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Primary hyperparathyroidism is the most common cause of high blood calcium level in the general population. In this disease, one or more of the parathyroid glands makes too much parathyroid hormone (PTH). This leads to calcium being taken out of the bones (which can cause osteoporosis) and gastrointestinal tract and being put into the blood stream. Since the kidneys clear the body’s calcium into the urine, this can cause kidney stones and damage the kidney function. Surgical removal of the abnormal parathyroid gland(s) is the only known cure for this condition. More about primary hyperparathyroidism >
Secondary hyperparathyroidism usually occurs in patients with kidney failure (dialysis patients). The body is unable to clear phosphorous and make enough Vitamin D, which causes low blood levels of calcium. This stimulates the parathyroid glands to grow and produce extra parathyroid hormone. Secondary hyperparathyroidism is usually treated with medications such as cinacalcet (Sensipar), and surgery is reserved for cases where the medications fail to work. If the kidney failure resolves (usually after a kidney transplant), secondary hyperparathyroidism usually resolves as well. If hyperparathyroidism does not resolve after a kidney transplant, this is called tertiary hyperparathyroidism and surgery may be necessary (usually subtotal parathyroidectomy, which is removal of three and a half parathyroid glands). More about secondary hyperparathyroidism >
The success rate of parathyroidectomy (surgical removal of an abnormal parathyroid gland) is 95% for experienced, high-volume surgeons. Because of the experience level of surgeons varies widely in the community, failed surgery occurs in 1-30% of initial operations. Recurrence following initial surgery is detected with laboratory tests showing high calcium and PTH levels. Persistent hyperparathyroidism means the calcium and PTH levels never became consistently normal following surgery, while recurrent disease means that the levels were normal for at least 6 months and then became abnormally high again. Re-operative parathyroid surgery (also known as re-do or remedial parathyroid surgery) can be successful but relies on high quality, accurate imaging and having a very experienced parathyroid surgeon.
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