Hyperparathyroidism is an endocrine disorder in which the parathyroid glands in the neck produce too much parathyroid hormone (PTH). The condition most often affects the bones and kidneys, although it also may play a part in other health problems. Learn more about symptoms, causes and how to avoid complications.
Calcification in the brain due to hyperparathyroidism (Phar's syndrome)
Image by James Heilman, MD
About
Hyperparathyroidism
Image by Scientific Animations, Inc.
Hyperparathyroidism
Image by Scientific Animations, Inc.
What Is Primary Hyperparathyroidism?
Primary hyperparathyroidism is a disorder of the parathyroid glands, four pea-sized glands located on or near the thyroid gland in the neck. “Primary” means this disorder begins in the parathyroid glands, rather than resulting from another health problem such as kidney failure. In primary hyperparathyroidism, one or more of the parathyroid glands is overactive. As a result, the gland makes too much parathyroid hormone (PTH).
Too much PTH causes calcium levels in your blood to rise too high, which can lead to health problems such as bone thinning and kidney stones. Doctors usually catch primary hyperparathyroidism early through routine blood tests, before serious problems occur.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (15)
pepper and salt appearance in the skull X-ray of patient with Hyperparathyroidism
pepper and salt appearance in the skull X-ray of patient with Hyperparathyroidism
Image by haitham alfalah/Wikimedia
What is Hyperparathyroidism? The Basic Video.
Video by Norman Parathyroid Center/YouTube
Diagnosing Hyperparathyroidism
Video by UW Health/YouTube
Overview of Parathyroid Disease (Causes, Symptoms and Treatment for Hyperparathyroidism)
Video by LarianMD/YouTube
Treating hyperparathyroidism in patients with chronic kidney disease
Video by Mayo Clinic/YouTube
How is hyperparathyroidism treated? (Dr Mark Vanderpump)
Video by Top Doctors UK/YouTube
Bone Health and Hyperparathyroidism | Michael Yeh, MD and Masha Livhits, MD | UCLAMDChat
Video by UCLA Health/YouTube
Understanding Hyperparathyroidism
Video by Zero To Finals/YouTube
Primary Hyperparathyroidism: A Discussion with Tina W. F. Yen, MD, MS
Video by Medical College of Wisconsin/YouTube
Diagnosis of primary hyperparathyroidism
Video by UW Health/YouTube
What is hyperparathyroidism? Causes, diagnosis, and treatment explained
Video by Top Doctors UK/YouTube
What are the symptoms of hyperparathyroidism? (Dr Mark Vanderpump)
Video by Top Doctors UK/YouTube
Treatment Options for Primary Hyperparathyroidism
Video by UW Health/YouTube
Parathyroid Glands and Hyperparathyroidism: Amazing Animation.
Video by Norman Parathyroid Center/YouTube
Hypoparathyroidism vs Hyperparathyroidism | Hyperparathyroidism and Hypoparathyroidism Nursing NCLEX
Video by RegisteredNurseRN/YouTube
pepper and salt appearance in the skull X-ray of patient with Hyperparathyroidism
haitham alfalah/Wikimedia
5:44
What is Hyperparathyroidism? The Basic Video.
Norman Parathyroid Center/YouTube
1:04
Diagnosing Hyperparathyroidism
UW Health/YouTube
4:57
Overview of Parathyroid Disease (Causes, Symptoms and Treatment for Hyperparathyroidism)
LarianMD/YouTube
4:21
Treating hyperparathyroidism in patients with chronic kidney disease
Mayo Clinic/YouTube
1:40
How is hyperparathyroidism treated? (Dr Mark Vanderpump)
Top Doctors UK/YouTube
44:50
Bone Health and Hyperparathyroidism | Michael Yeh, MD and Masha Livhits, MD | UCLAMDChat
UCLA Health/YouTube
6:53
Understanding Hyperparathyroidism
Zero To Finals/YouTube
9:16
Primary Hyperparathyroidism: A Discussion with Tina W. F. Yen, MD, MS
Medical College of Wisconsin/YouTube
1:26
Diagnosis of primary hyperparathyroidism
UW Health/YouTube
5:02
What is hyperparathyroidism? Causes, diagnosis, and treatment explained
Top Doctors UK/YouTube
1:21
What are the symptoms of hyperparathyroidism? (Dr Mark Vanderpump)
Top Doctors UK/YouTube
1:04
Treatment Options for Primary Hyperparathyroidism
UW Health/YouTube
5:18
Parathyroid Glands and Hyperparathyroidism: Amazing Animation.
