Do not underestimate the power of four tiny buttons
Parathyroid glands serve the purpose of producing parathyroid hormone (PTH) in response to the serum level of calcium in our body. When the calcium level is low, the body senses and tries to bring it back to normal by secreting more parathyroid hormone. Now, what has it got to do with calcium level anyway? Well, parathyroid hormone will cause resorption of calcium from the bone, causing the bone to release more calcium into the blood serum when there is a low calcium level detected. Another way of increasing the calcium level is that parathyroid hormone will control the amount of calcium excreted through the kidneys. If the body needs more calcium, PTH will “direct” the kidneys to reabsorb some of the calcium back to the blood serum. Fair enough?
When glands lose control over hormone production
If this happens in a healthy normal person, it must be due to a certain degree of genetic mutation. The disease could be due to the enlargement of the gland (parathyroid adenoma), malignancy (parathyroid carcinoma), or simply an increase in the number of cells in the glands (parathyroid hyperplasia). All these factors contribute to the hypersecretion of the parathyroid hormone. It also occurs in familial MEN syndromes.
Surveys say the prevalence of primary hyperparathyroidism is about 1 in 800 and it is 2-3 times more common in women than men. 90% of patients are over 50 years old.
When the term “secondary” is used, one must think of reasons other than genetic mutation, which lead to this condition. Chronic kidney disease holds accountability for the condition even though the kidneys and parathyroid glands stay far away from each other. The failing kidneys eventually cause more calcium to be excreted out from the body, leading to hypoglycaemia, a condition where serum calcium is too low in the body, thus, hyperparathyroidism.
Where do we get our vitamin D from? Yes, from the sun, and also from our dietary intake. Vitamin D deficiency can contribute to this condition for this results in the reduction in calcium absorption from the gut. This causes serum calcium level to fall, which is then detected by the parathyroid glands, which response by secreting more hormone to restore calcium level. Malabsorption is indirectly related to causing low-calcium-high-PTH condition as well.
Continuous stimulation of the parathyroids over a prolonged period of time results in adenoma formation and autonomous PTH secretion. This is commonly seen in individuals with advanced chronic kidney disease.
Bones. Stones. Groans. Moans.
That rhymes, no? In fact, they do make sense as these are the key features of hyperparathyroidism.
- Bones: More than 99% calcium is in bone. Hyperparathyroidism causes excess calcium to be lost from the bone, causing the bone to lose its density.
- Joint/ bone pain
- Development of calcium crystals within articular cartilage, causing secondary degenerative arthritis.
- Stones: High PTH may eventually cause high serum calcium level. This predispose to the formation of calcium stones in the kidneys or urinary tracks as more calcium has to be excreted out.
- Painful urination
- Blood in the urine
- Intermittent loin to groin pain
- (Abdominal) Groans:
- Peptic ulcer disease (increased serum calcium level induces production of more gastric acid)
- Nausea and vomiting
- Abdominal pain
- Acute pancreatitis
- Muscle weakness and easy fatigability
- Loss of focus
- Cardiac complications
- Slow/ irregular heartbeat
- Cardiac arrest
How to find out if you are at risk or have hyperparathyroidism?
- blood test to find out PTH and serum calcium level
- urine test
- ultrasound scan
The point of investigating is to find out the cause and to rule out other possible causes which lead to high calcium level.
At present surgery is the only curative option and should be offered to all patients with significant hypercalcaemia provided they are otherwise fit for the procedure.
There are a number of medical strategies and therapies, particularly in mild hyperparathyroidism, which includes simple expectant treatment until the calcium level or symptoms reach a level at which surgery becomes more attractive, low calcium diet, withdrawal of drugs (diuretics and lithium) which aggravate hypercalcaemia and, more recently, calcium reducing agents.
And finally, go for a blood test to detect your problems earlier before complications set in. the world would be a better place with more healthier and happier people.
by Angie Loh
A medical student with nothing but passion and a pen. Poems and novels never fail to make me feel alive. I'm inspired to make the world a better place and fill it with a little bit more love. But first, where's my coffee? View all articles by Angie Loh.