Hyperparathyroidism Support Group

The majority of patients with hyperparathyroidism are asymptomatic. Manifestations of hyperparathyroidism usually involves the kidney (stones) and the skeletal system (bone pain due to fibrous tissue replacement, termed osteitis fibrosa cystica)

If symptomatic, hyperparathyroidism can be classically remembered by the rhyme "moans" (myalgia), "groans" (abdominal pain), "stones" (kidney), "bones" (bone pain), and "psychiatric overtones" (confusion, altered mental state, lethargy, fatigue).

Other symptoms include: headaches, sleep disorders, memory problems, gastroesophageal reflux, decreased sex drive, thinning hair, hypertension, and heart palpitations.

Primary hyperparathyroidism causes hypercalcemia (elevated blood calcium levels) through the excessive secretion of parathyroid hormone (PTH), usually by an adenoma (benign tumors) of the parathyroid glands. Its incidence is approximately 42 per 100,000 people. It is approximately two to three times as common in women than men. Treatment is usually surgical removal of the gland(s) containing adenomas. Medications (such as estrogen replacement therapy in postmenopausal women and bisphosphonates) thus far have not been very effective. Future developements such as calcimemetic agents (e.g. cinacalcet) which activate the parathyroid calcium-sensing receptor may offer a good alternative to surgery.

Secondary hyperparathyroidism refers to the excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low blood calcium levels) and associated hypertrophy of the glands. If the underlying cause of the hypocalcemia can be addressed, the hyperparathyroidism will resolve. If left untreated, the disease can progress to tertiary hyperparathyroidism, where correction of the underlying cause will not stop excess PTH secretion, i.e. parathyroid gland hypertrophy becomes irreversible.

Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone (PTH) after a long period of secondary hyperparathyroidism and resulting in hypercalcemia. For example, a person may have chronic kidney disease, leading to hypocalcemia, which in turn leads to elevated PTH levels. If this person lives for a long time with hypocalcemia and then undergoes a kidney transplantation, the original cause of the hypocalcemia is cured, but PTH may remain high and even cause abnormally high blood calcium.