the glands, the cause of which is unknown. Secondary hyperparathyroidism may be caused by chronic hypocalcemia (decreased level of calcium) that originates elsewhere in the body, such as hypercalciuria, or it can be caused by a vitamin D deficiency. Tertiary hyperparathyroidism occurs following prolonged secondary hyperparathyroidism. It is characterized by autonomous parathyroid activity (the ability of the parathyroid gland to act independently) causing hypercalcemia. This condition is most commonly seen in people who have been receiving maintenance dialysis or after renal transplantation.Risk: Hyperparathyroidism is found approximately 3 times more common in women as in men, and the risk increases with age; postmenopausal women are at the highest risk (Klein). Incidence and Prevalence: Although primary hyperparathyroidism affects up to 30 people out of every 100,000 in the general population, those between the ages of 15 and 65 have an increased incidence of 70 to 150 per 100,000 people (Freitas). Because nutritional rickets is a form of secondary hyperparathyroidism, countries where this condition is a problem will see a higher incidence of hyperparathyroidism in children than in the US. |
Source: Medical Disability Advisor
| History: Hyperparathyroidism may have severe symptoms, subtle, or none at all (asymptomatic). It may cause generalized aches and pains, depression, or abdominal pain. Often, the only symptoms are those of kidney stones (urinary tract calculi). In severe cases, the symptoms are those of hypercalcemia (nausea, vomiting, tiredness, excessive urination, excessive thirst, muscle weakness, depression, personality disturbance, abnormal behavior and/or confusion). Physical exam: The exam may reveal muscle weakness or calcium precipitate in the tissues due to the hypercalcemia. Abnormal deposits of calcium (calcinosis) may occur in joints causing a type of arthritic inflammation known as pseudogout. Eye (ophthalmic) exam may reveal calcium precipitate in the corneas (band keratopathy). Enlargement or tumor of the parathyroid gland may be evident. Tests: Diagnosis of hyperparathyroidism is confirmed by tests to measure the level of calcium, phosphorus, and parathyroid hormone in the blood. In about 50% of cases, individuals are unaware of the disorder and discover it only through routine multi-panel blood work that reveals high levels of calcium and parathyroid hormone, or through urinalysis that shows high calcium levels. A twenty-four hour urine for calcium levels is critical to differentiate from FHH (familial hypocalciuria and hypocalcemia), which needs no treatment.
X-ray tests may also be used to diagnose hyperparathyroidism. X-ray films can show evidence of excess parathyroid hormone action on certain bones. Occasionally, a routine chest x-ray may reveal a parathyroid mass. |
Source: Medical Disability Advisor
| Primary hyperparathyroidism is typically treated by surgically removing all abnormal parathyroid tissue (parathyroidectomy). Rehydration (including intravenous fluids) and using diuretics to force the kidneys to pass large amounts of urine (diuresis) may be used to help dilute blood calcium levels, if they are particularly high. Diuretics should only be used in conjunction with aggressive rehydration. In addition, the individual may be advised to reduce or avoid calcium in the diet, increase fluids, and continue to take diuretics to effectively flush excess calcium levels out of the body.
When hyperparathyroidism causes severe hypercalcemia that cannot be controlled by diet and/or diuretics, drugs such as plicamycin, gallium nitrate, calcitonin, bisphosphonates, or corticosteroids may be required. Mild cases not associated with osteoporosis, nephrolithiasis, or symptoms of hypercalcemia, may be managed with watchful waiting and do not always require surgery.
Hyperparathyroidism will compound the already significant risk of osteoporosis in postmenopausal women. Therefore, postmenopausal women with this disease are usually counseled to have the problem fixed rather than watched conservatively.
Treatment for secondary hyperparathyroidism focuses on addressing the underlying cause of the problem. The individual may require vitamin D therapy and, in some cases, dialysis to remove excess calcium from the blood. General weakness that is commonly observed in individuals with secondary hyperparathyroidism is found more frequently in women, and in individuals with diabetic nephropathy or hypertensive nephropathy. Parathyroidectomy and autotransplantation can achieve improvement in muscle power and general weakness in cases of tertiary hyperparathyroidism. |
Source: Medical Disability Advisor
| Hyperparathyroidism is usually a chronically progressive disease unless surgically cured. Therefore, individuals who receive medical treatment only (without surgery) must be carefully monitored. With surgery (parathyroidectomy), most individuals are successfully cured. Bones may heal once a parathyroid tumor is removed. However, kidney or pancreas damage resulting from the hypercalcemia may persist. |
Source: Medical Disability Advisor
| Individuals with hyperparathyroidism are at increased risk for a variety of diseases/conditions due to the excessive amounts of calcium in the blood and urine. These complications include excessive urination, kidney stones, kidney failure, thinning and weakening bones (leading to increased risk of fracture), depression, abnormal behavior, personality disturbance, drowsiness, tiredness, excessive thirst, seizures, coma, nausea, vomiting, constipation, abdominal pain, flatulence, intestinal obstruction, inflammation of the pancreas (pancreatitis), ulceration of the stomach (peptic ulcer), inflammation of the joints (pseudogout), and muscle weakness, dehydration, irregular heartbeat (arrhythmia), and death can also occur. |
Source: Medical Disability Advisor
| Individuals with hyperparathyroidism may require an extended medical leave if surgery or hospitalization is required for treatment of the disease. Due to the increased risk for bone fractures, it may be necessary to limit strenuous activity in individuals with coexisting osteoporosis. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has the diagnosis of hyperparathyroidism been confirmed through blood test and/or x-ray?
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Has the correct gland been removed?
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Are other or are all four glands hyperplastic?
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Has individual experienced any complications?
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Does individual have an underlying condition that may impact recovery?
Regarding treatment:
- If parathyroidectomy is not an option, what are the extenuating circumstances?
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Has individual been compliant with prescribed treatment?
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Has drug therapy effectively controlled blood calcium levels?
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If postmenopausal, has individual had bone density test and been treated with estrogen or bisphosphonates if needed?
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Has any underlying condition been effectively treated or controlled? Is this enough to resolve hyperparathyroidism?
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If tertiary hyperparathyroidism, is individual a candidate for a parathyroidectomy?
Regarding prognosis:
- Has medical treatment alone been effective?
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At what point will parathyroidectomy be an option?
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To what extent does damage impair function?
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Source: Medical Disability Advisor
| Freitas, Bonnie, and Alex D. Freitas. "Hyperparathyroidism, Primary." eMedicine. Eds. Leon Lenchik, et al. 21 Aug. 2002. Medscape. 1 Jun. 2006 <http://emedicine.com/RADIO/topic355.htm>.Klein, Gordon L. "Hyperparathyroidism." eMedicine. Eds. Phyllis Speiser, et al. 28 Mar. 2003. Medscape. 15 Feb. 2005 <http://emedicine.com/ped/topic1086.htm>. |
Source: Medical Disability Advisor
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