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    Parathyroid hyperplasia

    Parathyroid hyperplasia is the enlargement of all four parathyroid glands. The parathyroid glands are glands in the neck that produce parathyroid hormone (PTH).

    Causes

    Parathyroid hyperplasia may occurin people without a family history of the disease, or as part of three inherited syndromes:

    • Multiple endocrine neoplasia I (MEN I)
    • MEN IIA
    • Isolated familial hyperparathyroidism

    In people with an inherited syndrome, a changed (mutated) gene is passed down through the family. You only need to get the gene from one parent to develop the condition.

    • In MEN I, problems in the parathyroid glandsare due totumors in the pituitary gland andpancreas.
    • In MEN IIA, overactivity of theparathyroid glandsis due to tumors in the adrenal or thyroid gland.

    Symptoms

    Symptoms may include:

    • Bone fractures
    • Constipation
    • Lethargy
    • Muscle pain
    • Nausea

    Exams and Tests

    Blood tests will be done to check calcium, phosphorus, magnesium, PTH, and vitamin D levels. A 24-hour urine testmay bedone to determine how much calcium is being removed from the body and is leaking into the urine.

    Bone x-rays and a bone density test(DXA) can help detect fractures, bone loss, and bone softening.

    Treatment

    Surgery is the preferred treatment. Usually 3 1/2 glands are removed. The remaining tissue may be implanted in the forearm so a doctor can easily operate on it if symptoms come back. This tissue will also help the body control calcium levels.

    Outlook (Prognosis)

    Increased calcium levels persist or return about 20% of the time after surgery.

    Possible Complications

    Parathyroid hyperplasia can cause hyperparathyroidism, which leads to an increase in blood calcium levels.

    Complications include increased calcium in the kidneys and osteitis fibrosa cystica(a softened, weak area in the bones).

    Patients may also have complications from the other tumors that are part of the multiple endocrine neoplasia syndromes. See also:

    • MEN I
    • MEN IIA

    When to Contact a Medical Professional

    Call your health care provider if:

    • You have any symptoms of hypercalcemia
    • You have a family history of a MEN syndrome

    Prevention

    Patients with a family history of the MEN syndromes may want to have genetic screening to check for the defective gene. Those who have the defective gene may have routine screening tests to detect any early symptoms.

    References

    Wysolmerski JJ, Insogna KL. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008:chap. 266.

    Bringhurst FR, Demay MB, Kronenberg HM. Disorders of mineral metabolism. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. St. Louis, Mo: WB Saunders; 2008:chap. 27.

    Wysolmerski JJ, Insogna KL. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 253.

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    • Endocrine glands

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    • Parathyroid glands

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      • Endocrine glands

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      • Parathyroid glands

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            Tests for Parathyroid hyperplasia

            Review Date: 7/19/2012

            Reviewed By: Shehzad Topiwala, MD, Chief Consultant Endocrinologist, Premier Medical Associates, The Villages, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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