Primary Hyperparathyroidism

  • Primary Hyperparathyroidism (PHPT):
    • Occurs when one (or more) of the four parathyroid glands grows into a tumor and behaves inappropriately by constantly making excess parathyroid hormone (PTH)
    • The parathyroid glands grow into a tumor and produce too much parathyroid hormone (PTH):
      • Which removes calcium from the bones
  • In Primary Hyperparathyroidism (PHPT) the tumor (Adenoma):
    • Has lost its control mechanism and makes large amounts of parathyroid hormone (PTH):
      • Thus, even when the serum calcium level is high:
        • When the normal response of the parathyroid glands should be to stop making any PTH at all:
          • One of the parathyroid glands keeps making the parathyroid hormone
  • One important thing to remember as you read about PHPT:
    • Is that the abnormal PTH production is caused by a benign parathyroid tumor, called ADENOMA:
      • It is not a cancer:
        • However this disease (PHPT) can increase the occurrence of other cancers:
          • Breast Cancer
          • Prostate Cancer
          • Renal Cancer
          • Skin Cancer
          • Colon and rectal cancer
  • The most common cause of excess hormone production (primary hyperparathyroidism):
    • Is the development of a benign tumor in one of the parathyroid glands:
      • This enlargement of one parathyroid glands is called a:
        • Parathyroid adenoma:
          • Which accounts for roughly 85% to 90% of all patients with primary hyperparathyroidism:
            • The other 10% to 15% will have more than one bad gland (mulitiglandular disease):
              • Doble Adenomas:
                • 6% to 9% of the cases
              • Triple Adenomas:
                • Less than 0.3% of the cases
              • Parathyroid Gland Hyperplasia:
                • 3% of the cases
  • This out of control (autonomously functioning) parathyroid gland:
    • Is essentially never cancerous (virtually 99% of them are benign tumors):
      • However, PHPT slowly causes damage to the body:
        • Because it induces an abnormally high level of calcium in the blood:
          • Which can slowly destroy a number of tissues
  • Parathyroid adenomas:
    • Typically are much bigger than the normal “grain-of-rice” parathyroid and will frequently be about the size of an olive or grape:
      • Thus, the typical patient with primary hyperparathyroidism will be cured of the disease when this “grape” size tumor is removed
    • Up to 30% will have more than one tumor
    • This tumor / adenoma will almost always continue to grow until it is removed:
      • As it grows, it makes more PTH and will make you feel worse (symptomatic)
    • This tumor is constantly making parathyroid hormone (PTH):
      • Which is what takes the calcium out of your bones and makes the calcium in your blood too high
Algorithm for Diagnosis of Primary Hyperparathyroidism *Borderline serum Calcium and PTH levels may need to be measured several times to establish the diagnosis, as levels will fluctuate over time. ** Common secondary causes of elevated PTH levels include chronic kidney disease, vitamin D deficiency, medications, renal hypercalciuria, malabsorption syndromes

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