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Hyperparathyroidism (HPRT)

Hyperparathyroidism (HPRT)

Hyperparathyroidism (HPRT) is a condition in which one or more of the parathyroid glands produce excessive amounts of parathyroid hormone (PTH), leading to elevated calcium levels in the blood (hypercalcemia) and disruption of calcium and phosphate balance in the body123.

Types

1. Primary Hyperparathyroidism
   Caused by an abnormality within the parathyroid glands themselves, most commonly a benign tumor (adenoma), hyperplasia (enlargement) of one or more glands, or rarely parathyroid cancer. This leads to autonomous overproduction of PTH, causing increased calcium release from bones, increased calcium absorption from the gut, and decreased calcium excretion by the kidneys134578.
2. Secondary Hyperparathyroidism
   Occurs as a compensatory response to chronic low calcium levels, often due to chronic kidney disease (CKD), vitamin D deficiency, or malabsorption. The parathyroid glands increase PTH secretion to maintain calcium levels, but this can lead to gland hyperplasia and eventually high PTH levels136.
3. Tertiary Hyperparathyroidism
   Develops when secondary hyperparathyroidism becomes autonomous, with parathyroid glands secreting excess PTH even after the initial cause (e.g., kidney disease) is resolved1.

Causes

• Primary: Parathyroid adenoma (most common), hyperplasia, parathyroid carcinoma (rare), genetic syndromes (e.g., MEN1)
• Secondary: Chronic kidney disease, vitamin D deficiency, malabsorption, hypocalcemia
• Risk factors: Radiation to head/neck, age >60, female sex predominance, genetic predisposition13567.

Symptoms

Many patients are asymptomatic and diagnosed incidentally on routine blood tests. When symptoms occur, they may include:

• Fatigue, weakness, depression, memory problems, confusion
• Bone pain, osteoporosis, fractures
• Kidney stones, increased urination, thirst
• Gastrointestinal symptoms: nausea, vomiting, constipation, loss of appetite
• Muscle weakness and joint pain12347.

Diagnosis

• Elevated serum calcium and PTH levels
• Low or normal serum phosphate (primary hyperparathyroidism)
• Imaging: Neck ultrasound, sestamibi scan to localize adenomas
• Bone density testing (DXA) to assess bone loss
• Kidney imaging for stones or calcifications34.

Treatment

• Primary hyperparathyroidism: Surgical removal of the overactive gland(s) is the definitive treatment, especially if symptomatic or with complications.
• Secondary hyperparathyroidism: Treat underlying cause (e.g., vitamin D supplementation, phosphate binders, dialysis in CKD).
• Tertiary hyperparathyroidism: May require surgery if glands remain overactive after correction of secondary causes1346.

Complications

• Osteoporosis and fractures due to bone resorption
• Kidney stones and nephrocalcinosis
• Cardiovascular calcifications and hypertension
• Neuropsychiatric symptoms and cognitive impairment
• Rarely, parathyroid carcinoma in primary hyperparathyroidism134.

Summary Table

Aspect	Details
Definition	Excessive PTH production by parathyroid glands causing hypercalcemia
Types	Primary (adenoma, hyperplasia), Secondary (CKD, vitamin D deficiency), Tertiary
Common Causes	Parathyroid adenoma, CKD, vitamin D deficiency, genetic syndromes
Symptoms	Fatigue, bone pain, kidney stones, GI symptoms, neuropsychiatric symptoms
Diagnosis	Elevated calcium and PTH, imaging (ultrasound, sestamibi), bone density tests
Treatment	Surgery (primary), medical management (secondary), vitamin D, phosphate binders
Complications	Osteoporosis, fractures, kidney stones, cardiovascular disease

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References

1. Cleveland Clinic: Hyperparathyroidism: What It Is, Symptoms & Treatment
   https://my.clevelandclinic.org/health/diseases/14454-hyperparathyroidism
2. NHS: Hyperparathyroidism
   https://www.nhs.uk/conditions/hyperparathyroidism/
3. Penn Medicine: Hyperparathyroidism – Symptoms and Causes
   https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/hyperparathyroidism
4. MSD Manuals: Hyperparathyroidism – Endocrine and Metabolic Disorders
   https://www.msdmanuals.com/professional/endocrine-and-metabolic-disorders/parathyroid-disorders/hyperparathyroidism
5. MedlinePlus: Hyperparathyroidism
   https://medlineplus.gov/ency/article/001215.htm
6. Johns Hopkins Medicine: Hyperparathyroidism
   https://www.hopkinsmedicine.org/health/conditions-and-diseases/hyperparathyroidism
7. Yale Medicine: Hyperparathyroidism
   https://www.yalemedicine.org/conditions/hyperparathyroidism
8. NIDDK: Primary Hyperparathyroidism
   https://www.niddk.nih.gov/health-information/endocrine-diseases/primary-hyperparathyroidism

Hyperparathyroidism is a disorder of excessive parathyroid hormone production with diverse causes and manifestations. Early diagnosis and appropriate treatment are essential to prevent complications such as bone loss and kidney damage.