Norman Parathyroid Center/YouTube
10:08
Hypoparathyroidism vs Hyperparathyroidism | Hyperparathyroidism and Hypoparathyroidism Nursing NCLEX
RegisteredNurseRN/YouTube
Is It Common?
pepper and salt appearance in the skull X-ray of patient with Hyperparathyroidism
Image by haitham alfalah/Wikimedia
pepper and salt appearance in the skull X-ray of patient with Hyperparathyroidism
pepper and salt appearance in the skull X-ray of patient with Hyperparathyroidism
Image by haitham alfalah/Wikimedia
How Common Is Primary Hyperparathyroidism?
In the United States, about 100,000 people develop primary hyperparathyroidism each year. Primary hyperparathyroidism is one of the most common hormonal disorders.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (1)
What is hyperparathyroidism? Causes, diagnosis, and treatment explained
Video by Top Doctors UK/YouTube
5:02
What is hyperparathyroidism? Causes, diagnosis, and treatment explained
Top Doctors UK/YouTube
What Do the Parathyroid Glands Do?
Parathyroid Gland
Image by BodyParts3D is made by DBCLS
Parathyroid Gland
Image showing thyroid/parathyroid in color against skeleton and various organs.
Image by BodyParts3D is made by DBCLS
What Do the Parathyroid Glands Do?
The parathyroid glands’ only purpose is to make PTH, which helps maintain the right balance of calcium in your body. PTH raises blood calcium levels by
causing bone, where most of your body’s calcium is stored, to release calcium into the blood
helping your intestines absorb calcium from food
helping your kidneys hold on to calcium and return it to your blood instead of flushing it out in urine
When the level of calcium in your blood falls too low, the parathyroid glands release just enough PTH to bring your blood calcium levels back to normal.
You need calcium for good health. This mineral helps build bones and teeth and keep them strong. Calcium also helps your heart, muscles, and nerves work normally.
Although their names are similar, the parathyroid glands and the thyroid gland are not related.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (5)
Thyroid and Parathyroid glands
Diagram showing the position of the thyroid and parathyroid glands
Image by Cancer Research UK uploader
Parathyroid Hormone in Maintaining Blood Calcium Homeostasis
Parathyroid hormone increases blood calcium levels when they drop too low. Conversely, calcitonin, which is released from the thyroid gland, decreases blood calcium levels when they become too high. These two mechanisms constantly maintain blood calcium concentration at homeostasis.
The parathyroid glands are visible as green marks on a human thyroid
Image by Busca tu equilibrio... Yin yang.svg
Parathyroid Gland - Parathyroid Hormone - Explained in 1 Minute
Video by 5MinuteSchool/YouTube
Thyroid and Parathyroid glands
Cancer Research UK uploader
Parathyroid Hormone in Maintaining Blood Calcium Homeostasis
CNX Openstax
Parathyroid Glands
CNX Openstax
Parathyroid
Busca tu equilibrio... Yin yang.svg
1:09
Parathyroid Gland - Parathyroid Hormone - Explained in 1 Minute
5MinuteSchool/YouTube
Causes
Parathyroid adenoma
Image by BruceBlaus
Parathyroid adenoma
Parathyroid Glands and Hyperparathyroidism
Image by BruceBlaus
What Causes Primary Hyperparathyroidism?
In about 8 out of 10 people with primary hyperparathyroidism, a benign, or noncancerous, tumor called an adenoma has formed in one of the parathyroid glands. The tumor causes the gland to become overactive. In most other cases, extra PTH comes from two or more adenomas or from hyperplasia, a condition in which all four parathyroid glands are enlarged. People with rare inherited conditions that affect the parathyroid glands, such as multiple endocrine neoplasia type 1 or familial hypocalciuric hypercalcemia, are more likely to have more than one gland affected.
Rarely, primary hyperparathyroidism is caused by cancer of a parathyroid gland.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (1)
Sensitive content
This media may include sensitive content
Parathyroid Adenoma Gross
The cut surface of a very large (4-centimeter) parathyroid adenoma removed from a woman who had hyperparathyroidism and hypercalcemia. Following surgery, her serum calcium level returned to normal.
Image by Ed Uthman, MD/Wikimedia
Sensitive content
This media may include sensitive content
Parathyroid Adenoma Gross
Ed Uthman, MD/Wikimedia
Risk Factors
Parathyroid diseases and relation between calcium and PTH
Image by Dr.Vijaya chandar, MBBS/Wikimedia
Parathyroid diseases and relation between calcium and PTH
This chart explains the relation between calcium and parathyroid hormone in different diseases.
Image by Dr.Vijaya chandar, MBBS/Wikimedia
Who Is More Likely to Develop Primary Hyperparathyroidism?
