Hyperparathyroidism

Hyperparathyroidism often remains subtly asymptomatic for a long period. In more advanced cases, it can cause:

• Fatigue and weakness

• Muscle aches and joint pain

• Depression, irritability, and psychological instability
• Kidney stones (nephrolithiasis)
• Osteopenia, osteoporosis, and spontaneous bone fractures
• Constipation and gastrointestinal disturbances

The presence and severity of these symptoms depend on the level of hypercalcemia and the duration of the condition.

According to ICD-10 classification, hyperparathyroidism is divided into three main types, based on the underlying cause:

A. Primary Hyperparathyroidism

This is the most common form, caused by an adenoma in one or more parathyroid glands, leading to uncontrolled PTH production and hypercalcemia.

B. Secondary Hyperparathyroidism

This occurs as a reactive mechanism in response to chronic kidney disease, vitamin D deficiency, or malabsorption.

C. Tertiary Hyperparathyroidism

This is a complication of the secondary type, where the parathyroid glands become permanently overactive.

The causes of hyperparathyroidism may include:

• Parathyroid adenoma (the most common)
• Genetic syndromes (e.g., Multiple Endocrine Neoplasia – MEN)
• Chronic kidney disease
• Long-term vitamin D deficiency
• Disrupted calcium metabolism

In some cases, the disorder may also have a hereditary component.

Until recently, hyperparathyroidism often went unnoticed by primary care physicians. Today, endocrinologists, with a heightened index of clinical suspicion, can diagnose the condition relatively early and recommend surgical treatment when appropriate.

Mild, often nonspecific symptoms, accompanied by elevated or borderline calcium and parathyroid hormone (PTH) levels in the blood, usually provide the first clues for diagnosis.

Diagnosis is based on a combination of clinical evaluation, laboratory tests, and imaging studies, including:

• Blood tests (Calcium, Parathyroid Hormone, Phosphorus, Vitamin D)
• Urine tests (24-hour urine calcium)
• Neck ultrasound
• Parathyroid scintigraphy (Sestamibi scan)
• DEXA scan (bone density measurement)

Treatment depends on the type and severity of the condition.

• Primary Hyperparathyroidism: Surgical removal of the affected parathyroid gland (parathyroidectomy) provides a definitive cure.
• Secondary Hyperparathyroidism: Management focuses on correcting calcium and vitamin D levels and optimizing kidney function.
• Tertiary Hyperparathyroidism: In advanced stages, surgical intervention is recommended.

Nowadays, there are medications that can temporarily reduce calcium levels (though they may have side effects) and are often prescribed by endocrinologists while awaiting surgery.

In selected cases, patients may receive calcimimetics (e.g., Mimpara, Cinacalcet), vitamin D, or phosphate supplements as needed.

However, medication is not a definitive solution. It only provides temporary symptom control without addressing the underlying cause of the disease. The definitive treatment is the surgical removal of the affected parathyroid gland.

Yes, if left undiagnosed or untreated, hyperparathyroidism can lead to serious complications, such as:

• Osteoporosis and pathological fractures
• Kidney stones or even kidney failure
• Cardiovascular complications (arrhythmias, hypertension)
• Cognitive and psychiatric disturbances
• Gastric ulcers or pancreatitis

Early diagnosis and proper treatment can prevent most of these complications.

If you are dealing with endocrine disorders and seeking specialized care, contact Dr. Evangelos Karvounis. Dr. Karvounis, MD, PhD, FACS, is an award-winning endocrine surgeon, Doctor of the Medical School of Athens, and Fellow of the American College of Surgeons. He currently serves as Director of Endocrine Surgery at Euroclinic Athens. Schedule a consultation with this highly experienced surgeon for a scientifically grounded, safe, and effective approach to the treatment of hyperparathyroidism.