Hyperparathyroidism is a condition where the parathyroid glands, located in the neck, produce excessive parathyroid hormone (PTH). This overproduction of PTH leads to elevated calcium levels in the blood, a condition known as hypercalcemia. Maintaining proper calcium balance is important for many bodily functions, including bone health, nerve function, and muscle contraction. Diagnosis is crucial for appropriate management and to prevent complications.
Understanding the Symptoms
Many individuals with hyperparathyroidism experience no symptoms or only mild ones, often discovering the condition incidentally during blood tests. When symptoms do manifest, they can be vague and non-specific, making diagnosis challenging. Common complaints include persistent fatigue, aches and pains in joints and bones, and muscle weakness.
The elevated calcium levels can impact various body systems, leading to more noticeable issues. Some individuals may develop kidney stones due to increased calcium excretion in the urine, or experience frequent urination and increased thirst. Other symptoms can involve the digestive system, such as nausea, vomiting, constipation, loss of appetite, and abdominal pain. Neurological and psychological symptoms like depression, forgetfulness, and difficulty concentrating may also occur. If you experience a combination of these persistent symptoms, consulting a doctor is advisable to determine the underlying cause.
Key Blood Tests for Diagnosis
The initial diagnosis of hyperparathyroidism relies on blood tests that measure the levels of calcium and parathyroid hormone (PTH). A healthcare provider orders these tests if elevated calcium levels are found during routine blood work or if symptoms suggest the condition. Elevated calcium levels, often confirmed by a repeat test after fasting, are a primary indicator.
Concurrently, high levels of parathyroid hormone (PTH) are a definitive sign of hyperparathyroidism. The parathyroid glands normally adjust PTH production to keep calcium levels balanced, so consistently high PTH alongside high calcium suggests the glands are overactive. Beyond calcium and PTH, other blood tests are conducted to provide a more complete picture. These include checking vitamin D levels, as vitamin D plays a role in calcium absorption. Kidney function tests, such as creatinine levels, are also assessed to understand overall impact and rule out other causes of elevated PTH.
Advanced Imaging and Additional Assessments
Once blood tests indicate hyperparathyroidism, advanced imaging studies pinpoint the abnormal parathyroid gland or glands. A common localization study is the Sestamibi parathyroid scan, which uses a radioactive compound absorbed by overactive parathyroid tissue for detection. Another imaging technique is an ultrasound of the neck, which helps visualize enlarged parathyroid glands. These imaging tests are performed if surgery is being considered to help guide the surgeon to the affected gland.
Beyond locating the source, additional assessments are performed to evaluate the effects of prolonged high calcium levels on the body. A bone density scan (DEXA) checks for bone loss, also known as osteoporosis, a complication of hyperparathyroidism. To assess kidney health and the risk of kidney stone formation, a 24-hour urine collection for calcium is performed. This test measures the amount of calcium excreted in the urine over a full day, providing insights into kidney function and calcium handling.
What a Diagnosis Means
A diagnosis of hyperparathyroidism marks the first step toward managing the condition and improving health. There are different types. Primary hyperparathyroidism is the most common, where an overactive parathyroid gland directly causes high calcium and PTH. Secondary hyperparathyroidism occurs when another condition, such as kidney disease or severe vitamin D deficiency, leads the parathyroid glands to overproduce PTH to compensate for low calcium. Tertiary hyperparathyroidism can develop if secondary hyperparathyroidism persists for a long time and the glands become independently overactive.
Upon diagnosis, a specialist will determine the appropriate course of action, which can range from watchful waiting for mild cases with few symptoms, to surgical intervention to remove the problematic gland, known as parathyroidectomy. Medications may also be considered to manage symptoms or complications. The specific treatment strategy depends on the type of hyperparathyroidism, the severity of symptoms, and the presence of complications like bone density loss or kidney stones. This diagnosis provides the foundation for ongoing monitoring and personalized management to address the condition effectively.