Primary hyperparathyroidism is a condition in which excessive levels of parathyroid hormone are secreted due to abnormalities in the parathyroid glands themselves. Like other hormones, parathyroid hormone is essential for the body, but excessive levels are harmful.
Primary hyperparathyroidism is a disease that occurs when the parathyroids secrete too much parathyroid hormone, resulting abnormally high blood calcium levels. Causes of the disease include hyperplasia and tumors, such as adenomas and carcinomas, in the parathyroid glands. Primary hyperparathyroidism is detected in approximately one in 4,000 to 5,000 people. The proportion of parathyroid carcinoma is in these cases is approximately 1-5%. We rarely see this form of cancer.
Hyperparathyroidism may occur due to causes other than the parathyroid glands, such as renal failure. Cases of hyperparathyroidism caused by the parathyroid glands themselves are called primary hyperparathyroidism, while other cases with other origins are called secondary hyperparathyroidism.
(1) Bone lesions. Bones are brittle and fracture easily. In severe cases, body height decreases.
(2) Urolithiasis (kidney and bladder stones)
(3) Hypercalcemia (high levels of calcium in the blood). This may cause a host of symptoms, including headache, thirst, heartburn, nausea, lack of appetite, upset stomach, constipation, irritability, fatigue, and muscle weakness.
In recent years, medical check-ups and other screenings have been increasingly (and incidentally) finding hypercalcemia in patients who have no symptoms.
In primary hyperparathryoidism, slightly high blood calcium levels for a short period of time are not associated with other symptoms in most cases. Very high calcium levels are associated with increased severity in the symptoms listed above.
In cases of parathyroid carcinoma, extremely high calcium levels are frequent, and patients have a high probability of suffering symptoms.
Primary hyperparathyroidism is rare, and some patients remain undiagnosed for a long time. This is in part due to the fact that their symptoms, such as sluggishness, are often attributed to emotional factors. It is certainly true that these sorts of symptoms can have other causes and not all patients suffering from these symptoms have primary hyperparathyroidism. However, most hospitals now offer blood tests for calcium and parathyroid hormone levels, allowing this primary hyperparathyroidism to be detected.
(1) Diagnostic tests: blood tests and urine tests
These tests detect abnormalities such as an increased serum calcium levels (Ca), increased parathyroid hormone levels (intact-parathyroid hormone [PTH], whole PTH, etc.), and changes in urinary calcium levels (Ca).
(2) Identifying the location of parathyroid tumors
Ultrasonography (echography), isotope examination (parathyroid scintigraphy: methoxy-isobutyl-isonitrile [MIBI] scintigraphy), neck computed tomography (CT) examination
Parathyroid carcinoma is difficult to diagnose before treatment. Therefore, a diagnosis has to be made comprehensively based on symptoms, the aforementioned tests and examinations, and a histopathological examination after surgery.
If tests reveal high blood calcium and parathyroid hormone levels and identify the exact location of parathyroid enlargement, the disease will be treated. The primary treatment is surgical removal of parathyroid lesions, but some patients may undergo other treatments, such as percutaneous ethanol injection therapy (PEIT) and drug therapy. At a National Institutes of Health (NIH) conference the concept of asymptomatic hyperparathyroidism was proposed. If the criteria are met in patients, follow-up and monitoring will be an option.
|Disease||Type of surgical procedure|
|Adenoma||Removal of enlarged parathyroid glands|
|Hyperplasia||Complete removal of the parathyroid glands, followed by transplantation of a portion of the removed parathyroid tissue into the forearm|
|Cancer||Removal of part of the thyroid gland and lymph nodes in addition to cancer|
Patients with extremely high blood calcium levels and severe symptoms need to be hospitalized immediately. Individuals with brittle bones need rest. If there are no obvious symptoms other than slightly elevated blood calcium levels, patients do not need to receive treatment immediately. They can continue to lead a normal life, work as usual, and have normal meals until the date of hospital admission is determined. Unless otherwise instructed, these patients can eat food rich in calcium, such as milk and small fish, without restrictions.