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 secretion leading to hypercalcemia and its associated complications 1.
Common Symptoms
- Bone pain
- Kidney stones
- Excessive urination
- Abdominal pain
- Fatigue
- Depression
- Memory problems
- Muscle weakness
- Fragile bones
Hypercalcemia-Related Issues
- Constipation
- Nausea
- Vomiting
- Loss of appetite
- Increased thirst
Neuropsychiatric Manifestations
- Confusion
- Difficulty concentrating
- Personality changes
Other Complications
- Osteoporosis, leading to increased fracture risk, particularly in the spine, hips, and wrists
- Joint pain
- Heartburn
- High blood pressure It's essential to note that approximately 80% of patients with primary hyperparathyroidism are asymptomatic, with the condition often discovered incidentally through routine blood tests showing elevated calcium levels 1. The symptoms result from excessive parathyroid hormone secretion, which pulls calcium from bones, increases calcium absorption from the intestines, and reduces calcium excretion by the kidneys, leading to hypercalcemia and its associated complications. Symptoms typically develop gradually and may be subtle, making diagnosis challenging without laboratory testing.
From the Research
Symptoms of Hyperparathyroidism
- Non-specific signs and symptoms of hypercalcemia 2
- Skeletal fragility 2
- Nephrolithiasis and nephrocalcinosis 2
- The majority of individuals present at an asymptomatic stage following routine biochemical screening, without any signs or symptoms of calcium or parathyroid hormone (PTH) excess or target organ damage 2
Treatment and Management
- Parathyroidectomy is advised in patients younger than 50 years old and in the presence of either significant hypercalcemia, impaired renal function, renal stones or osteoporosis 2
- Medical management may be considered in those with mild asymptomatic disease, contraindications to surgery or failed previous surgical intervention 2
- Cinacalcet, a calcimimetic agent, has been shown to effectively lower serum calcium and PTH levels 2, 3, 4, 5
- Antiresorptive therapy may be used for skeletal protection in patients with an increased fracture risk 2
- Calcium and vitamin D intake should be optimized 2
Cinacalcet Treatment
- Cinacalcet has been shown to decrease serum calcium and parathyroid hormone serum levels in patients with PHPT 3, 4, 5
- The effect of cinacalcet on bone mineral density is uncertain, and more frequent monitoring of bone mineral density may be required along with a medication proven to improve bone mineral density 3
- Cinacalcet may be considered to reduce serum calcium and parathyroid hormone serum levels in patients with PHPT who cannot or will not undergo surgery and those with refractory PHPT after parathyroidectomy 3
- Common adverse events from cinacalcet treatment include gastrointestinal symptoms, such as nausea and appetite loss 4