What Causes Hyperparathyroidism?

Hyperparathyroidism is caused by the excessive production of parathyroid hormone by one or more of the parathyroid glands. This over activity of the parathyroid glands results in the excess production of parathyroid hormone (PTH).

PTH helps maintain the proper levels of calcium and phosphorus in your body. Normal parathyroid glands are suppressed with an elevated calcium level. The problem occurs when a diseased parathyroid gland continues to secrete PTH despite an elevated calcium level. The diagnosis of hyperparathyroidism is made when there is an elevated blood calcium level together with an elevated or high normal PTH.

There are two main types of hyperparathyroidism: Primary and secondary hyperparathyroidism. The term "hyperparathyroidism" generally refers to primary hyperparathyroidism.

Primary hyperparathyroidism is most commonly caused by one or more of the parathyroid glands forming a tumor that secretes excessive parathyroid hormone. This enlarged parathyroid gland tumor is called a parathyroid adenoma. Rarely is primary hyperparathyroidism is caused by parathyroid cancer. The abnormal parathyroid adenoma does not stop secreting PTH in response to a normal or elevated calcium level in the blood stream. This causes an elevated calcium level in the blood.

Symptoms of primary hyperparathyroidism include bone pain, osteoporosis (thin bones), kidney stones, and abdominal discomfort. Primary hyperparathyroidism is usually suspected from elevated calcium level in the blood stream. Usually an elevated calcium level, kidney stones or osteoporosis leads to a further workup to rule out hyperparathyroidism.

In almost all cases, the recommendation is for surgery to remove the abnormal parathyroid adenoma. No other medicine or treatment can cure primary hyperparathyroidism. The traditional parathyroid operation technique requires the surgeon to place a large incision in the neck to locate and examine the four parathyroid glands located behind the thyroid. The tumorous gland or glands are then located and removed. Patients that opt for traditional surgery require at least one night of hospitalization, and the patient is left with a larger inch scar on the neck.

Today, minimally invasive parathyroid surgery is an option. Preoperative imaging and localization of the abnormal parathyroid tumor enables a minimally invasive or "mini-incision" approach. This is an outpatient procedure that requires an incision of only a one-inch or less, and the procedure can be performed in less than half an hour.

Secondary hyperparathyroidism is caused by medical conditions that cause low blood calcium levels. In response to this low calcium level, the parathyroid glands react and produce PTH. The PTH is elevated beyond the normal limits because the body is trying to increase the calcium levels in the blood stream. Conditions that cause secondary hyperparathyroidism include vitamin D deficiency, kidney disease and calcium deficiency. Treatment for secondary hyperparathyroidism is focused on correcting the underlying cause of the low calcium levels. This usually includes vitamin D and calcium supplements. Surgery is sometimes indicated, but not as often as with primary hyperparathyroidism, where surgery is nearly always recommended.

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