Hyperparathyroidism occurs when one or more of the parathyroid glands become overactive, resulting in excessive production of PTH. This leads to increased levels of calcium in the blood (hypercalcemia), which can cause various symptoms and complications.
Hyperparathyroidism is a disorder of the parathyroid glands, which are small endocrine glands located in the neck. These glands produce parathyroid hormone (PTH), which regulates calcium, vitamin D, and phosphorus levels in the blood and bone.
Primary hyperparathyroidism is the most common form and occurs due to issues within the parathyroid glands themselves:
Adenomas: These benign tumours are the most frequent cause, resulting in one or more glands producing excess PTH.
Hyperplasia: This involves an increase in the number of cells within the parathyroid glands, leading to increased hormone production.
Carcinoma: Although rare, cancer of a parathyroid gland can lead to the overproduction of PTH.
Secondary hyperparathyroidism is a response to other medical conditions that cause low calcium levels in the body:
Chronic Kidney Disease: Chronic kidney disease can impair the kidney’s ability to convert vitamin D to its active form, leading to decreased calcium absorption and increased PTH production.
Vitamin D Deficiency: Lack of vitamin D reduces calcium absorption from the diet, which can trigger an increase in PTH output.
Dietary Calcium Deficiency: Insufficient dietary calcium can also lead to elevated PTH levels as the body tries to maintain normal calcium levels in the blood.
Tertiary hyperparathyroidism often develops in individuals with prolonged secondary hyperparathyroidism, particularly in those with end-stage renal disease who have had a kidney transplant.
Hyperparathyroidism can present with a variety of symptoms, largely due to high calcium levels in the blood.
Excessive fatigue and general weakness are common, often due to the body’s inability to regulate calcium properly.
Elevated PTH levels can lead to bone resorption, which weakens bones and may result in pain or fractures.
High calcium levels can cause the kidneys to work harder, which often leads to increased thirst and urination.
Digestive disturbances are common as hypercalcemia can affect the stomach and intestines.
Patients may experience depression or irritability as a result of the disorder.
Difficulty concentrating or experiencing confusion can significantly impact daily functioning.
Diagnosing hyperparathyroidism typically involves a combination of clinical evaluation, blood tests, and imaging studies.
Medical History and Symptoms: The doctor will review the patient’s medical history, symptoms, and previous blood test results indicating altered calcium levels.
Physical Examination: Although physical signs are not always prominent in hyperparathyroidism, the doctor might look for signs of bone tenderness or abnormalities.
Calcium Levels: This test measures the level of calcium in the blood, which is typically elevated in hyperparathyroidism.
Parathyroid Hormone (PTH) Levels: An elevated PTH level in the presence of high calcium levels is a key indicator of hyperparathyroidism.
Vitamin D Levels: Low vitamin D levels can contribute to secondary hyperparathyroidism.
Ultrasound of the Neck: This can help identify an enlarged parathyroid gland or the presence of a tumour.
Sestamibi Scan: A specialised scan that uses a small amount of radioactive material to visualise parathyroid glands, particularly useful in locating adenomas.
MRI or CT Scans: These provide detailed images of the neck and chest, especially if surgery is considered or if ultrasound and sestamibi scan results are inconclusive.
Treatment for hyperparathyroidism is tailored to the individual’s symptoms, the severity of the disease, and the underlying cause. The main treatment strategies include medication and surgery.
The choice of surgical technique depends on various factors, including the number and location of overactive glands, the patient’s overall health, and previous surgical history. Preoperative imaging and intraoperative PTH monitoring are important for the success of the surgery. Consulting with an endocrine surgeon can help determine the most appropriate treatment plan for each individual patient.
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Untreated hyperparathyroidism can lead to a variety of complications, largely due to prolonged high calcium levels in the blood.
Prolonged elevation of PTH can result in increased bone turnover, leading to weakened bones and a higher risk of fractures.
Excess calcium can lead to the formation of kidney stones, which can cause severe pain and blockages in the urinary system.
Chronic high calcium levels can also impair kidney function over time, potentially leading to chronic kidney disease.
High calcium levels can affect the nervous system, leading to issues such as confusion, memory loss, and difficulty concentrating.
Patients may experience depression or mood swings as a direct effect of the calcium imbalance in their body.
Hypercalcemia can increase blood pressure, posing a risk for hypertension.
Abnormal heart rhythms can occur if calcium levels affect the electrical impulses of the heart.
Dr Jesse specialises in managing both benign and malignant breast and thyroid conditions, which also includes breast pain, breast lumps, breastfeeding problems, neck lumps, amongst others.
Her dual expertise in cancer removal and plastic surgery techniques expands the design of individualized treatments, leading to holistic patient outcomes.
Dr Jesse was part of the teaching faculties of both NUS Yong Loo Lin School of Medicine and Lee Kong Chian School of Medicine, where she teaches and mentors the next generation of medical students and trainee doctors.
Dr Jesse is recognized as an authority in breast cancer and thyroid surgery and a sought-after conference speaker.
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Hyperparathyroidism can lead to high calcium levels, which can be dangerous for both the mother and the developing fetus. It is essential to manage calcium levels carefully during pregnancy to prevent complications.
Certain forms of hyperparathyroidism, particularly those associated with familial syndromes like multiple endocrine neoplasia, can be hereditary.
The frequency of medical check-ups depends on the severity of the disease and the treatment method, but typically every 6 to 12 months is recommended.