Primary hyperparathyroidism most often affects people between age 50 and 60. Women are affected 3 to 4 times more often than men. The disorder was more common in African Americans, followed by Caucasians, in one large study performed in North America.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (1)
Understanding Hyperparathyroidism
Video by Zero To Finals/YouTube
6:53
Understanding Hyperparathyroidism
Zero To Finals/YouTube
Symptoms
Hyperparathyroidism
Image by Frank Gaillard
Hyperparathyroidism
Brown tumours of the hands in a patient with hyperparathyroidism. This is an edited version of the source image made for use in the "Anatomist" iOS and Android app and shared here under the terms of the source image's Share Alike Creative Commons license.
Image by Frank Gaillard
What Are the Symptoms of Primary Hyperparathyroidism?
Most people with primary hyperparathyroidism have no symptoms. When symptoms appear, they’re often mild and similar to those of many other disorders. Symptoms include
muscle weakness
fatigue
depression
aches and pains in bones and joints
People with more severe disease may have
loss of appetite
nausea
vomiting
constipation
confusion
increased thirst and urination
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (1)
What are the symptoms of hyperparathyroidism? (Dr Mark Vanderpump)
Video by Top Doctors UK/YouTube
1:21
What are the symptoms of hyperparathyroidism? (Dr Mark Vanderpump)
Top Doctors UK/YouTube
Diagnosis
Hyperparathyroidism
Image by James Heilman, MD
Hyperparathyroidism
Calcification in the brain due to hyperparathyroidism (Phar's syndrome)
Image by James Heilman, MD
How Do Doctors Diagnose Primary Hyperparathyroidism?
Doctors diagnose primary hyperparathyroidism when a blood test shows high blood calcium and PTH levels. Sometimes PTH levels are in the upper portion of the normal range, when they should drop to low-normal or below normal in response to high calcium levels. Other conditions can cause high calcium, but elevated PTH is the only source in primary hyperparathyroidism.
Routine blood tests can detect high blood calcium levels. High blood calcium may cause health care professionals to suspect hyperparathyroidism, even before symptoms appear.
Sometimes PTH levels are high but calcium levels are not. Doctors don’t routinely test for PTH but may do so if you have osteoporosis or another disorder that affects bone strength. In some cases, this may be the first phase of primary hyperparathyroidism, before calcium levels start to rise.
Once doctors diagnose hyperparathyroidism, a 24-hour urine collection can help find the cause. This test measures certain chemicals, such as calcium and creatinine, a waste product that healthy kidneys remove. You will collect your urine over a 24-hour period and your health care professional will send it to a lab for analysis. Results of the test may help tell primary hyperparathyroidism from hyperparathyroidism caused by a kidney disorder. The test can also rule out familial hypocalciuric hypercalcemia, a rare genetic disorder, as a cause.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (4)
Diagnosing parathyroid cancer
A nuclear medicine parathyroid scan demonstrates a parathyroid adenoma adjacent to the left inferior pole of the thyroid gland. The above study was performed with Technetium-Sestamibi (1st column) and Iodine-123 (2nd column) simultaneous imaging and the subtraction technique (3rd column).
Image by Myohan at en.wikipedia
General Information About Parathyroid Cancer
Ultrasound of right lower lobe parathyroid adenoma measuring 17*12mm in a dialysis patient, 50M
Image by Copyright: Nevit Dilmen
Diagnosing Hyperparathyroidism
Video by UW Health/YouTube
Diagnosis of primary hyperparathyroidism
Video by UW Health/YouTube
Diagnosing parathyroid cancer
Myohan at en.wikipedia
General Information About Parathyroid Cancer
Copyright: Nevit Dilmen
1:04
Diagnosing Hyperparathyroidism
UW Health/YouTube
1:26
Diagnosis of primary hyperparathyroidism
UW Health/YouTube
Vitamin D Test
Vitamin D Test
Also called: 25-hydroxyvitamin D, 25(OH)D, Cholecalciferol Test, Ergocalciferol Test, Calcidiol Test, Vitamin D2 Test, Vitamin D3 Test
Vitamin D is an essential nutrient necessary to maintain healthy bones and for tissues to grow properly. It can be found in several foods and through sun exposure. Low vitamin D levels are associated with brittle bones and fractures.
Vitamin D Test
Also called: 25-hydroxyvitamin D, 25(OH)D, Cholecalciferol Test, Ergocalciferol Test, Calcidiol Test, Vitamin D2 Test, Vitamin D3 Test
Vitamin D is an essential nutrient necessary to maintain healthy bones and for tissues to grow properly. It can be found in several foods and through sun exposure. Low vitamin D levels are associated with brittle bones and fractures.
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Use the slider below to see how your results affect your
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Your result is Normal.
Measuring 25(OH)D blood levels is the recommended test for monitoring vitamin D levels for deficiency.
