Dr Chinnadorai Rajeswaran, consultant endocrinologist explains about hyperparathyroidism. Please email him, if you need more information

Parathyroid Hormone (PTH) is produced by the Parathyroid glands. PTH helps maintain an appropriate balance of calcium and is responsible for bone metabolism.

There are 4 parathyroid glands located in the neck. One or more of the parathyroid glands could start producing too much parathyroid hormone resulting in hyperparathyroidism.

PTH raises the level of calcium in the body and can cause a variety of symptoms including:

• Tiredness
• Increased thirst
• Increased frequency of urination
• Abdominal pain
• Constipation
• Fractures
• Depression/Low mood

People with Hyperparathyroidism if not treated could go on to develop:

• Kidney stones
• Fractures and osteoporosis
• Cardiac problems
• Pancreatitis
• Peptic ulcers
• Kidney damage

Hyperparathyroidism often goes undiagnosed for many years. It is often mistaken for other conditions.

Hyperparathyroidism can be primary, secondary or tertiary.

What causes primary hyperparathyroidism?

In primary hyperparathyroidism, one or more of your parathyroid glands become enlarged, overactive and release too much parathyroid hormone.

Causes of primary hyperparathyroidism include:

single parathyroid adenoma: This is the most common cause of primary hyperparathyroidism. There is a benign tumour of one of the parathyroid glands.

Hyperplasia of the parathyroid gland: Hyperplasia means that the parathyroid gland has got bigger. It may affect more than one gland at the same time.

Parathyroid carcinoma: This is very rare and caused by cancer of one of the parathyroid glands.

Primary hyperparathyroidism does not usually run in families. Rarely, it can be a result of an inherited condition called familial isolated hyperparathyroidism or a syndrome called multiple endocrine neoplasia (MEN) which affects the parathyroid gland, pancreas and the pituitary gland.

What is secondary hyperparathyroidism?

Low levels of calcium stimulate the parathyroid glands to produce more parathormone. This results in enlargement of the parathyroid gland. There are some conditions, which stimulate the parathyroid gland leading to secondary hyperparathyroidism, which include:

• Vitamin D deficiency
• Chronic kidney disease
• Intestinal malabsorption

What is tertiary hyperparathyroidism?

This type of hyperparathyroidism occurs as a result of long-standing secondary hyperparathyroidism. Even after the condition which results in secondary hyperparathyroidism is treated.

Parathyroid gland in tertiary hyperparathyroidism works independently, that is irrespective of the blood calcium levels. This is usually seen in people with long standing kidney failure and patients who have had kidney transplant.

Are you at risk of hyperparathyroidism?

You may be at an increased risk of primary hyperparathyroidism if you :

• Are a woman who has attained menopause
• Have prolonged, severe calcium and/or vitamin D deficiency
• Have a rare condition like multiple endocrine neoplasia (MEN), type 1.
• Have had radiation treatment to the neck.
• Have taken lithium

Diagnosis: This involves blood and urine tests along with ultrasound scans of the neck, Sestamibi scan and ultrasound of abdomen.  A DEXA scan will also be requested to assess bone mineral density, to rule out osteoporosis.

Management: Hyperparathyroidism can be cured by surgery. If surgery is not possible or contraindicated, symptoms can be relieved by some medications.

Dr Chinnadorai Rajeswaran is a consultant Physician specialising in Endocrinology, Diabetes and Obesity. As a private endocrinologist he  has private endocrine, diabetes and weight loss clinics in Harley Street, London, Chennai (India), Claremont Hospital, Sheffield, Nuffield Hospital, Leeds and Simplyweight, Bradford.

He has face to face consultations with people from Barnsley, Rotherham, Chesterfield, Doncaster, Wakefield, Huddersfield, Bradford, Harrogate, Leeds, Sheffield, London and Chennai (India). He also offers video consultations.