Hyperparathyroidism

What primary hyperparathyroidism means

The parathyroids are the glands in neck which monitor and control calcium levels via the parathyroid hormone (PTH). If one or more parathyroid glands is abnormally secreting too much parathyroid hormone, there can be an abnormal increase in the level of calcium in the blood. "Primary" refers to the main problem being located primarily within the hormone secreting gland, "hyper" means too much, "parathyroid" refers to the parathyroid gland, and "ism" refers to a medical condition. There are also conditions of Secondary and Tertiary hyperparathyroidism, which are more rare.

What causes primary hyperparathyroidism

The cause of primary hyperparathyroidism is either a benign tumor of one parathyroid gland (very common), an overgrowth of all four parathyroid glands called hyperplasia (less common), or a malignant tumor of a parathyroid gland (extremely rare). More than 80% of cases are caused by a single parathyroid adenoma. One hundred thousand new patients each year in the united states have a diagnosis of ths condition. An apparent increase in the incidence of primary hyperparathyroidism can be traced to the wide spread use of multi-channel analyzers in laboratories which has lead to earlier detection of the disease since 1970.

Diagnosis and localization of Abnormal Parathyroid Glands

The diagnosis of primary hyperparathyroidism is made by an endocrinologist who performs chemical testing to rule out other benign causes of hypercalcemia and finds inappropriately elevated parathyroid hormone. Imaging studies are NOT useful in diagnosing this condition and should only be done after the diagnosis has been confirmed chemically. Understanding the anatomy of the parathyroid glands is important in localizing which gland is abnormal. The most common studies for locating parathyroid adenomas have been 99 Tc MINI nuclear functional testing and ultrasonography. The endocrinologists at Houston Thyroid and Endocrine have ultrasound capabilities to visualize these tumors. CT and MRI Are also used for localization. These imaging studies are most helpful for the treating surgeon in planning the appropriate treatment.

Treatment

Once primary hyperparathyroidism is confirmed, then the treatment is primarily surgical. This surgery is called a parathyroidectomy and should be performed by a surgeon skilled in this type of operation. This operation removes the entire parathyroid tumor responsible for the high parathyroid hormone levels. There is a medication called cinacalet that is only approved to be used in patients that cannot undergo parathyroidectomy. The pill does not remove the tumor but reduces the parathyroid hormone production only. Treatment options need to be discussed with your endocrinologist.