Related conditions
A vitamin D test measures the level of vitamin D in your blood to make sure you have enough for your body to work well. Vitamin D is essential for healthy bones and teeth. It also helps keep your muscles, nerves, and immune system working normally.
Having low levels of vitamin D is a common problem that can lead to bone disorders and other medical problems. Vitamin D testing can let you know if you need to increase your vitamin D levels.
You get vitamin D in three ways:
Your body makes vitamin D when your bare skin is exposed to sunlight.
You get vitamin D from certain foods. Only a few foods, such as egg yolks and fatty fish, naturally contain vitamin D. That's why vitamin D is added to foods, including breakfast cereals, milk, and other dairy items.
You can take vitamin D supplements.
Before your body can use vitamin D, your liver must change it into another form called 25 hydroxyvitamin D, or 25(OH)D. Most vitamin D blood tests measure the level of 25(OH)D in your blood.
Your kidneys use 25(OH)D to make "active vitamin D." Active vitamin D lets your body use calcium to build bone and helps other cells work properly. If you have kidney problems or abnormal calcium levels in your blood, your health care provider may order a test of active vitamin D. But this test is not generally used to check whether you have enough vitamin D.
Testing 25(OH)D is the most accurate way to measure how much vitamin D is in your blood.
A vitamin D test is used to screen for low levels of vitamin D in your blood so you can treat it with supplements before it causes health problems.
If you have a known bone disorder or a problem absorbing calcium, a vitamin D test may be used to see if a lack of vitamin D is causing your condition. Your provider may order a Vitamin D test if you have:
Osteomalacia, soft bones, often with muscle weakness
Low bone density, which can lead to osteoporosis.
Rickets, a problem with bone growth in children
Because vitamin D can affect many parts of your body, you may have your vitamin D level checked if you have other chronic (long-term) medical conditions. Ask your provider if you should be tested.
Your provider may order a vitamin D test if you have signs or symptoms of a bone condition that may be related to a vitamin D deficiency (very low levels of vitamin D), such as:
Bone pain
Muscle weakness or aches
Soft bones
Deformed bones
Weak bones and fractures (broken bones)
Low bone density (osteoporosis or osteopenia)
A vitamin D insufficiency (mildly low levels of vitamin D) usually doesn't cause symptoms. So, your provider may order a test if you have a high risk for developing a deficiency because you:
Are older than 65. As you age, your skin is less able to make vitamin D from sunlight.
Rarely expose your skin to sunshine because you stay indoors, cover up outside, use sunscreen, or live where there is little sunlight
Have dark skin, which makes less vitamin D from sunlight
Have had weight loss surgery
Have obesity
Have a condition that makes it difficult to absorb nutrients in food, such as Crohn's disease, ulcerative colitis, and celiac disease
Have kidney or liver disease that affects your ability to change vitamin D into a form your body can use
Take certain medicines that affect your vitamin D levels
A lack of vitamin D can cause serious problems for babies and children. A provider may order a screening test for:
Babies that are mainly fed breastmilk. Breastmilk is low in vitamin D (All babies need vitamin D supplements shortly after birth, unless they are fed only formula, which contains vitamin D.)
Children with darker skin who live in areas with little sunlight
Children with diets low in vitamin D
If you are taking vitamin D supplements to increase your vitamin D level, your provider may order a test to see if your vitamin D levels are improving.
A vitamin D test is a blood test. During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
You don't need any special preparations for a vitamin D test.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
Your test results may be reported in different ways. It may give you a total vitamin D result, or it may include separate results for vitamin D2 and vitamin D3. These two types of vitamin D work about the same in your body. Your total vitamin D level is the sum of these two types. The total vitamin D number is the important number.
If your total vitamin D level shows a vitamin D deficiency or insufficiency, it may mean you:
Don't get enough vitamin D from your diet and/or exposure to sunlight
Have trouble absorbing vitamin D in your food, which may be a sign of a malabsorption disorder
Have trouble changing vitamin D into a form your body can use, which may be a sign of kidney or liver disease
The treatment for low vitamin D levels is usually supplements and/or dietary changes. This is usually safer than getting more sun, which may cause skin cancer.
If your total vitamin D level shows you have too much vitamin D, it is most likely from getting too much from supplements. This is very uncommon, but if it happens, you'll need to stop taking these supplements to reduce your vitamin D levels. Too much vitamin D can cause serious damage to your organs and blood vessels. If you take vitamin D supplements, ask your provider what dose is right for you.
To learn what your vitamin D test results mean, talk with your provider.
Be sure to tell your provider about medicines, vitamins, or supplements you are taking, because they can affect your test results.
