Condition Overview
Hyperparathyroidism is a condition characterized by the overproduction of parathyroid hormone (PTH) by the parathyroid glands. This can lead to elevated levels of calcium in the blood (hypercalcemia). There are three main types of hyperparathyroidism: primary, secondary, and tertiary.
- Primary Hyperparathyroidism: This is usually caused by a benign tumor called a parathyroid adenoma on one of the parathyroid glands. It can also be caused by hyperplasia (enlargement) of the parathyroid glands or, rarely, by parathyroid cancer. Treatment is usually surgical.
- Secondary Hyperparathyroidism: This occurs as a response to chronic low calcium levels, often due to chronic kidney disease or Vitamin D deficiency. The parathyroid glands become overactive in an attempt to maintain normal calcium levels. Surgery is only used in rare situations (such as before or after a kidney transplant).
- Tertiary Hyperparathyroidism: This is a progression of secondary hyperparathyroidism where the parathyroid glands become autonomously overactive, even after the underlying cause of low calcium has been treated. It is managed similar to primary hyperparathyroidism.
Symptoms of hyperparathyroidism can vary from mild to severe and may include fatigue, weakness, depression, bone pain, fractures, kidney stones, excessive urination, abdominal pain, and cognitive disturbances.
Diagnosis involves measuring blood levels of calcium, PTH, and Vitamin D. Imaging studies such as ultrasound, sestamibi scans, CT scans, or MRI may be used to locate any abnormal parathyroid tissue.
Treatment Options
- Parathyroidectomy
- Description: Surgical removal of the overactive parathyroid gland(s) is the primary treatment for primary hyperparathyroidism. It can also be used for secondary and tertiary hyperparathyroidism when medical management is insufficient.
- Indications: Confirmed primary hyperparathyroidism with symptoms or complications, secondary or tertiary hyperparathyroidism with persistent symptoms or complications despite medical treatment.
- Radiofrequency Ablation (RFA)
- Description: RFA is a minimally invasive technique that uses heat generated by radiofrequency energy to destroy abnormal parathyroid tissue. It is considered in cases where surgery is not feasible or preferred, but is usually not the first recommendation. The reason it is not usually the first recommendation is that the parathyroid can usually be removed in a very short amount of time (and fix the problem definitively), usually without anesthesia. RFA does not permit a view of the nerve that controls the voice, and it is also less likely to be definitive. Despite these drawbacks, it remains an option for the right patient.
- Indications: Patients unsuitable for surgery, single adenomas, palliative treatment for recurrent hyperparathyroidism.
- "Scarless" Parathyroidectomy
- Description: Also known as minimally invasive or endoscopic parathyroidectomy, this procedure involves removing the overactive parathyroid gland(s) through small incisions that are hidden, reducing visible scarring.
- Indications: Patients with a single parathyroid adenoma or those who are motivated to avoid a cervical incision.
- Minimally Invasive Parathyroidectomy (MIP)
- Description: When a single parathyroid gland is believed to be the cause, a targeted surgery can limit operative time and surgical risks. This can be done with or without a scar.
- Indications: Desire to limit surgical risks
Management of hyperparathyroidism requires a comprehensive approach involving endocrinologists, experienced surgeons, and radiologists. Early diagnosis and appropriate treatment are crucial to manage symptoms, prevent complications, and improve the patient's quality of life. Regular monitoring and follow-up are important to ensure successful outcomes and detect any recurrence. Finding an experienced surgeon and center where your goals are the priority ensures that you get the best care. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for your hyperparathyroidism.
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