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    Parathyroid-related hypercalcemia

    Hyperparathyroidism is a disorder in which the parathyroid glands in your neck produce too much parathyroid hormone (PTH).


    The parathyroid glands are located in the neck, near or attached to the back side of the thyroid gland. They produce parathyroid hormone. This hormone controls calcium, phosphorus, and vitamin D levels in the blood and bone.

    When calcium levels are too low, the body responds by making moreparathyroid hormone. This hormone causes calcium levels in the blood to rise, as more calciumis taken from the bone and reabsorbed by the intestines and kidney.

    One or more of the parathyroid glands may grow larger. This leads to too much parathyroid hormone (a conditioncalled primary hyperparathyroidism). Most often, the cause is not known.

    • The disease is most common in people over age 60, but it can also occur in younger adults. Hyperparathyroidism in childhood is very unusual.
    • Women are more likely to be affected than men.
    • Radiation to the head and neck increases the risk.
    • Rarely, the disease is caused by parathyroid cancer.

    Medical conditions that cause low blood calcium levels or increased phosphate levels can lead to secondary hypoparathyroidism. Common causes include:

    • Conditions that make it hard for the body to break down phosphate
    • Kidney failure
    • Not enough calcium in the diet
    • Too much calcium lostin the urine
    • Vitamin D disorders (which are often seen in children who do not get enough nutrition, and in older adults who do not get enough sunlight
    • Problems absorbing nutrients from food (called malabsorption)


    Often hyperparathyroidism is diagnosed before symptoms occur.

    Symptoms are mostly caused by damage to organs from high calcium levels in the blood, or by the loss of calcium from the bones.Symptoms can include:

    • Bone pain or tenderness
    • Depressionand forgetfulness
    • Feeling tired, ill, and weak
    • Fragile bones of the limbs and spine that can break easily
    • Increased amount of urine produced
    • Kidney stones
    • Nausea and loss of appetite 

    Exams and Tests

    Blood tests will be done to check for increased levels of parathyroid hormone (PTH), calcium, and alkaline phosphatase, and lower levels of phosphorous. A 24-hour urine collection test can help determine how much calcium is being removed from the body.

    Bone x-rays and bone mineral density (DXA) tests can help detect bone loss, fractures, or bone softening.

    X-rays, ultrasound, or CT scans of the kidneys or urinary tract may show calcium deposits or a blockage.


    If you have mildly increased calcium levels from primary hyperparathyroidism andyou do not havesymptoms, you may choose to have regular checkups or get treated.

    If you decide to have treatment, it may include:

    • Drinking more fluids to prevent kidney stones from forming
    • Exercising
    • Avoiding thiazide-type diuretics ("water pills")
    • Having surgery to remove the overactive glands (recommended for people under age 50)

    If you have symptoms or your calcium level is very high, you may need surgery to remove the parathyroid gland that is overproducing the hormone.

    Treatment for secondary hyperparathyroidism depends on the cause. Your doctor may suggest:

    • A special form of prescribed vitamin D, if you have low vitamin D levels
    • Surgery for cancer

    Patients whose hyperparathyroidism is caused by kidney failure may be treated with:

    • Extra calcium and vitamin D
    • Avoiding phosphate in the diet
    • The medicine cinacalcet (Sensipar)
    • Dialysis or a kidney transplant
    • Parathyroid surgery, if the parathyroid levels become uncontrollably high

    Outlook (Prognosis)

    The outlook depends on the type of hyperparathyroidism.

    Long-term problems that can occur when hyperparathyroidism is not well controlled include:

    • Increased risk of bone fractures
    • High blood pressure and heart disease
    • Kidney stones


    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.

    Bringhurst FR, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Kronenberg HM, Schlomo M, Polansky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap. 28.


    • Parathyroid glands


      • Parathyroid glands


      A Closer Look

      Tests for Hyperparathyroidism

        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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        St. Luke's Hospital - 232 South Woods Mill Road - Chesterfield, MO 63017 Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
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