What is Hyperparathyroidism

What is hyperparathyroidism and how you can cope with it

The parathyroid glands are 4 small hormone-producing organs. They are located at the front of the neck on either side, behind the upper and lower thyroid glands.

Together with vitamin D, they are the main regulators of calcium metabolism in the body.

99% of the body's total calcium content is localized in bone. The parathyroid glands produce a hormone called parathyroid hormone (PTH), which stimulates the mobilization of calcium from the bones into the blood and the reduction of calcium excretion through the urine.

Both effects lead to an increase in blood calcium concentration, as occurs when intestinal calcium resorption is stimulated, which is a common effect of PTH and vitamin D.

PTH also regulates the concentration of phosphorus in the blood in the opposite direction to that of calcium, increasing its excretion through the kidneys. A well-balanced interaction between parathyroid hormone and vitamin D is necessary to maintain blood calcium levels within the reference range. It is also important for bone health. Low concentrations of calcium and vitamin D in the blood cause PTH concentrations to rise to ensure that the blood calcium concentration remains within the normal range. In healthy individuals, elevated blood calcium concentrations result in depressed PTH concentrations.

We asked Prof. Dr. Anton Luger, a specialist in endocrinology and attending physician at Wiener Privatklinik, what could be disrupting the parathyroid glands, what this will lead to and what the treatment is.

 

What can disrupt the normal functioning of the parathyroid glands?

Increased PTH activity can be caused by an adenoma, which is a benign tumor of one parathyroid gland, or less commonly by hyperplasia (an increase in the number of cells and therefore function) of one or all four parathyroid glands. In addition, decreased vitamin D levels lead to a compensatory increase in PTH to keep blood calcium concentrations within normal limits. The use of edications, such as lithium, which is used in the treatment of bipolar disorders, can also cause elevated PTH and blood calcium levels.

Lowered PTH activity is much less common and is usually caused by inadvertent removal of the parathyroid glands during thyroid surgery and very rarely after childbirth.

  

What are the symptoms when something is wrong?

Reduced levels of parathyroid hormone, or so-called hypoparathyroidism, lead to reduced concentrations of calcium in the blood and can cause muscle pain or cramping, particularly in the areas around the mouth, hands, wrists, legs and feet.

Other possible manifestations of hypoparathyroidism include weakness, calcium deposits in the kidneys, hair loss, brittle nails, depressive mood swings and ECG changes.

 

How does hyperparathyroidism manifest itself?

Elevated PTH levels with elevated blood calcium levels can cause exhaustion, depression and even coma, loss of bone mineral content with osteopenia, dehydration, calcium deposits in the kidneys, kidney stones, loss of appetite and body weight, and increased risk of gastric hemorrhage.

 

What tests are needed to check parathyroid activity?

In order to adequately assess parathyroid function, a measurement of the PTH concentration in the blood should be made, while also determining the phosphorus, albumin and vitamin D content of the blood, as well as urinary calcium excretion.

Increased PTH and calcium concentrations in the blood and increased urinary calcium excretion are diagnostic signs of primary hyperparathyroidism. Imaging studies should then be performed, usually by neck ultrasonography.

In some cases, additional procedures such as scintigraphy, CT, MRI, PET-CT or PET-MRI are necessary.

 

How are these imbalances treated?

Primary hyperparathyroidism is usually treated by surgery, in most cases removing the adenoma that led to the increased PTH secretion. After surgery, when PTH levels return to normal ranges, calcium is moved into the bone (fasting bone), necessitating calcium infusion for a short period of time, and then normal calcium balance is restored.

In the case of mild PTH excess and only slightly elevated blood calcium concentrations, without kidney or bone involvement, a strategy of watch-and-wait may be considered, especially in not-so-young patients.

Hypoparathyroidism is treated by calcium and vitamin D supplementation, and in some cases daily injections of PTH are also necessary.

Prof. Dr. Anton Luger, a specialist in endocrinology and attending physician at the Wiener Privatklinik, has been listed by Stanford University in the top 4% of the world's top scientists in 2021. He is an active member of several international medical societies, including The Endocrine Society. President of the European Union of Medical Specialists (UEMS), Endocrinology, Diabetes and Metabolism Section. Author and co-author of more than 230 books and journal articles; editorial board member of medical journals such as Hormones and Endocrine.

The Wiener Privatklinik (WPK) was founded in 1871 in Vienna. It is one of the largest private hospitals in Austria. It was awarded as one of the best in the world in 2021 and 2022. The hospital offers over 30 different medical specialties. It has 10 competence centers, 145 beds, a surgical department with 4 operating rooms.

The facility offers imaging services at the Radiology Center, including PET scanner (PET-CT) and nuclear medicine. In 2020, the only private Radiotherapy Centre in Austria was also founded.