Primary Hyperparathyroidism

What is Primary Hyperparathyroidism?

Primary hyperparathyroidism occurs when one or more of the parathyroid glands become abnormal and cause an elevated production of parathyroid hormone (PTH). The parathyroid glands use PTH production to regulate and maintain calcium levels in the body. When the parathyroid glands produce too much PTH, calcium levels can become elevated. If left untreated, the calcium increase can lead to osteoporosis and kidney stones. 

What Causes Primary Hyperparathyroidism? 

In the order of most to least common, the following abnormalities of the parathyroid glands can cause PTH production to rise: 

  • Adenomas – benign tumors that grow on one or more parathyroid glands 
  • Hyperplasia – all four parathyroid glands are enlarged or overactive
  • Cancer – a malignant tumor that grows from a parathyroid gland 

What Are the Symptoms of Primary Hyperparathyroidism? 

Not every patient with primary hyperparathyroidism will have symptoms. Those that do may experience: 

  • Abdominal pain (pancreatitis) 
  • Brittle bones (osteoporosis or osteopenia) 
  • Decreased kidney function 
  • Depression 
  • Heart disease 
  • Increased urination 
  • Joint pain 
  • Kidney stones 
  • Loss of appetite 
  • Muscle weakness 
  • Nausea or vomiting 

How Is Primary Hyperparathyroidism Diagnosed? 

Commonly, primary hyperparathyroidism is found during a routine blood test. If your blood test shows elevated levels of calcium, your doctor may order one or more of the following tests: 

  • A bone mineral density test to measure how many grams of calcium and other minerals are found in a bone segment 
  • A urine test that will collect your urine in a 24-hour period to determine how much calcium is excreted in the urine and how well your kidneys are working 
  • Imaging tests, such as an X-ray, to evaluate your kidneys 

How Is Primary Hyperparathyroidism Treated? 

At Tampa General Hospital, our parathyroid surgeons have performed over 35,000 parathyroid gland examinations combined and perform minimally invasive procedures to treat parathyroid disorders. Our specialists often recommend the following treatments for patients with primary hyperparathyroidism: 

  • Watchful waiting – An approach used for patients with only slightly elevated calcium levels, kidneys that are functioning as normal and normal bone density. 
  • Medication – Hormone replacement therapy, calcimimetics and bisphosphonates are some of the medications used to treat primary hyperthyroidism.  
  • Surgery – The most common treatment that often provides a cure, surgery removes only the enlarged glands. (If all four glands are enlarged, a portion of the fourth gland may remain to provide the patient with functioning parathyroid tissue.)