Hyperparathyroidism

Hyperparathyroidism often goes unnoticed for a long time if it doesn't cause any symptoms, or only mild ones. Things like generally feeling tired or weak, having trouble concentrating or mood swings can also be caused by something else.

More typical symptoms may develop over time. These symptoms occur because the higher levels of parathyroid hormone lead to problems in the following three areas of the body:

• Kidneys: Kidney stones may form in the kidneys. These can cause pain and cramping in your lower belly. The stones can damage the soft membranes lining the urinary tract, which may lead to blood in your urine (pee). You may also see small fragments of kidney stones in your urine when you go to the toilet.
• Bone: To make up for the lack of calcium in your blood, calcium is released from bones in your body. This can lead to pain in your joints and back.
• Digestive tract: Too much acid is made in the stomach. This can lead to symptoms such as loss of appetite, belly ache, nausea, constipation, bloating or weight loss.

Hyperparathyroidism is often caused by a type of benign (not cancer) growth called an adenoma. Parathyroid adenomas are made out of parathyroid gland tissue. They make a lot of parathyroid hormone even when there is already enough calcium in the blood. In most cases, there's just one adenoma in one of the four parathyroid glands. It is quite rare to have more than one adenoma in one or more parathyroid glands at the same time.

It is often not clear why adenomas develop. It is thought that certain medications play a role, especially those containing lithium. These can be prescribed for certain mental health problems, such as bipolar disorder.

In some people, hyperparathyroidism is passed down in their genes (hereditary). Then they may have growths in other glands, too. There is also a rare hereditary form of hyperparathyroidism that can already occur in newborn babies.

Sometimes, the parathyroid glands make a lot of parathyroid hormone because the body is losing calcium or having trouble absorbing it due to another medical condition. A typical example here is chronic kidney disease.

1 to 4 out of every 1,000 people are likely to have hyperparathyroidism that is caused by the parathyroid glands themselves. Some estimates are higher. Experts believe that the disease has been diagnosed more frequently in recent years because blood calcium levels are being tested more often. This means that it's also being discovered by chance in people who don't have any symptoms.

The disease typically first develops in middle age, between the ages of 50 and 60 – and it's more common in women than in men. But it can also develop in children and older adults.

Many people don't notice anything at first. Then signs of the disease are only discovered when blood calcium levels are measured – for example, during a routine check-up. Many people only have slightly higher calcium levels and no symptoms. In others, increasing amounts of parathyroid hormone are produced over time, damaging the kidneys, bones and digestive tract, and eventually leading to symptoms.

If the hyperparathyroidism is caused by another medical condition, treating that condition is often the main focus. For example, some people may have had kidney disease for a long time and then already need dialysis.

Kidney stones can lead to complications. For example, if a stone becomes stuck in a ureter (tube between the kidneys and the bladder), it can cause severe cramping pain (colic) and possibly trouble peeing. This puts a strain on the kidneys and can lead to infections. Hyperparathyroidism can also lead to a build-up of calcium deposits in the kidney tissue, causing the tissue to harden. This weakens the kidneys, and eventually they can no longer filter the blood properly (renal insufficiency).

Because your body takes calcium from the bones, hyperparathyroidism can lead to a form of osteoporosis: The bones become unstable and may crack or break – even without falls or accidents. Increased stomach acid can lead to stomach ulcers or duodenal ulcers, which you might notice because of the pain they cause in the belly area. The ulcers may bleed as well. Sudden, heavy bleeding can even be life-threatening. Losing a small amount of blood over longer periods of time can result in anemia. Hyperparathyroidism can also lead to inflammation in the pancreas, causing severe belly pain, a fever and sometimes even serious circulation problems. Belly pain can also be caused by gallstones, although they rarely occur.

If the calcium level in the blood increases a lot, further complications may arise. The medical term for this is hypercalcemia. It can occur in people who are bed-ridden. This is because if you don't move much, your bones break down faster than they rebuild. Calcium is released as a result. Hypercalcemia can also happen if you have high calcium levels but still take calcium or medications that increase your calcium levels even more – such as certain kidney medications (diuretics) or vitamin D. People with hypercalcemia typically pee more and vomit. As a result, they become very dehydrated (don't have enough fluids in their body).

In rare cases, complications occur because high levels of calcium in the blood affect the nerves. Then people become weak, drowsy and may lose consciousness. Some hallucinate or are confused. Life-threatening heart rhythm problems may occur, too. So hypercalcemia is a medical emergency that needs to be treated urgently in a hospital.

Blood tests play an important role in the diagnosis of hyperparathyroidism. In most cases, high blood calcium levels are detected at first. Calcium levels are usually measured as part of routine blood tests. If there are also high levels of parathyroid hormone in your blood, that's usually a sign that you have one or more adenomas.

If you have high levels of parathyroid hormone but your calcium levels are normal or even too low, it's likely that your parathyroid glands are making too much of the hormone to compensate for a calcium deficiency caused by another medical issue.

More blood tests and urine tests can be done to find out how severe the hyperparathyroidism is or to rule out other illnesses. For example, some test results can help doctors to see how well your kidneys are working. Other test results can show whether the bones are already being affected.

If the doctor thinks you might have an adenoma, they will try to find it using an ultrasound scan, a computed tomography (CT) scan, a scintigraphy, or a PET scan. Damage to the kidneys or bones can be seen using ultrasound scans and x-ray exams. If it's thought that you might have stomach ulcers, a gastroscopy may be done.

The treatment options for hyperparathyroidism depend on what's causing it. If you have an adenoma but no symptoms and your blood calcium level is only slightly high, you can wait and see at first. Your blood levels are then checked every 1 to 2 years.

Surgery to remove the adenoma may be considered if you have troublesome symptoms, damage to the kidneys, bones or digestive tract, or an increased risk of hypercalcemia. If possible, the procedure is then done using a minimally invasive technique that leaves healthy tissue intact.

Sometimes medications are used to stop adenomas making so much parathyroid hormone – for example, if you don't want to have surgery or are unable to have it.

If your parathyroid glands are overactive because of another medical problem that is causing a calcium deficiency, surgery is not advisable. Then it's important to treat the underlying condition first instead. Some people with hyperparathyroidism need to take calcium and vitamin D supplements over the long term to balance out the calcium deficiency. Then the parathyroid glands no longer have to work so hard, and they make normal levels of parathyroid hormone again. If that doesn't help enough, you can try medication to make the parathyroid glands produce less of the hormone.

When people are ill or need medical advice, they usually go to see their family doctor first. Endocrinologists specialize in the diagnosis and treatment of hormonal disorders. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.