Primary Hyperparathyroidism: Symptoms, High Calcium and Next Steps

What it involves

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains that primary hyperparathyroidism is a disorder of the parathyroid glands, four pea-sized glands on or near the thyroid gland in the neck. One or more of them is overactive and makes too much parathyroid hormone, which raises the calcium in your blood and can lead to bone thinning and kidney stones.

Who this is for

• Adults whose routine blood work showed a high calcium level.
• Patients with a past kidney stone, thin bones or a broken bone after a minor fall.
• People with muscle weakness, tiredness, low mood or bone and joint aches that have no clear cause.
• Women in midlife and beyond, since NIDDK says it most often appears between ages 50 and 60 and affects women 3 to 4 times more often than men.

What to expect

• Questions about symptoms, kidney stones, broken bones, family history and the medicines and supplements you take
• Blood work, which the practice offers, such as a calcium level, with a parathyroid hormone level when a provider orders one
• A review of your kidney health and bone health history
• A referral for bone density testing, kidney imaging or an endocrine or surgical opinion when those are needed

Why it is often found by accident

NIDDK says doctors usually catch primary hyperparathyroidism early through routine blood tests, before serious problems occur, and that when symptoms do show up they are mild and look like those of many other disorders. That is why one slightly high calcium number on a basic panel deserves a follow-up visit rather than a shrug. The basic metabolic panel guide explains what a routine panel checks, and the high calcium guide covers high calcium from any cause.

What the parathyroid glands do

According to NIDDK, the only job of these glands is to make parathyroid hormone, which keeps the calcium in your body in balance by telling bone to release calcium, helping the intestines absorb it from food and helping the kidneys hold on to it. When calcium falls too low, the glands release just enough hormone to bring it back. Despite the similar names, NIDDK notes that the parathyroid glands and the thyroid gland are not related, so the thyroid blood tests guide covers a different set of problems.

What too much calcium does to bones and kidneys

NIDDK says primary hyperparathyroidism most often affects the bones and the kidneys. High hormone levels pull extra calcium out of bone and may weaken it, which is one reason a provider asks about fractures and the bone density screening guide is worth reading. Extra calcium also passes into the urine and can form kidney stones, and the flank pain guide describes the pain in the side and back that a stone can cause. NIDDK adds that high calcium might play a part in heart disease, high blood pressure and trouble concentrating, though more research is needed.

Causes and who is more likely to have it

In about 8 out of 10 people, NIDDK explains, the cause is a benign tumor called an adenoma in one parathyroid gland. In most other cases two or more adenomas, or enlargement of all four glands, make the extra hormone, and rarely the cause is cancer of a gland. Rare inherited conditions make more than one gland likely to be involved. About 100,000 people in the United States develop primary hyperparathyroidism each year, which NIDDK calls one of the most common hormonal disorders. A lump in the front of the neck is usually a different matter, and the neck lump guide explains how those are sorted out.

How it is diagnosed

NIDDK says doctors diagnose primary hyperparathyroidism when blood tests show high calcium together with high parathyroid hormone, and sometimes the hormone sits in the upper normal range when it should be low. Doctors do not routinely test the hormone, but may if you have osteoporosis or another bone problem. A 24-hour urine collection can help find the cause. A provider may then order or refer you for a bone density scan, kidney imaging and a vitamin D level, because NIDDK notes that low vitamin D is common in people with the condition. The practice offers the blood work; scans and specialist opinions are arranged by referral.

Treatment, monitoring and when to get help fast

NIDDK says surgery to remove the overactive gland is the only sure cure, and when performed by experienced surgeons it almost always cures the disorder. Doctors use guidelines, such as a calcium level more than 1 mg/dL above normal, thin bones on a DXA scan, kidney stones, a fracture from minimal force or age under 50, to decide who should have it. People who do not meet them, or who prefer not to have surgery, can be monitored with regular visits, a yearly calcium and kidney check and a bone density test every 1 to 2 years. Go to the ER or call 911 for confusion, repeated vomiting, or severe side or belly pain with fever, because very high calcium and infected kidney stones need urgent care.

Sources

• NIDDK (NIH): Primary Hyperparathyroidism
• MedlinePlus: Parathyroid Disorders