Definition and Overview

Parathyroid disorders involve impairment in the functions of the parathyroid glands, which are small endocrine glands located in the neck. These glands are responsible for producing calcitonin and parathyroid hormones, which play a major role in regulating calcium levels in the blood and the skeletal system. With parathyroid disorders, the glands are not performing their tasks normally affecting the levels of calcium in the blood and bones.

There are four different types of parathyroid disorders, namely:

  • Primary hyperparathyroidism, which means that both the amount of parathyroid hormone production and calcium levels in the body are high

  • Secondary hyperparathyroidism, which means that only the amount of parathyroid hormones are high while calcium levels remain at normal amounts

  • Primary hypoparathyroidism, which means that both the amount of parathyroid hormone production and calcium levels in the body are low

  • Pseudohypoparathyroidism, the calcium levels in the blood and bones are abnormally low and the parathyroid hormone production is high

Abnormally high levels of calcium in the blood and bones can lead to hypercalcemia, which causes a variety of complications, including renal or biliary stones, pain in the bones, polyuria (abnormally large amounts of urine produced or passed), anxiety, problems in cognitive functions, trouble sleeping, depression, insomnia, and in some cases, even coma, as the body becomes unable to cope with the drastic imbalance within it. In the majority of cases of hypercalcemia, hyperparathyroidism is the cause. Too much calcium in the body can also lead to a decrease in heart rate, as well as an increase in the amount of contractions the heart makes per second. Severe hypercalcemia is a serious medical emergency, and if left unchecked, it could lead to cardiac arrest.

Hypocalcemia or the condition of having abnormally low calcium levels can also pose serious health risks. It can lead to involuntary muscle contraction, cramping, and twitching. Like severe hypercalcemia, severe hypocalcemia is also potentially life-threatening.

Cause of Condition

Parathyroid disorders are caused by dysfunctions in the parathyroid gland. There are different factors that can cause these dysfunctions, with varying results that can affect the amount of parathyroid hormones and calcitonin produced by the glands.

Primary hyperparathyroidism is typically caused by an adenoma (a benign tumor that grows in glandular structures) that grows in one or more of the parathyroid glands. It can also be caused by hyperplasia (the enlargement of the gland caused by an increase in cell reproduction, usually associated with the initial stage of cancer development) or carcinoma (a type of cancer) of the parathyroid glands. In some very rare cases, pregnant women may develop primary hyperthyroidism.

Secondary hyperparathyroidism, on the other hand, is often caused by chronic kidney failure. This is because the patient’s dysfunctional or failing kidneys are unable to activate vitamin D, keeping the body from excreting normal amounts of phosphate. The phosphate that remains in the body fuses with calcium and forms insoluble calcium phosphate that dramatically reduces the amount of calcium the body could circulate. Secondary hyperparathyroidism can also be caused by conditions that lead to malabsorption of nutrients, such as small bowel disease and chronic pancreatitis. Bariatric surgery can also cause this problem.

Hypoparathyroidism can be caused by different factors, including the following:

  • Autoimmune invasion and destruction, and can be one of the components of autoimmune polyendocrine syndromes
  • Injury to the parathyroid glands, which can also occur in the form of trauma following a thyroidectomy or other forms of neck surgery
  • Removal of the parathyroid glands after surgery
  • Low magnesium levels in the body or insufficient amounts of magnesium in the diet
  • Genetic conditions leading to problems in the functions of the parathyroid glands
  • Hemochromatosis, a hereditary condition that results in iron salts being deposited in the tissues, which can also lead to lower calcium absorption and circulation in the body
  • DiGeorge Syndrome, which involves the congenital absence of parathyroid glands. This often occurs with other forms of endocrinal disorders and issues.

Key Symptoms

Symptoms can also vary depending on what causes the parathyroid disorder. Here are the common signs and symptoms associated with the types of disorders described above:

Primary hyperparathyroidism

  • Diabetes insipidus, which can involve polydipsia (abnormal thirst) and polyuria (abnormal amounts and frequency of urination)
  • Kidney stones
  • Nephrocalcinosis, or abnormal calcium salt deposits in the renal parenchyma
  • Osteitis fibrosa cystica, which causes fractures and pains in the bone
  • Osteoporosis
  • Arthritis
  • Osteomalacia, or softening of the bones
  • Constipation
  • Peptic ulcers
  • Vomiting
  • Nausea
  • Indigestion
  • Acute pancreatitis
  • Depression
  • Memory loss
  • Lethargy
  • Delirium
  • Psychosis
  • Ataxia
  • Itching
  • Appearance of calcium in the central cornea, or band keratopathy
  • Thickening of the heart muscles in the left ventricle

Secondary hyperparathyroidism

  • Limb deformities
  • Joint pain
  • Bone pain
  • Issues in the blood, neurological system, and immune system

Hypoparathyroidism

  • Issues with nerve conduction and muscle contraction
  • A tingling sensation in the hands, feet, and around the mouth
  • Severe spasms of the hands and feet
  • Headaches
  • Insomnia
  • Muscle pain
  • Abdominal pains and cramps
  • Severe heartbeat irregularities
  • Spasms in the bronchi, which can lead to respiratory failure

Who to See and Types of Treatment Available

When the symptoms above are observed, it is best to consult a general practitioner who may then refer you to an endocrinologist, a medical professional who specializes in hormonal problems or to a nephrologist, who specializes in kidney and mineral disorders.

Treatment varies from one kind of parathyroid disorder to the other, including the following:

  • Primary hyperparathyroidism - The patient will first need to have the adenomas removed from the parathyroid glands by surgery. Medication will also be required to normalize the hormone and calcium levels in the body.

  • Secondary hyperparathyroidism - The low levels of calcium in the blood will first be treated with medication, which is usually enough for most cases of secondary hyperparathyroidism. In some cases, especially for patients with chronic kidney failure, a healthier diet with less phosphorus and vitamin D supplements will be prescribed.

  • Hypoparathyroidism - Calcium will be introduced into the patient’s body through IV drips to normalize the calcium levels. Treatment often continues with oral medication prescribed by the doctor.
    References:

  • Bilezikian, Khan, Potts, et al.: “Hypoparathyroidsim in the adult”

  • New England Journal of Medicine: “Hypoparathyroidism”
  • The Critical Role of Serum Calcium: An Educational Network for Secondary Hyperparathyroidism
  • Parathyroid.com
  • University of Texas Medical Branch: “Parathyroid Disease: Diagnosis and Treatment
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