Vitamin D Test: MedlinePlus Medical Test [accessed on Dec 26, 2023]
25-hydroxy vitamin D test: MedlinePlus Medical Encyclopedia [accessed on Dec 26, 2023]
Vitamin D Test - Testing.com. Dec 14, 2023 [accessed on Dec 26, 2023]
Additional Materials (13)
Vitamin D (D3, Cholecalciferol) Molecule
Vitamin D, or calciferol, is a fat-soluble vitamin available in a few foods, though most of the vitamin in American diets is derived from fortified foods. Vitamin D is commonly referred to as \"the sunshine vitamin\" because the body can synthesize Vitamin D when skin is exposed to sunlight. The type of Vitamin D synthesized from the sun's ultraviolet rays is Vitamin D3, or cholecalciferol. Vitamin D2, or ergocalciferol, originates in plants. Once in the system, both types are converted by the liver and kidneys into an active form which is involved in strengthening bones and other critical functions. Few foods naturally contain much Vitamin D; most of the nutrient comes from fortified foods and exposure to sunlight. In this model, carbon atoms are dark gray, hydrogen atoms are white, and oxygen atoms are red.
Image by TheVisualMD
Vitamin D, Sunshine
Vitamin D is produced by skin cells in the presence of sunlight. The skin's ability to produce the vitamin, however, declines with age; sunscreen also interferes with synthesis of the vitamin. General guidelines are difficult to determine, but some researchers suggest that 5-30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen is usually sufficient. Public health experts also caution that with rates of deadly skin cancers soaring in recent decades, getting vitamin D from fortified foods or supplements is a safer alternative.
Image by TheVisualMD
UV Exposure versus Burden of Disease Chart
This simplified graph plots UV exposure for optimal Vitamin D synthesis against commensurate risks (cancer or eye disease). Vitamin D is called the \"sunshine vitamin\" because the body synthesizes its own Vitamin D when skin is exposed to sunlight. Small amounts are available in a handful of natural foods, though most of the Vitamin D in American diets comes from fortified foods. The type of Vitamin D synthesized from the sun's ultraviolet rays is Vitamin D3, or cholecalciferol. Vitamin D2, or ergocalciferol, originates in plants. Once in the system, both are converted by the liver and kidneys into an active form, 1,25-dihydroxyvitamin D, which is involved in several essential functions. Health authorities scratch their heads over sunlight recommendations since UV exposure is the leading cause of skin cancer. Once you sort out the mixed messages, the upshot is that a little UV exposure without protection - about two half-hour periods in mild sun per week - is probably adequate, with Vitamin D supplies to be topped off by fortified foods. The amount of D that you derive from sunlight should be qualified by what you know about your own susceptibility to skin cancer, paying attention to risk factors such as skin type, geographical location, and family history.
Image by TheVisualMD
Vitamin D: Let the Sun Shine In
A study released in March, 2011, by the CDC indicated that about a quarter of the U.S. population is low on Vitamin D, and about 8% at risk for a full-blown deficiency. Around the world, surveys have found that between 40% and 90% of people have less-than-optimal levels, and that includes those living in sunny climates. Vitamin D deficiency can be asymptomatic, and the only way to know for sure whether your levels are low is to have a blood test. Those most likely to need Vitamin D supplements include seniors, breastfed infants, people with dark skin, and people with certain conditions including liver diseases, cystic fibrosis, and Crohn`s disease. People who are obese or have had gastric bypass surgery may also need a boost.
Image by TheVisualMD
This browser does not support the video element.
Vitamin D and Baselining Your Health
Vitamin D has long been linked to bone health; when researchers discovered that rickets was caused by a deficiency of the vitamin, public health experts urged the fortification of this staple with vitamin D, which made milk, already naturally rich in calcium, virtually synonymous with bone health. More recently, however, researchers are finding more evidence that vitamin D is a critical nutrient; it is also essential for muscle, nerve and immune system function and may play roles in cancer, dementia and depression. Vitamin D is also produced by skin cells, in the presence of sunlight, though our ability to manufacture the vitamin declines with age. Different forms of vitamin D can be measured in the blood (including active versions and inactive precursors); testing is likely to increase as research reveals the importance of the vitamin to overall health.
Video by TheVisualMD
This browser does not support the video element.
Vitamin D
A study released in March, 2011, by the CDC indicated that about a quarter of the U.S. population is low on Vitamin D, and about 8% at risk for a full-blown deficiency. Around the world, surveys have found that between 40% and 90% of people have less-than-optimal levels, and that includes those living in sunny climates. Learn why this vitamin is unique and important and how much you need daily to avoid deficiency.
Video by TheVisualMD
This browser does not support the video element.
Dr. Mark Liponis, MD on vitamin D
Dr. Mark Liponis, MD on vitamin D
Video by TheVisualMD
Vitamins D2 and D3, How Do They Differ?
