Signs and Symptoms of Primary Hyperparathyroidism

Hi, I'm James Wu, one of the endocrine surgeons at the UCLA Endocrine Center. Today, I'd like to talk to you about the signs and symptoms of primary hyperparathyroidism.

Instead of providing an extensive list of symptoms, it is more beneficial to delve into the root causes that lead to the symptoms experienced by patients. Hyperparathyroidism occurs when one or more of the four parathyroid glands overproduce parathyroid hormone (PTH). These tiny glands, each about the size of a grain of rice in their healthy state, reside near the thyroid at the base of the neck. Their primary function is to maintain calcium levels in the blood.

Excessive parathyroid hormone levels initially impact the bones, as they store the majority of the body's calcium. This hormone signals the bones to release more calcium into the bloodstream. Over time, the bone can become depleted of calcium. Progressive reductions reduction in bone mineral density lead to osteopenia and eventually osteoporosis. which are associated with increased rates of fracture.

Parathyroid hormone also exerts significant effects on the kidneys and intestines. It acts as a signal for these organs to boost blood calcium levels by reducing calcium loss through urine in the kidneys and enhancing calcium absorption from food in the intestines. Consequently, calcium levels in the bloodstream increase. In patients with primary hyperparathyroidism (excessive PTH secretion) the kidneys may compensate by increasing urine output to prevent excessive calcium accumulation. This process often leads to symptoms such as frequent urination, dehydration, and increased thirst. Many patients notice an increase in fluid intake and urine frequency. Additionally, some individuals may develop kidney stones due to excess calcium in the urine, resulting in symptoms such as back pain, flank pain, or painful urination.

Elevated levels of calcium in the bloodstream can exert a broad impact on the body, affecting muscles and nerves. This elevation may result in subtle yet significant symptoms such as fatigue, weakness, changes in mood, difficulty concentrating, vague abdominal discomfort, and can even worsen heartburn. It is important to note that many of these symptoms are nonspecific, meaning that they are often caused by conditions unrelated to the parathyroid glands.

Not all patients with primary hyperparathyroidism experience symptoms. Meaning, the disease can often be silent. We meet many patients who have had high calcium levels for years, often going unnoticed by their doctors. Some of these patients eventually discover that they have osteopenia or osteoporosis. Currently, most cases of primary hyperparathyroidism are diagnosed through routine blood tests detecting elevated calcium levels. Often, the disease hasn't progressed enough to show noticeable symptoms, underscoring the significance of prompt diagnosis and treatment in order to prevent significant bone loss.

Key Insights:

  • Primary hyperparathyroidism is characterized by the overproduction of parathyroid hormone, leading to various symptoms. Understanding the underlying causes of these symptoms can help in identifying and managing the condition effectively.
  • Bones are significantly affected by primary hyperparathyroidism due to the excessive release of calcium from the bones. This can result in bone density loss, osteoporosis, fractures, and bony pain.
  • Kidneys and intestines play a crucial role in calcium regulation. Excess parathyroid hormone causes the kidneys to conserve calcium and the intestines to absorb more from food.
  • Elevated calcium levels in the blood can affect muscles and nerves throughout the body. This can lead to fatigue, weakness, mood alterations, difficulty concentrating, and abdominal pain.
  • Not all patients with primary hyperparathyroidism will experience symptoms. Routine blood tests often help in the diagnosis of the condition, even before symptoms become apparent.
  • Primary hyperparathyroidism can be successfully treated with surgery. Seeking appropriate medical care and exploring surgical options can help manage the condition effectively.

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