ontrol is thus needed for many basic functions. Phosphorus (usually in phosphate form) is also essential, and closely linked to calcium movements, bone metabolism, and sources of energy for the whole body.
Symptoms and signs
Excess Pth results in raised calcium and phosphate levels, which causes both general, non-specific symptoms, and some which are directly related to the organs affected by changes in these levels.
General symptoms usually arise slowly and include vague body aches, fatigue and weakness.
Specific symptoms and signs related to high calcium levels include:
- Abdominal pain - often linked to peptic ulcers/pancreatitis - high calcium levels cause increased stomach acid production,
- Nausea, vomiting,
- Loss of appetite,
- Hypertension and heart failure,
- Increased thirst and urination,
- Kidney stones in 15-20 percent due to high urinary calcium,
- Specific muscular weakness,
- Thinning of bones - may lead to fractures, and
- Mental confusion and memory loss.
To confirm clinical findings, and locate the abnormal gland/s, test needed are
- Blood Pth levels,
- 24-hour urine collection - for renal function and calcium excretion,
- Bone mineral density scan - to assess bone strength and risk of fractures,
- X-rays or ultrasound - to check for kidney-stones, and
- Radio-scans to locate the overactive parathryroid gland/s.
Underlying causes for Secondary hyparathryoidism must be identified and treated: this usually resolves the hormone problem. Chronic kidney disease is often the cause, with inadequate vitamin D production. Vitamin D is easily given as a supplement, but becomes less effective after a time. Cinacalcet may be tried (under strict supervision) for these patients, provided they are not on regular dialysis.
For Primary cases, surgery remains the most effective option. If tests identify one or more abnormal glands, only these are removed. If no single overactive gland is found, then three of the four glands are removed, leaving one intact to provide at least some natural hormone to regulate calcium and phosphate. Apart from those for any operation, there are some specific risks involved in this surgery (such as damage to the vocal cords’ nerve supply, and removing too much parathyroid, causing a deficiency state, which will need immediate treatment).
(Dr AG Hall)