Video by EmpowHER/YouTube
Healthy Bone and Calcium Deficient Bone Comparison
Our bones not only bear the body's weight and make possible a remarkable range of flexible movement, they also store minerals, protect internal organs, and, in their spongy interiors (marrow), produce blood cells. Bones also perform their own maintenance. Throughout a person's lifetime, old bone is constantly being broken down and replaced with new bone, at a rate of about 10% a year. From infancy through young adulthood, new bone is added faster than old bone is removed. Bone mass peaks between the ages of 25 and 30 years; after that, bone loss outpaces bone formation. Vitamin D plays a critical role in bone health by regulating the absorption of calcium, phosphorus, and magnesium. A deficiency of vitamin D can result in soft, malformed bones in children (rickets) or weak bones easily fractured in adults (osteomalacia). Osteopenia is a condition in which bones lose minerals and mass; if the loss of bone mass continues, osteopenia leads to osteroporosis. Women are significantly more likely than men to develop osteoporosis because of hormonal changes at menopause that hasten bone mineral loss.
Image by TheVisualMD
Woman with visible anatomy sunbathing
Vitamin D plays a critical role in bone health by regulating the absorption of minerals, and is also essential for muscle, nerve and immune system function. Because few foods are naturally rich in vitamin D (oily fish are the exception), vitamin D is added to milk and cereals. Vitamin D is also produced by skin cells in the presence of sunlight. Our body's ability to produce the vitamin declines, however, with age. Sunscreen also reduces the skin's ability to absorb vitamin D, but with melanoma rates in young adults soaring, getting vitamin D from fortified foods or supplements is a safer alternative.
Image by TheVisualMD
Vitamin D
Illustration of the Synthesis of Vitamin D
Image by OpenStax College
Rickets
Widening of wrist
Image by Original uploader was DRPEDS at en.wikipedia
Shedding light on vitamin D
Air Force Senior Airman Michael Cossaboom pretends to eat the sun. Unlike other nutrients, vitamin D occurs naturally in very few foods, so it can be difficult to get enough through your diet. Vitamin D is an essential nutrient that your body produces when your skin is exposed to sunlight, but there are ways to get it from foods too.
Image by U.S. Air Force photo by Senior Airman Jensen Stidham
Vitamin D (D3, Cholecalciferol) Molecule
TheVisualMD
Vitamin D, Sunshine
TheVisualMD
UV Exposure versus Burden of Disease Chart
TheVisualMD
Vitamin D: Let the Sun Shine In
TheVisualMD
1:06
Vitamin D and Baselining Your Health
TheVisualMD
1:19
Vitamin D
TheVisualMD
0:21
Dr. Mark Liponis, MD on vitamin D
TheVisualMD
0:50
Vitamins D2 and D3, How Do They Differ?
EmpowHER/YouTube
Healthy Bone and Calcium Deficient Bone Comparison
TheVisualMD
Woman with visible anatomy sunbathing
TheVisualMD
Vitamin D
OpenStax College
Rickets
Original uploader was DRPEDS at en.wikipedia
Shedding light on vitamin D
U.S. Air Force photo by Senior Airman Jensen Stidham
Screening for Complications
Parathyroid Disorders
Image by Busca tu equilibrio... Yin yang.svg
Parathyroid Disorders
The parathyroid glands are visible as green marks on a human thyroid
Image by Busca tu equilibrio... Yin yang.svg
What Tests Do Doctors Use to Look for Complications of Primary Hyperparathyroidism?
Once doctors diagnose primary hyperparathyroidism, they may use other tests to look for bone weakness, kidney problems, and low levels of vitamin D.
Bone mineral density test
Dual energy x-ray absorptiometry, also called a DXA or DEXA scan, uses low-dose x-rays to measure bone density. During the test, you will lie on a padded table while a technician moves the scanner over your body. A bone expert or radiologist will read the scan.
Kidney imaging tests
Doctors may use one of the following imaging tests to look for kidney stones.
Ultrasound. Ultrasound uses a device called a transducer that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician does the procedure. A radiologist reads the images, which can show kidney stones.
Abdominal x-ray. An abdominal x-ray is a picture of the abdomen that uses low levels of radiation and is recorded on film or on a computer. During an abdominal x-ray, you lie on a table or stand up. A technician positions the x-ray machine close to your abdomen and asks you to hold your breath so the picture won’t be blurry. A radiologist reads the x-ray, which can show the location of kidney stones in the urinary tract. Not all stones are visible on an abdominal x-ray.
