What are the causes of parathyroid hormone (PTH) elevation?

From the Guidelines

Parathyroid elevation, or hyperparathyroidism, should be treated based on the underlying cause and severity, with surgery being the definitive treatment for primary hyperparathyroidism and treating the underlying cause for secondary hyperparathyroidism. For primary hyperparathyroidism, surgery to remove the overactive gland(s) is recommended, especially for those with symptoms or significant hypercalcemia (calcium >1 mg/dL above normal) 1. Asymptomatic patients with mild elevations may be monitored with regular blood tests every 6-12 months. Secondary hyperparathyroidism, often due to vitamin D deficiency or kidney disease, requires treating the underlying cause, which may include:

• Vitamin D supplementation (typically 1,000-2,000 IU daily)
• Calcium supplements (500-1,000 mg daily)
• Medications like cinacalcet (starting at 30 mg daily) for those with kidney disease 1 Symptoms of hyperparathyroidism include bone pain, kidney stones, abdominal discomfort, fatigue, and cognitive changes. The condition occurs because PTH regulates calcium balance in the body, and when the glands become overactive, they release excess hormone, pulling calcium from bones into the bloodstream, which can lead to osteoporosis and other complications if left untreated. Some key points to consider in the treatment of hyperparathyroidism include:
• The type of PTH assay used can affect diagnosis and management, particularly in secondary hyperparathyroidism 1
• Surgical parathyroidectomy can provide effective reductions in serum PTH levels, especially in patients with severe hyperparathyroidism associated with hypercalcemia or hyperphosphatemia 1
• Total parathyroidectomy with autotransplantation (TPTX + AT) is a common surgical approach, but the choice of procedure should be individualized based on the patient's specific needs and circumstances 1
• Recent studies suggest that TPTX may have advantages over TPTX + AT in reducing the relapse of secondary hyperparathyroidism, but more research is needed to confirm this finding 1.

From the FDA Drug Label

The calcium-sensing receptor on the surface of the chief cell of the parathyroid gland is the principal regulator of PTH synthesis and secretion. Cinacalcet, the active ingredient in cinacalcet tablets, is a calcimimetic agent that directly lowers PTH levels by increasing the sensitivity of the calcium-sensing receptor to activation by extracellular calcium.

Parathyroid Elevation: Cinacalcet is used to treat secondary hyperparathyroidism (HPT) in adult patients with chronic kidney disease (CKD) on dialysis. It works by lowering PTH levels, which can help to reduce parathyroid elevation.

• Key Points:
  • Cinacalcet lowers PTH levels by increasing the sensitivity of the calcium-sensing receptor to activation by extracellular calcium.
  • It is used to treat secondary HPT in adult patients with CKD on dialysis.
  • The goal of treatment is to achieve targeted intact parathyroid hormone (iPTH) levels. 2

From the Research

Parathyroid Elevation

Parathyroid elevation, also known as hyperparathyroidism, is a condition characterized by elevated parathyroid hormone (PTH) levels. The following are key points related to parathyroid elevation:

• Hyperparathyroidism can be primary, secondary, or tertiary, with primary hyperparathyroidism being the most common form 3, 4, 5.
• Primary hyperparathyroidism is often asymptomatic, but can manifest with symptoms such as osteoporosis, hypercalciuria, and nephrolithiasis 3, 4.
• Diagnosis of primary hyperparathyroidism is typically made through biochemical tests, including measurement of PTH, calcium, and phosphate levels 5.
• Treatment options for hyperparathyroidism include parathyroidectomy, which is the only curative treatment for primary hyperparathyroidism, and medical therapies such as cinacalcet and vitamin D analogues 3, 4, 6.
• Medical therapies can help manage symptoms and reduce the risk of complications, but may not be able to cure the condition 6.

Causes and Risk Factors

The causes and risk factors for parathyroid elevation include:

• Adenoma or hyperplasia of one or more parathyroid glands 6.
• Deficiency in vitamin D or uremia, which can cause secondary hyperparathyroidism 6.
• Family history of multiple endocrine neoplasia syndrome (types 1 or 2) 5.
• Personal history of neck irradiation 5.

Treatment and Management

Treatment and management options for parathyroid elevation include:

• Parathyroidectomy, which is the gold standard treatment for primary hyperparathyroidism 3, 4.
• Medical therapies such as cinacalcet and vitamin D analogues, which can help manage symptoms and reduce the risk of complications 6.
• Clinical management, which is indicated if surgery cannot be performed 4.