Hyperparathyroidism - Diagnosis and Treatment (2023)

Diagnosis

In most cases, high calcium is detected by blood tests ordered for other reasons. For example, routine blood tests or tests to determine the cause of symptoms for another condition. Your provider can diagnose hyperparathyroidism by ordering:

blood test

If your blood test results show that you have high levels of calcium in your blood, your doctor will likely repeat the test. This repeated test can confirm the results after you haven't eaten for a while.

Many conditions can increase calcium levels. But your doctor may diagnose hyperparathyroidism if blood tests show that you also have high levels of parathyroid hormone.

complementary exams

After primary hyperparathyroidism is diagnosed, your doctor will likely order more tests. These can rule out possible conditions that cause hyperparathyroidism, identify possible complications, and determine the severity of the condition. These tests include:

  • Bone density test.This test is done to see if you have developed osteoporosis. The most common test to measure bone density is dual-energy X-ray absorptiometry (DEXA).

    This test uses special X-ray machines to measure how many grams of calcium and other bone minerals have accumulated in a section of bone.

  • Urine tests.A 24-hour urine collection can provide information about how your kidneys are working and how much calcium is excreted in your urine.

    This test can help your doctor determine the severity of your hyperparathyroidism or diagnose a kidney disorder that is causing your hyperparathyroidism. If a very low level of calcium is found in the urine, it may indicate a condition that does not require treatment.

  • Kidneys illustration.Your doctor may order an X-ray or other imaging tests of your abdomen to see if you have kidney stones or other kidney problems.

Image before surgery

If your doctor recommends surgery, one of these imaging tests may be used to find the parathyroid gland or glands that are causing problems:

  • Parathyroid scintigraphy with sestamibi.Sestamibi is a radioactive compound taken up by overactive parathyroid glands. It can be detected by a scanner that detects radioactivity.

    A healthy thyroid gland also absorbs sestamibi. To prevent thyroid uptake from being blocked in terms of uptake in a parathyroid tumor (adenoma), radioactive iodine is also given. This is only absorbed by the thyroid. This procedure digitally removes the image of the thyroid so that it cannot be seen.

    A computed tomography (CT) scan can be combined with a sestamibi scan to improve detection of any problems with the parathyroid glands.

  • Ultrasound.Ultrasound uses sound waves to create images of the parathyroid glands and surrounding tissue.

    A small device placed on the skin (transducer) emits high-frequency sound waves and records the echoes of the sound waves reflected off internal structures. A computer converts the echoes into images on a screen.

Treating Parathyroid Disease at the Mayo Clinic

Here at the Mayo Clinic in Endocrine and Metabolic Surgery, we treat the full spectrum of parathyroid issues. And this ranges from the simplest primary hyperparathyroidism to the most complex cases.

What they are are four small glands that regulate calcium. And most of the time, only one of them develops a tumor.

We use multimodal imaging, which means different types of imaging to locate where the abnormal parathyroid is. And that can include various imaging techniques like ultrasound, sestamibi parathyroid scan, which is nuclear medicine imaging. We use a four-dimensional CT scan, which is an advanced CT scan of the neck and parathyroid glands. And finally, cutting-edge imaging such as positron emission tomography (PET) of choline.

Therefore, choline PET is one of the newer imaging modalities. It requires the production of an isotope of choline in situ. And therefore this is not widely available. In fact, it's only available at a few centers across the country. And so with this type of scanning, we can find parathyroid glands that would otherwise be undetectable with traditional imaging techniques.

Once this step is completed, the patient can confidently proceed to the next step, which is treatment.

Patients may come to the office experiencing a variety of symptoms that are generally nonspecific but quite debilitating for them. In many of these cases, we can treat the hyperparathyroidism and see these symptoms literally disappear.

What we're really looking for is having a very effective and efficient program for patients and knowing that they're going to be operated on by experienced, high-volume parathyroid surgeons. He feels confident that they will come here and get the care they need and deserve.

More information

  • bone mineral density test
  • Electrocardiogram (ECG or EKG)
  • urinal
  • bone scan

Treatment

Treatment options for primary hyperparathyroidism may include watchful waiting, surgery, and medications.

watchful waiting

Your doctor may recommend no treatment and regular monitoring if:

  • Your calcium levels are only slightly elevated.
  • His kidneys are working fine and he has no kidney stones.
  • Is your bone mineral density within the normal range or slightly below the normal range?
  • You have no other symptoms that might improve with treatment.

If you choose this watch-and-wait approach, you will likely need regularly scheduled tests to monitor your blood calcium levels and bone density.

Surgery

Surgery is the most common treatment for primary hyperparathyroidism and offers a cure in most cases. A surgeon will only remove glands that are enlarged or tumorous.