Computed tomography (CT) scans. CT scans use a combination of x-rays and computer technology to create images of your urinary tract. CT scans sometimes use a contrast medium—a dye or other substance that makes structures inside your body easier to see. Contrast medium isn’t usually needed to see kidney stones. For the scan, you’ll lie on a table that slides into a tunnel-shaped machine that takes the x-rays. A radiologist reads the images, which can show the size and location of a kidney stone.
Vitamin D blood test
Health care professionals test for vitamin D levels because low levels are common in people with primary hyperparathyroidism. In patients with primary hyperparathyroidism, the low vitamin D level can further stimulate the parathyroid glands to make even more parathyroid hormone. Also, a very low vitamin D level may cause a secondary form of hyperparathyroidism, which resolves when vitamin D levels are returned to normal.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (1)
Primary Hyperparathyroidism: A Discussion with Tina W. F. Yen, MD, MS
Video by Medical College of Wisconsin/YouTube
9:16
Primary Hyperparathyroidism: A Discussion with Tina W. F. Yen, MD, MS
Medical College of Wisconsin/YouTube
Treatment
Parathyroidectomy
Image by Manitoba Coupon Maven - Michelle Roy
Parathyroidectomy
Parathyroidectomy Scar 11 days post operation
Image by Manitoba Coupon Maven - Michelle Roy
How Do Doctors Treat Primary Hyperparathyroidism?
Guidelines help doctors to decide whether or not parathyroid surgery should be recommended. You might be a candidate for surgery if you meet any of these guidelines
Blood calcium > 1 mg/dL above normal
Bone density by DXA -2.5 at any site (lumbar spine, hip, or forearm)
History of kidney stones or evidence of kidney stones or calcifications in the kidney by imaging (e.g., X-ray, ultrasound, CT scan). Evidence for stone risk by 24-hour urine with excessive calcium and other stone risk factors.
A fracture resulting from relatively little force, such as a fall from a standing or sitting position (a fragility fracture)
Age 50
Doctors most often recommend parathyroid surgery, particularly if the patient meets one or more of the guidelines noted above. It is also not inappropriate to recommend surgery in those who do not meet guidelines as long as there are no medical contraindications to surgery. In those who do not meet guidelines or do not choose surgery, the doctor will monitor the patient’s condition. If there is evidence for progressive disease (e.g., higher calcium level, lower bone density, a fracture, kidney stone), surgery would be advised. For patients who are not going to have parathyroid surgery, even though guidelines are met, doctors can prescribe medicines to control the high blood calcium or improve the bone density.
Surgery
Surgery to remove the overactive parathyroid gland or glands is the only sure way to cure primary hyperparathyroidism. Doctors recommend surgery for people with clear symptoms or complications of the disease. In people without symptoms, doctors follow the above guidelines to identify who might benefit from parathyroid surgery. Surgery can lead to improved bone density and can lower the chance of forming kidney stones.
When performed by experienced surgeons, surgery almost always cures primary hyperparathyroidism.
Surgeons often use imaging tests before surgery to locate the overactive gland or glands to be removed. The tests used most often are sestamibi, ultrasound, and CT scans. In a sestamibi scan, you will get an injection, or shot, of a small amount of radioactive dye in your vein. The overactive parathyroid gland or glands then absorb the dye. The surgeon can see where the dye has been absorbed by using a special camera.
Surgeons use two main types of operations to remove the overactive gland or glands.
Minimally invasive parathyroidectomy. Also called focused parathyroidectomy, surgeons use this type of surgery when they think only one of the parathyroid glands is overactive. Guided by a tumor-imaging test, your surgeon will make a small incision, or cut, in your neck to remove the gland. The small incision means you will probably have less pain and a faster recovery than people who have more invasive surgery. You can go home the same day. Your doctor may use regional or general anesthesia during the surgery.
Bilateral neck exploration. This type of surgery uses a larger incision that lets the surgeon find and look at all four parathyroid glands and remove the overactive ones. If you have bilateral neck exploration, you will probably have general anesthesia and may need to stay in the hospital overnight.
Parathyroid surgery is safe. Rarely, problems can occur after surgery. In about 1 out of every 100 people, the nerves controlling the vocal cords are damaged during surgery, which most often results in hoarseness. This condition usually gets better on its own.
Low calcium levels in the blood may occur after surgery but usually return to normal in a few days or weeks. On rare occasions, not enough parathyroid tissue is left to make PTH, which can result in hypoparathyroidism.
Monitoring
Some people who have mild primary hyperparathyroidism may not need surgery right away, or even any surgery, and can be safely monitored.
You may want to talk with your doctor about long-term monitoring if you
don’t have symptoms
have only slightly high blood calcium levels
have normal kidneys and bone density
Long-term monitoring should include regular doctor visits, a yearly blood test to measure calcium levels and check your kidney function, and a bone density test every 1 to 2 years.
