American Medical Association Family Medical Guide - American Medical Association [619]
Symptoms
Symptoms of hyperparathyroidism can include muscle aches, muscle weakness, or frequent urination. Other possible symptoms are drowsiness, fatigue, depression, confusion, or seizures. Some people experience nausea and vomiting, abdominal pain, flatulence, or constipation.
Diagnosis
To diagnose hyperparathyroidism, a doctor will order blood tests to measure the levels of calcium, phosphorus (a mineral that has an essential role in bone formation), and parathyroid hormone in the blood. In some cases, the doctor may recommend an ultrasound scan (see page 111) or a radionuclide scan (see page 114) to determine which of the four parathyroid glands is causing the problem. Hyperparathyroidism can also be detected by genetic analysis to look for a rare genetic disorder called multiple endocrine neoplasia, which can lead to cancer.
Treatment
The usual treatment for hyperparathyroidism is surgical removal of a tumor if there is one, or of three of the four enlarged parathyroid glands. After surgery, the person may develop hypoparathyroidism (see next article), in which the parathyroid glands do not produce enough parathyroid hormone; he or she will then be treated for that condition.
If hyperparathyroidism causes kidney stones to form, a doctor may recommend treatment with extracorporeal lithotripsy (see page 816), a procedure in which shock waves pulverize the stones into a powder that can be passed out of the body in urine. Kidney stones also can be removed surgically.
Medications called bisphosphonates can help prevent bone loss resulting from hyperparathyroidism. Scientists are currently developing medications to prevent the parathyroid glands from secreting too much parathyroid hormone.
Hypoparathyroidism
Hypoparathyroidism is a rare disorder in which the parathyroid glands are underactive and do not produce enough parathyroid hormone. Along with vitamin D and a hormone called calcitonin produced by the thyroid gland, parathyroid hormone regulates the levels of calcium in the body. A deficiency of parathyroid hormone leads to low levels of calcium in the blood and in the tissues, which can affect the functioning of muscles and nerves. Hypoparathyroidism can occur alone or along with problems in other endocrine glands, such as the thyroid gland or the adrenal glands.
Hypoparathyroidism usually results when tissue is removed from the parathyroid glands in surgery performed to control hyperparathyroidism (overactivity of the parathyroid glands; see previous page). The disorder also can result from surgery performed on the thyroid gland to control overactivity of the thyroid gland (hyperthyroidism; see page 901) or to remove a cancerous tumor. In some cases, hypoparathyroidism has no obvious cause.
Symptoms
The main symptom of hypoparathyroidism is uncontrollable, painful, cramplike spasms in the face, hands, arms, and feet. Other symptoms include numbness and tingling in the face and hands, dry skin, and thinning hair. In rare cases, a person may have seizures. People who have hypoparathyroidism often develop a yeast infection in the mouth called oral thrush (see page 744). Women who have the disorder are susceptible to developing vaginal yeast infections (see page 880).
Diagnosis
Hypoparathyroidism is diagnosed by the symptoms and the results of a blood test to measure the level of parathyroid hormone in the blood. Low levels of parathyroid hormone indicate that the parathyroid glands are underactive.
Treatment
To quickly relieve the painful muscle spasms caused by hypoparathyroidism, your doctor will recommend intravenous injections of calcium. You will need to take calcium and vitamin D supplements for the rest of your life to help maintain normal levels of calcium in your body and to prevent symptoms of calcium deficiency. Your doctor will examine you and perform blood tests on a regular basis to evaluate the effectiveness of your treatment and to monitor