Understanding Primary Hyperparathyroidism: A Simple Guide
What Is Primary Hyperparathyroidism?
Primary hyperparathyroidism is a condition where the parathyroid glands produce too much parathyroid hormone (PTH), leading to high calcium levels in the blood. It’s more common than many people realize, affecting about 20 out of every 100,000 people. It occurs more often in women, especially between the ages of 50 and 60.
What Causes It?
The condition happens when the parathyroid glands become overactive, often due to a small growth called an adenoma (non-cancerous tumor). This leads to high calcium levels in the blood, which can cause various health issues.
Types of Primary Hyperparathyroidism
Primary hyperparathyroidism can vary in severity. Here’s how it’s categorized:
| Type | Calcium Levels | PTH Levels | Surgery Recommendation |
|---|---|---|---|
| Primary Hyperparathyroidism | High | High | Surgery strongly recommended for all patients |
| Asymptomatic Hyperparathyroidism | High | High | 25-30% will need surgery eventually; early surgery prevents complications |
| Normocalcemic Hyperparathyroidism | Normal | High | Surgery benefits unclear; decisions made on a case-by-case basis |
How Is It Diagnosed?
Primary hyperparathyroidism is diagnosed through blood tests, not imaging. The key tests include:
- PTH & Calcium Levels: To confirm the diagnosis.
- Vitamin D, Creatinine, and Phosphate Levels: To rule out other conditions that cause similar symptoms.
- 24-Hour Urine Calcium Test: To rule out familial hypocalciuric hypercalcemia (FHH), a genetic condition that doesn’t benefit from surgery.
The Role of Imaging
Imaging is not used to diagnose primary hyperparathyroidism but helps locate the overactive gland before surgery.
Common Imaging Tests:
| Test | Detection Rate (%) | Accuracy (%) |
|---|---|---|
| Sestamibi Scan | 71-79 | 72-95 |
| Ultrasound | 64-91 | 83-96 |
| Sestamibi-SPECT | 70-81 | 91-95 |
| 4D-CT Scan | 83-95 | 88-99 |
If imaging is positive, surgery can be done using a minimally invasive approach. If imaging is negative, patients still need surgery, but the surgeon will explore both sides of the neck to find the problem.
When Is Surgery Needed?
Surgery is the only cure for primary hyperparathyroidism. It’s recommended in the following cases, summarized by the acronym “CRABS”:
- C: Calcium levels more than 0.2 mmol/L above normal
- R: Renal (Kidney) Issues such as kidney stones, poor kidney function, or increased creatinine levels
- A: Age under 50 (younger patients benefit more from surgery)
- B: Bone Problems like osteoporosis or fractures
- S: Symptoms such as fatigue, forgetfulness, mood changes, or depression (The PASIEKA questionnaire can help measure these symptoms)
What to Expect After Surgery?
- Success Rate: Surgery cures the condition in about 90-95% of cases.
- Health Benefits: Most people experience a significant improvement in their health, including better bone strength, fewer kidney problems, and improved mental well-being.
Key Takeaways
- Primary hyperparathyroidism is diagnosed through blood tests (high calcium and PTH levels).
- Surgery is the only effective treatment, with a high success rate of 90-95%.
- Successful surgery improves quality of life and reduces health risks.
If you have primary hyperparathyroidism, talk to an endocrine surgeon to discuss whether surgery is the right option for you.