If you and your doctor choose long-term monitoring, you should
drink plenty of water so you don’t get dehydrated
get regular physical activity to help keep your bones strong
avoid certain diuretics, such as thiazides
Medicines
Cinacalcet is a medicine that decreases the amount of PTH the parathyroid glands make and lowers calcium levels in the blood. Doctors may prescribe cinacalcet to treat very high calcium levels in people with primary hyperparathyroidism who can’t have surgery.
Cinacalcet does not improve bone density. If you have bone loss, your doctor may prescribe alendronate or other medications to help increase bone density.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (1)
Treatment Options for Primary Hyperparathyroidism
Video by UW Health/YouTube
1:04
Treatment Options for Primary Hyperparathyroidism
UW Health/YouTube
Complications
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MEN1 Pedigree
Image by National Cancer Institute / National Cancer Institute
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MEN1 Pedigree
Pedigree showing some of the features of a family with a deleterious MEN1 mutation across four generations, including transmission occurring through paternal lineage. The unaffected male proband is shown as having an affected sister (self-report of neck surgery confirmed upon review of medical records to be hyperparathyroidism diagnosed at age 18 y, parathyroidectomy, and pituitary adenoma), father (self-report of stomach cancer confirmed upon review of medical records to be gastrinoma diagnosed at age 45 y), and paternal grandmother (suspected hyperparathyroidism and/or pancreatic tumor).
MEN1 pedigree. MEN1 can be very difficult to identify in a pedigree. The pedigree on the left was constructed based on self-report, and the pedigree on the right depicts the same family following a review of available medical records. This pedigree shows some of the features of a family with a deleterious MEN1 mutation across four generations, including affected family members with hyperparathyroidism, a pituitary adenoma, gastrinoma, and a suspected pancreatic tumor. The tumors in MEN1 typically occur at an earlier age than their sporadic counterparts. MEN1 families may exhibit some or all o
Image by National Cancer Institute / National Cancer Institute
What Are the Complications of Primary Hyperparathyroidism?
Primary hyperparathyroidism most often affects the bones and kidneys, although it also may play a part in other health problems.
Weakened bones
High PTH levels trigger the bones to release more calcium than normal into the blood. The loss of calcium from the bones may weaken them.
Kidney stones
The small intestine may absorb more calcium from food, adding to high levels of calcium in your blood. Extra calcium that isn’t used by your bones and muscles goes to your kidneys and is flushed out in urine. Too much calcium in your urine can cause kidney stones.
Other complications
High blood calcium levels might play a part in other problems, such as heart disease, high blood pressure, and trouble concentrating. However, more research is needed to better understand how primary hyperparathyroidism affects the heart, blood vessels, and brain.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Additional Materials (1)
MEN2A Pedigree
Pedigree showing some of the classic features of a family with a deleterious RET mutation across four generations, including transmission occurring through paternal lineage. The unaffected female proband is shown as having an affected brother (medullary thyroid cancer diagnosed at age 22 y and hyperparathyroidism diagnosed at age 24 y), father (medullary thyroid cancer diagnosed at age 54 y and pheochromocytoma diagnosed at age 67 y), and paternal aunt (medullary thyroid cancer diagnosed at age 38 y).
MEN2A pedigree. This pedigree shows some of the classic features of a family with a deleterious RET mutation across four generations, including affected family members with medullary thyroid cancer, pheochromocytoma, and hyperparathyroidism. Age at onset can vary widely, even within families. Medullary thyroid cancer can present with earlier onset and more aggressive disease in successive generations, depending on the genotype. MEN2A families may exhibit some or all of these features. As an autosomal dominant syndrome, transmission can occur through maternal or paternal lineages.
Image by National Cancer Institute / National Cancer Institute
MEN2A Pedigree
National Cancer Institute / National Cancer Institute
Diet & Nutrition
Vitamin D calcium tablets
Image by Buntysmum/Pixabay
Vitamin D calcium tablets
Image by Buntysmum/Pixabay
Should I Change My Diet If I Have Primary Hyperparathyroidism?
You don’t need to change your diet or limit the amount of calcium you get from food and beverages. You will need to take a vitamin D supplement if your vitamin D levels are low. Talk with your health care professional about how much vitamin D you should take.
If you lose all your healthy parathyroid tissue and develop lasting low-calcium levels, you’ll need to take both calcium and vitamin D for life.
Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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Hyperparathyroidism
Hyperparathyroidism is an endocrine disorder in which the parathyroid glands in the neck produce too much parathyroid hormone (PTH). The condition most often affects the bones and kidneys, although it also may play a part in other health problems. Learn more about symptoms, causes and how to avoid complications.