If all four glands are affected, the surgeon will likely remove only three glands and perhaps part of a fourth, leaving some functional parathyroid tissue.

The surgery can be performed on an outpatient basis, allowing you to go home the same day. In such cases, surgery can be done through very small incisions (incisions) in the neck. You are only given local anesthesia to numb the area.

Complications from surgery are not common. Risks include:

  • Damage to the nerves that control the vocal cords.
  • Long-term low calcium levels requiring the use of calcium and vitamin D supplements due to removal or damage of all parathyroid glands. This means that the body cannot produce enough parathyroid hormone to keep calcium in the normal range.

medication

Medications to treat hyperparathyroidism include the following:

  • Calcimimetics.A calcimimetic is a drug that mimics circulating calcium in the blood. The drug may induce the parathyroid glands to release less parathyroid hormone. This medication is sold as cinacalcet (Sensipar).

    Cinacalcet may be an option for treating primary hyperparathyroidism, especially if surgery has not successfully treated the disorder or if the person is not a good candidate for surgery.

    Cinacalcet and vitamin D analogues (prescribed forms of vitamin D) are used to manage secondary hyperparathyroidism in chronic kidney disease. These medications help maintain a balance of the minerals calcium and phosphorus so that the parathyroid glands don't have to work as hard.

    The most common side effects of cinacalcet are joint and muscle pain, diarrhea, nausea and respiratory infection.

  • Hormone replacement therapy.For women who have gone through menopause and are showing signs of osteoporosis, hormone replacement therapy can help bones retain calcium. However, this treatment does not address the underlying problems of the parathyroid glands.

    Long-term use of hormone replacement therapy can increase your risk of blood clots and breast cancer. Work with your doctor to weigh the risks and benefits to help you decide what's best for you.

    Some common side effects of hormone replacement therapy include breast pain and tenderness, dizziness and headaches.

  • Bisphosphonates.Bisphosphonates also prevent the loss of calcium from bones and may reduce osteoporosis caused by hyperparathyroidism. Some side effects associated with bisphosphonates include low blood pressure, fever and vomiting. This treatment does not address the underlying problems of the parathyroid gland and the level of calcium in the blood remains above the normal range.

More information

  • Parathyroidectomy
  • Treating Parathyroid Disease at the Mayo Clinic

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Lifestyle and home remedies.

If you and your doctor have chosen to monitor, rather than treat, your primary hyperparathyroidism, the following suggestions may help prevent complications:

  • Watch how much calcium and vitamin D you get in your diet.Limiting the amount of calcium you eat or drink is not recommended for people with hyperparathyroidism.

    The recommended daily allowance of calcium for adults ages 19 to 50 and men ages 51 to 70 is 1,000 milligrams (mg) of calcium per day. This calcium recommendation increases to 1,200 mg per day for women age 51 and older and men age 71 and older.

    The recommended daily allowance for vitamin D is 600 international units (IU) of vitamin D per day for people aged 1 to 70 years and 800 IU per day for adults aged 71 years and older. Talk to your provider about dietary guidelines that are right for you.

  • Drink large amounts of fluids.Drink enough fluids, especially water, to produce nearly clear urine to reduce the risk of kidney stones.
  • Exercise regularly.Regular exercise, including strength training, helps keep your bones strong. Talk to your provider about what type of exercise program is best for you.
  • smokelessSmoking can increase bone loss and increase your risk of many serious health problems. Talk to your doctor about the best ways to stop smoking.
  • Avoid medications that increase calcium.Certain medications, including some diuretics and lithium, can increase calcium levels. If you are taking these medications, ask your doctor if another medication might be right for you.

Preparing for your appointment

In most cases, high calcium is detected by blood tests ordered by a healthcare professional as part of a routine physical, testing for an unrelated condition, or testing to identify the cause of very general symptoms.

Talk to your doctor about test results if they show you have high calcium levels. Questions you can ask include:

  • Do I have hyperparathyroidism?
  • What test do I need to confirm the diagnosis or determine the cause?
  • Should I consult a specialist in hormonal disorders (endocrinologist)?
  • If I have hyperparathyroidism, do you recommend surgery?
  • What alternatives do I have to surgery?
  • I have these other health conditions. How can I best manage them together?
  • Do you have literature on hyperparathyroidism that I can take home with me?

To understand the effect of hyperparathyroidism on your overall health, your doctor may ask you questions about possible mild signs or symptoms, such as:

  • Have you been feeling depressed?
  • Do you often feel tired, easily tired or generally unwell?
  • Do you experience unexplained pain?
  • Are you often forgetful, distracted or unable to concentrate?
  • Have you experienced increased thirst and excessive urination?

Your doctor may ask you additional questions about the medications you take and your diet to help determine if you are getting adequate amounts of calcium and vitamin D.

By the staff at the Mayo Clinic

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