Hyperparathyroidism

Hyperparathyroidism is an excess of parathyroid hormone in the bloodstream due to overactivity of one or more of the body's four parathyroid glands. These glands are about the size of a grain of rice and are located in your neck.The parathyroid glands produce parathyroid hormone, which helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning.Two types of hyperparathyroidism exist. In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of the hormone, resulting in high levels of calcium in the blood (hypercalcemia), which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism.Secondary hyperparathyroidism occurs as a result of another disease that initially causes low levels of calcium in the body and over time, increased parathyroid hormone levels occur.

Symptoms may be so mild and nonspecific that they don't seem at all related to parathyroid function, or they may be severe. The range of signs and symptoms include:Fragile bones that easily fracture (osteoporosis),Kidney stones,Excessive urination,Abdominal pain,Tiring easily or weakness,Depression or forgetfulness,Bone and joint pain,Frequent complaints of illness with no apparent cause,Nausea, vomiting or loss of appetite

The only 2 choices available for patients with primary hyperparathyroidism are to simply do nothing or to have the diseased parathyroid gland (or infrequently, more than one diseased parathyroid gland) surgically removed. Some physicians will elect to not refer their patients for an operation if they have a mild form of primary hyperparathyroidism.Much of this management style stems from the fact that standard parathyroid surgery in the past required the use of general anesthesia and was a major operation. But it's important to understand that parathyroid disease will get worse. It won't go away on its own. Remember, it is caused by a tumor that has developed from one of the parathyroid glands. Waiting will just allow the parathyroid tumor to grow bigger.Your age should also not be a reason to forego surgery. The new minimally invasive parathyroidectomy techniques have been performed on patients of many ages. The procedure uses local anesthesia that sends patients home in a matter of hours. To learn more, read our article about minimally invasive parathyroid surgery.

The impact of primary hyperparathyroidism (HPT) on the population has not been well documented, particularly with respect to asymptomatic HPT. Only 83 deaths were attributed to hyperparathyroidism in the United States in 1999, for a reported death rate of just 0.3 per million per year. Many more patients are affected, of course, and the national hospitalization rate for HPT was 8.0 per 100,000 in 1999, counting 22,000 "all-listed" diagnoses, and 1.8 per 100,000 counting only the 5000 admissions where HPT was the first-listed discharge diagnosis. Surgery was performed on approximately 12,000 hospitalized patients in the United States in 1999, for a parathyroidectomy rate of about 4.4 per 100,000 per year. Overall, the annual incidence of HPT was 20.8 per 100,000 in Rochester, MN, during 1983-1992, although this represented a substantial decline from incidence rates reported a decade earlier. There are no estimates of HPT prevalence from this country, but the figure was 4.3 per 1000 in one Swedish survey. By any of these measures, HPT is more common in women than men and increases with aging in both sexes. Other risk factors are obscure. The cost of parathyroidectomies for HPT has been estimated at $282 million annually in the United States, but no reliable estimate of overall expenditures for HPT has been made, and no formal assessment of the cost-effectiveness of any treatment approach has been carried out. Better data on the disability and costs related to HPT and its treatment will be needed to devise the most efficient approaches to patient management.