From the Guidelines
Hyperparathyroidism symptoms include bone pain, kidney stones, excessive urination, abdominal pain, fatigue, depression, memory problems, muscle weakness, and fragile bones, as a result of excessive parathyroid hormone (PTH) production, which raises blood calcium levels by pulling calcium from bones and increasing calcium absorption from food 1. The condition occurs when overactive parathyroid glands produce too much parathyroid hormone (PTH), leading to elevated calcium levels, which causes most symptoms.
- Key symptoms of hyperparathyroidism include:
- Bone demineralization
- Fractures
- Nephrolithiasis
- Nephrocalcinosis
- Muscle weakness
- Neurocognitive disorders Many patients may be asymptomatic, especially in early or mild cases, as seen in countries where biochemical screening is routine, such as the United States, Canada, and most of Europe 1. However, in countries where routine biochemical screening is not commonplace, such as China or India, hyperparathyroidism predominately presents with symptoms related to target organ involvement, including bone, kidney, and neuropsychiatric symptoms 1. Laboratory findings typically show high calcium and PTH levels, which are used to diagnose primary hyperparathyroidism (PHPT) 1. Symptoms often develop gradually and may be subtle, with the classic description being "bones, stones, abdominal groans, and psychic moans." Severe cases can lead to osteoporosis, cardiac arrhythmias, and neuropsychiatric symptoms, highlighting the importance of early diagnosis and treatment 1. Treatment depends on severity but often includes surgery to remove the overactive gland(s), especially when symptoms are present or calcium levels are significantly elevated, as surgical excision of the abnormally functioning parathyroid tissue is typically indicated even when asymptomatic, given potential negative effects of long-term hypercalcemia 1. Regular monitoring of calcium levels is important for those with mild cases not requiring immediate intervention.
From the FDA Drug Label
Adverse events of hypocalcemia were reported in three patients (7%). Seizures were observed in 0. 7% (1/140) of cinacalcet-treated patients and 0. 0% (0/46) of placebo-treated patients in all clinical studies. Table 3 lists the following adverse reactions: Nausea, Vomiting, Paresthesia, Fatigue, Fracture, Hypercalcemia, Anorexia, Asthenia, Dehydration, Anemia, Arthralgia, Constipation, Depression, Headache, Infection Upper Respiratory, Pain Limb, Hypocalcemia
The symptoms of hyperparathyroidism are not directly listed in the provided drug label. However, based on the adverse reactions reported, the following symptoms can be associated with hyperparathyroidism or its treatment:
- Gastrointestinal symptoms: Nausea, Vomiting, Anorexia, Dehydration
- Musculoskeletal symptoms: Fracture, Arthralgia, Pain Limb
- Neurological symptoms: Paresthesia, Seizures, Headache
- Psychological symptoms: Depression, Fatigue, Asthenia
- Cardiovascular symptoms: None directly listed, but hypocalcemia can lead to cardiovascular issues
- Renal symptoms: None directly listed, but hyperparathyroidism can lead to kidney damage 2
From the Research
Symptoms of Hyperparathyroidism
The symptoms of hyperparathyroidism can be subtle and may be attributed to other conditions, making diagnosis challenging 3. Some common symptoms include:
- Anxiety or depression-like symptoms, although the overall cluster does not fit standard criteria 3
- Renal stones and metabolic bone disease, although these severe symptoms are less frequent now than in the past 4
- Mild hypercalcemia, which may not always be accompanied by apparent clinical symptoms 5
- Increased mortality and concealed morbidity, emphasizing the importance of early diagnosis and treatment 5
Diagnosis and Treatment
Diagnosis of hyperparathyroidism is crucial, and serum calcium levels play a significant role in this process 3. Treatment options vary depending on the severity of the disease and may include:
- Surgical removal of an adenoma, which can cure primary hyperparathyroidism 4
- Medical management with bisphosphonates, hormone replacement therapy, and calcimimetics for mild disease 4
- Vitamin D analogs and other treatments for secondary hyperparathyroidism, particularly in patients with chronic kidney disease 6