From the Guidelines
Hyperparathyroidism symptoms often include bone pain, kidney stones, excessive urination, abdominal pain, fatigue, depression, memory problems, and muscle weakness, and the condition is typically diagnosed through biochemical testing, with imaging playing a crucial role in preoperative parathyroid gland localization for surgical cure. The symptoms of hyperparathyroidism can vary widely, but common manifestations include:
- Bone pain
- Kidney stones
- Excessive urination
- Abdominal pain
- Fatigue
- Depression
- Memory problems
- Muscle weakness These symptoms occur due to the overproduction of parathyroid hormone (PTH) by the parathyroid glands, leading to elevated calcium levels in the blood 1. Many patients experience subtle symptoms that develop gradually, including increased thirst, constipation, nausea, loss of appetite, and joint pain. Some individuals may also notice bone fractures that occur easily, osteoporosis, and psychiatric symptoms like anxiety or difficulty concentrating. In severe cases, patients might develop cardiac arrhythmias or pancreatitis. The severity of symptoms typically correlates with calcium levels, though some patients remain asymptomatic despite laboratory abnormalities 1.
Diagnosis and Treatment
Diagnosis involves blood tests measuring calcium, PTH levels, and sometimes imaging studies to locate enlarged parathyroid glands. Treatment depends on the cause and severity but often includes surgery to remove the overactive gland(s), especially in primary hyperparathyroidism cases. The role of imaging in hyperparathyroidism is to localize the abnormally functioning gland or glands with high accuracy and high confidence to facilitate targeted curative surgery, as stated in the ACR Appropriateness Criteria for parathyroid adenoma 1.
Key Considerations
It is essential to note that imaging has no utility in confirming or excluding the diagnosis of hyperparathyroidism, but it is crucial for preoperative localization of the parathyroid adenoma to guide surgical approach 1. The choice of surgical approach, either bilateral neck exploration (BNE) or minimally invasive parathyroidectomy (MIP), depends on the presence of a single adenoma or multigland disease, with MIP being preferred for single adenomas due to its less invasive nature and faster recovery times 1.
From the Research
Hyperparathyroidism Symptoms
- Hyperparathyroidism is characterized by an alteration of the pathophysiological parathyroid hormone (PTH) secretion, which can lead to various symptoms, including non-specific signs and symptoms of hypercalcemia, skeletal fragility, nephrolithiasis, and nephrocalcinosis 2.
- The majority of individuals with primary hyperparathyroidism (PHPT) present at an asymptomatic stage, without any signs or symptoms of calcium or PTH excess or target organ damage 2.
- Symptomatic presentation of PHPT includes bone loss and kidney stones, and the disease always has the potential to become symptomatic 3.
- Secondary hyperparathyroidism (2HPT) is characterized by a progressive hyperplasia of the parathyroid glands and an increased production of PTH, which can lead to skeletal and extraskeletal damage, including damage to the cardiovascular system, nervous system, immune, hematopoietic, and endocrine system 4.
- Tertiary hyperparathyroidism (3HPT) is considered a state of excessive autonomous secretion of PTH due to long-standing 2HPT, and it's usually the result of a lack of suppression in the production of PTH 4.
Medical Management
- Medical management of PHPT may be considered in patients with mild asymptomatic disease, contraindications to surgery, or failed previous surgical intervention 2.
- Calcium and vitamin D intake should be optimized in patients with PHPT 2.
- Antiresorptive therapy may be used for skeletal protection in patients with an increased fracture risk 2.
- Cinacalcet, a calcimimetic agent, has been shown to effectively lower serum calcium and PTH levels in patients with PHPT 5, 2, 6.
- The effect of medical treatment on the reduction in fracture risk is unknown and should be the focus of future research 2.
Surgical Treatment
- 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.
- Surgery is always appropriate in suitable surgical candidates, and it can achieve biochemical cure in 96.1% of patients with PHPT 5.
- Surgery may be associated with an increase in bone mineral density, but the evidence is low or very low quality 5.
- Indication for surgical treatment is unresponsive medical therapy, and there are no large prospective studies that compare the medical and surgical treatment 4.