From the Guidelines
Hyperparathyroidism symptoms include bone pain, kidney stones, excessive urination, abdominal pain, nausea, vomiting, constipation, fatigue, depression, memory problems, and muscle weakness. These symptoms occur because overactive parathyroid glands produce too much parathyroid hormone (PTH), which raises blood calcium levels by pulling calcium from bones and increasing calcium absorption from the intestines 1. High calcium levels (hypercalcemia) cause most symptoms, while bone demineralization leads to osteoporosis and fracture risk. Many patients, especially those with mild disease, may have no obvious symptoms and are diagnosed through routine blood tests showing elevated calcium levels. If you suspect hyperparathyroidism, seek medical evaluation as treatment options include surgery to remove the affected gland(s), medication like cinacalcet (Sensipar) to lower calcium levels, or monitoring for mild cases. Some key points to consider:
- Regular hydration is important to prevent kidney stone formation while awaiting treatment.
- The diagnosis of hyperparathyroidism is made through biochemical testing, specifically serum calcium and serum PTH levels 1.
- Imaging has no role in confirming or excluding the diagnosis of hyperparathyroidism but is useful for preoperative parathyroid gland localization with the intent of surgical cure 1.
- Treatment of hyperparathyroidism is surgical excision of the abnormally functioning parathyroid tissue and is typically indicated even when asymptomatic, given potential negative effects of long-term hypercalcemia 1.
From the Research
Symptoms of Hyperparathyroidism
The symptoms of hyperparathyroidism can be divided into several categories, including:
- Non-specific signs and symptoms of hypercalcemia, such as cognitive impairment, changes in sensorium, proximal muscle weakness, nausea and vomiting, constipation, and severe dehydration 2
- Skeletal fragility, including osteoporosis and osteitis fibrosa cystica (OFC) 3, 4, 5
- Nephrolithiasis and nephrocalcinosis, which are characterized by the formation of kidney stones and the deposition of calcium salts in the kidneys 3, 6
- Gastrointestinal symptoms, such as nausea and vomiting, which occur in 66% of patients with hypercalcemic-related symptoms 2
- Cognitive impairment, which occurs in 44% of patients with hypercalcemic-related symptoms 2
Severity of Symptoms
The severity of symptoms in hyperparathyroidism can vary widely, with some patients presenting with mild, asymptomatic disease, while others experience severe symptoms, such as:
- Bone pain, skeletal deformities, and pathological fractures 5
- Proximal muscle weakness with hyperreflexia 5
- Hypertensive heart failure 2
- Severe dehydration 2
Risk Factors for Symptomatic Hyperparathyroidism
Several risk factors have been identified for symptomatic hyperparathyroidism, including: