How is hyperparathyroidism diagnosed?

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Dr. Jack Merendino, MD
Endocrinology Diabetes & Metabolism
Diagnosing hyperparathyroidism is usually straightforward, but there are exceptions. If one has an elevated parathyroid hormone level in the blood, then one has hyperparathyroidism, but that isn’t the end of the story.

The most common form of hyperparathyroidism is what we term “primary” hyperparathyroidism. In this case one or more of the parathyroid glands is enlarged and overactive and this, in turn, leads to a high blood calcium. Usually there is a single benign tumor which we call an adenoma. In other settings all four of the parathyroid glands have grown and are somewhat overactive. We refer to this as hyperplasia. In either case, the problems results from the high parathyroid hormone (PTH) level leading to an elevated blood calcium level. People with primary hyperparathyroidism have a tendency to kidney stones, certain kinds of osteoporosis, muscle and joint aches and pains and neurological or psychiatric symptoms. In some cases a patient with primary hyperparathyroidism will have a PTH level that is normal but a very high blood calcium level. In this case the “normal” PTH level is actually abnormal because a normally functioning parathyroid would shut off parathyroid hormone production in the setting of a high calcium. So the “normal” level is actually elevated relative to the calcium. Primary hyperparathyroidism can be monitored if it is mild and asymptomatic. With higher blood calcium levels or symptoms, surgery is the best treatment. There are medications for people who cannot undergo surgery.

Secondary hyperparathyroidism is a situation where the “abnormal” high PTH level is actually normal. In these cases the blood calcium is low for some reason -- most commonly kidney disease or a very low vitamin D. PTH levels go up in an effort to raise the blood calcium. Treatment here does not involve lowering the PTH. Instead, one treats the low calcium, often with some form of vitamin D replacement. The PTH level then falls into the normal range.

The term “tertiary” hyperparathyroidism is applied to individuals who have had secondary hyperparathyroidism for such a long time that the parathyroid glands have become enlarged and overactive. Most of these individuals have longstanding kidney failure and are on dialysis. These people need care by doctors with special expertise in this condition.

Adenoma or Carcinoma of parathyroid gland releases high levels of parathyroid hormone (PTH). Through PTH’s action in the bones, the intestines, the kidney, there is an increase in the level of calcium in the body. So the blood is examined for both PTH level and calcium level. Elevated levels of calcium and PTH in the absence of secondary causes such as renal failure are diagnostic of the disease.

For additional information, please refer to www.endocrine diseases.org:  

Parathyroid gland

Joane Goodroe
Nursing
Dr. James Norman of the Norman Parathyroid Clinic states: 

A blood calcium level that is too HIGH, and is associated with a HIGH parathyroid hormone level MUST be due to a tumor in the parathyroid gland. That is, the high blood calcium is a result of the excess parathyroid hormone (PTH). It is the parathyroid gland that is the problem.
IMPORTANT:  20% of patients will have parathyroid disease when they have high calcium and NORMAL PTH levels... 
Some patients will have a normal calcium level but an elevated parathyroid level. It is very important that the symptoms of these patients be used as part of the diagnosis of hyperparathyroidism. 

Parathyroid scans often DO NOT show tumors that are present. This can lead to the misdiagnosis of a patient who actually has a tumor(s) but the scan does not show it. 

Continue Learning about Endocrine System

Endocrine System

Your endocrine system works with your nervous system to control important bodily functions. The endocrine systems responsibilities include regulating growth, sexual development and function, metabolism and mood. The endocrine syst...

em also helps give your body the energy it needs to function properly. Endocrine glands secrete hormones into the bloodstream. Hormones are considered chemical messengers, coordinating your body by transferring information from one set of cells to another. Your endocrine system health can be affected by hormone imbalances resulting from impaired glands. A hormone imbalance can cause problems with bodily growth, sexual development, metabolism and other bodily functions. Endocrine system diseases or conditions include diabetes, growth disorders and osteoporosis.
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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.