From the Guidelines
Elevated Parathyroid Hormone (PTH) is associated with gastrointestinal issues, such as hypercalcemia-related symptoms, due to its effects on calcium and phosphate metabolism.
Relationship between PTH and Gastrointestinal Issues
- Hypercalcemia, which can be caused by elevated PTH, can lead to gastrointestinal symptoms such as nausea, vomiting, and constipation 1.
- Elevated PTH levels can also lead to secondary hyperparathyroidism, which can cause bone disease and alter vitamin D metabolism, further contributing to gastrointestinal issues 1.
- The administration of active vitamin D sterols, such as calcitriol, can help reduce PTH levels and improve bone histology, but careful monitoring of serum calcium, phosphorus, and PTH levels is essential to avoid worsening kidney function 1.
Key Factors Contributing to Gastrointestinal Issues
- Hypocalcemia: a common condition in patients with chronic kidney disease (CKD), which can lead to secondary hyperparathyroidism and elevated PTH levels 1.
- Phosphate retention: a factor that can contribute to the development of secondary hyperparathyroidism and altered vitamin D metabolism 1.
- Vitamin D deficiency: a common condition in patients with CKD, which can exacerbate secondary hyperparathyroidism and contribute to gastrointestinal issues 1. In clinical practice, it is essential to monitor PTH levels and adjust treatment accordingly to prevent gastrointestinal issues and other complications associated with elevated PTH levels.
From the Research
Relationship between Elevated Parathyroid Hormone (PTH) and Gastrointestinal Issues
The relationship between elevated Parathyroid Hormone (PTH) and gastrointestinal issues is complex and has been studied in various research papers. Some of the key findings include:
- Hyperparathyroidism can cause constipation due to reduction in neuromuscular excitability by high calcium levels 2
- The incidence of peptic ulcer disease (PUD) in patients with hyperparathyroidism is 9% compared with autopsy rates of 4% to 5% 2
- Hyperparathyroidism can also cause pancreatitis, with an incidence ranging from 1.5% to 12% 2
- Gastrointestinal symptoms are common in patients with primary hyperparathyroidism (PHPT), with abdominal pain, constipation, and nausea/or vomiting being the most common manifestations 3
- The prevalence of gallstone disease is higher in women with PHPT, while pancreatitis is more common in men 3
Hypercalcemia-Related Symptoms
Hypercalcemia-related symptoms are also an important aspect of the relationship between elevated PTH and gastrointestinal issues. Some of the key findings include:
- Hypercalcemia can cause smooth-muscle atony, leading to upper and lower gastrointestinal symptoms such as nausea, heartburn, and constipation 4
- Acute pancreatitis due to primary hyperparathyroidism is one of the most studied topics, with the causative effect of high calcium level being confirmed 4
- The distinction between primary and secondary hyperparathyroidism is mandatory in the diagnosis of hypercalcemia-related symptoms 5
Effect of Parathyroid Surgery on Gastrointestinal Manifestations
Parathyroid surgery can have a significant impact on gastrointestinal manifestations of PHPT. Some of the key findings include:
- In majority of patients, gastrointestinal manifestations resolve within three months of curative parathyroidectomy 3
- Except in rare cases, none of the patients had recurrence of pancreatitis after parathyroidectomy 3
- The study revealed that the gastrointestinal symptoms were common in patients with symptomatic PHPT, and parathyroid surgery can be an effective treatment option 3