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

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