Hyperparathyroidism

Hypercalcemia frequently causes high levels of calcium in the urine (hypercalciuria), which can lead to kidney stones Stones in the Urinary Tract Stones (calculi) are hard masses that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine. Tiny stones may cause no symptoms, but larger stones... read more . Chronic hypercalcemia may also cause weakness and wasting of muscles.

Excess PTH stimulates activity in bone cells (osteoclasts), which over time can cause the bones to weaken from loss of calcium.

Surgery to remove the parathyroid glands (parathyroidectomy) is indicated for people with symptoms and for those with worsening hyperparathyroidism. Whether people with primary hyperparathyroidism who have no symptoms need surgery is unclear.

Many experts, however, recommend surgery when

During surgery, a parathyroid gland that has an adenoma is removed. The parathyroid hormone (PTH) level in the blood is measured before and after removal of the abnormal gland(s). If PTH levels fall by 50% or more 10 minutes after the adenoma is removed, the treatment is considered a success.

In people with hyperplasia of all parathyroid glands, surgery involves removal of each gland. A small portion of a normal-appearing parathyroid gland is reimplanted in one of the sternocleidomastoid muscles on either side of the neck or under the skin in the forearm. Reimplantation is done to prevent hypoparathyroidism Hypoparathyroidism Hypoparathyroidism is a deficiency of parathyroid hormone (PTH) often caused by an autoimmune disorder, treatment-related damage to the parathyroid glands, or removal of the glands during surgery... read more , a deficiency of PTH. Occasionally, parathyroid tissue is set aside and frozen (called cryopreservation) to allow for later transplantation in the same person in case persistent hypoparathyroidism develops.

When hyperparathyroidism has been mild, blood calcium levels drop to just below normal within 24 to 48 hours after surgery. In moderate and severe hyperparathyroidism, calcium levels must be monitored closely for the first several days after surgery to make sure calcium does not go too low.

Hyperparathyroidism in people with kidney failure Overview of Kidney Failure Kidney failure is the inability of the kidneys to adequately filter metabolic waste products from the blood. Kidney failure has many possible causes. Some lead to a rapid decline in kidney function... read more is due to a complex set of problems involving vitamin D, calcium, phosphate, and parathyroid hormone. Treatment is with active forms of vitamin D, restriction of phosphate in the diet, and the use of oral phosphate binders (medications that reduce the absorption of phosphate from food) and medications that lower PTH and calcium levels, such as cinacalcet or etelcalcetide.

Hyperphosphatemia (excess phosphate in the blood) should be prevented or treated if present in people with kidney failure. Doctors restrict the amount of phosphate in the person's diet and prescribe phosphate-binding agents, such as calcium carbonate, calcium acetate, lanthanum, or sevelamer to be take with each meal. Both approaches are usually needed, especially in patients with kidney failure who are on dialysis.

People with kidney failure frequently need vitamin D supplements to improve calcium absorption, but the improved calcium absorption can increase phosphate absorption too and contribute to hyperparathyroidism. People with advanced kidney disease, especially those with kidney failure, require close monitoring of their calcium and phosphate levels and frequent adjustment of the dosages of the medications they are taking.

Doctors can also give cinacalcet or etelcalcetide to people receiving dialysis to decrease the level of PTH when vitamin D, phosphate restriction, or phosphate binders are ineffective or unable to be used safely.