Parathyroid hyperfunction - causes, symptoms and treatment

Hyperparathyroidism - parathyroid dysfunction

Hyperparathyroidism is an overfunction of the parathyroid gland (hyperparathyroidism), which is associated with increased formation and secretion of the parathyroid hormone and thus with changes in the calcium and phosphate levels in the blood. The more common hormone disorder in women can occur in different variants. The spectrum of possible symptoms is commonly summarized as "stone, leg, and stomach pains." The most common and primary form usually requires surgical removal of the diseased glandular tissue to allow for healing.

contents

• Hyperparathyroidism - parathyroid dysfunction
• A short overview
• definition
• Symptoms: stone, leg, stomach
• causes
• diagnosis
• treatment
• Naturopathy

A short overview

The following overview summarizes the most important facts about the clinical picture of hyperparathyroidism shortly. The following article provides more detailed information.

• definitionThe term hyperparathyroidism refers to a functional disorder and hyperfunction of the parathyroid gland. The hormonal disorder is characterized by an excessive secretion of parathyroid hormone, which affects the levels of calcium and phosphate in the blood. Prolonged disease duration leads to hypercalcaemia (increased calcium levels).
• symptoms: This hormone disorder with different causes are assigned to different symptoms. The first rather uncharacteristic symptoms include loss of appetite, nausea, constipation and general fatigue. Later, a typical symptom combination known as "stone, leg, stomach peek" occurs. The disease may also be asymptomatic at the beginning.
• causes: Most diseases are the primary cause of parathyroid disease, such as a benign or malignant tumor. If the trigger is of a secondary nature, underlying diseases of other organs cause an excessive production of parathyroid hormone. Over a longer period of time, the secondary variant may also result in a combination with the first (tertiary disease form)..
• diagnosis: The most important information provides a blood test. In routine examinations, evidence of high parathyroid hormone levels and other parameters often leads to a random diagnosis. For protection and further clarification, ultrasound examinations and scintigraphy of the parathyroid glands are possible.
• treatment: The most common primary form usually requires surgery to remove diseased glandular tissue to allow for healing. Only in a few cases is a drug treatment in question, but only a limited symptomatic effect.
• NaturopathyBioenergetic diagnostic methods and naturopathic treatment methods, such as electro-acupuncture, can offer an alternative for those affected, especially in the secondary variant with certain regulatory disorders of the vitamin D, calcium and phosphate balance.

Parathyroid hyperfunction is one of the most common hormonal disorders that should be treated for specific causes. (Image: Orawan / fotolia.com)

definition

Hyperparathyroidism (HPT) refers to hyperparathyroidism (Glandula parathyreoideae). The parathyroid gland consists of four hormone-producing glands, the so-called epithelial bodies (upper and lower parathyroid glands), which can be found directly behind the thyroid in the neck area. The primary role of this hormone gland is the formation and release of parathyroid hormone (PTH), which regulates the body's calcium and phosphate levels. The parathyroid hormone increases the calcium level in the blood while lowering the phosphate level. Calcium and phosphate play a vital role in building and reducing bones, keeping these processes in proper balance as long as the parathyroid gland is functioning normally. In addition, vitamin D is significantly involved in the calcium and phosphate balance and thus assumes a central role in the bone care.

In the case of an overfunction, excessive formation of parathyroid hormone occurs, which is released into the bloodstream and causes the calcium content in the blood to rise. Prolonged existence of this condition leads to a so-called hypercalcemia. The increased supply of calcium in the blood is achieved through altered metabolic processes. In bone metabolism, more calcium is released, leading to increased degradation of lime (calcium carbonate) from the bones. It also comes to other metabolic changes such as in the kidneys and in the intestine. The urine excretes more phosphate.

There is a distinction between three different forms. The most common is primary hyperparathyroidism (pHPT), which causes parathyroid disease itself. In diseases of other organs as a cause of disease, it is called secondary hyperparathyroidism (sHPT). The rare third form, tertiary hyperparathyroidism (tHPT), may arise as a result of a persistent secondary variant.

The primary variant of hyperparathyroidism is one of the most common endocrine disorders (hormonal and metabolic diseases). First and foremost is diabetes mellitus, but thyroid hyperfunction and hyperthyroidism (hyperthyroidism and hypothyroidism) are also widespread diseases.

The hormonal imbalance can occur at any age, but most cases are recorded after the age of 45. Women are twice as likely to be affected by men. It is suspected that the increased occurrence of bone loss (osteoporosis) in women after menopause, an increased rate of diagnosis of hitherto unrecognized parathyroid overweight functions possible.

The four epithelial bodies of the parathyroid are located directly behind the thyroid in the neck area. Changes in glandular tissue can cause dysfunction. (Image: Henrie / fotolia.com)

Symptoms: stone, leg, stomach

At the onset of illness usually no complaints occur and also over years the illness can proceed asymptomatisch. Sometimes, however, sufferers report at an early stage of nonspecific symptoms such as:

• high blood pressure,
• anorexia,
• Gastrointestinal complaints, such as nausea and vomiting or constipation,
• chronic fatigue,
• depressions,
• emotional and physical inefficiency.

If the disease is not detected and treated early, an advanced combination of symptoms typically occurs, referred to as "stone, leg, stomach peptic". This describes the following often painful sequelae:

• Steinpein: Kidney stones or gallstones, calcification in muscles, joints, kidneys (diffuse nephrocalcinosis) and pancreas.
• Beinpein: Back pain, body aches, bone pain, bone inflammation, fractures, bone deformities.
• Magenpein: Stomach ulcers.

The reason for these complaints is the excess of calcium in the blood. This caused deposits and calcifications (Steinpein) can affect the kidney and lead to chronic renal hypofunction. In addition, the body is caused to frequent urination and there is an increased feeling of thirst. This can lead to a heavy fluid loss. Stones in the pancreas may also lead to pancreatitis (pancreatitis) in the further course.

Due to the excess of parathyroid hormone, calcium is released from the bones and bone is broken down (leg pee). The consequent calcium deficiency in the bones can lead to osteoporosis, bone cysts or extremely rarely to bone tumors, such as an osteoclastoma (giant cell tumor).

Among the various symptoms, the formation of kidney stones may be a possible result of hyperparathyroidism. (Image: Henrie / fotolia.com)

Among other things, it is believed that the increased calcium content leads to increased acid production in the stomach, which promotes the formation of gastric ulcers (stomach pee). There may also be weight loss and anorexia associated with hypercalcemia syndrome.

Patients with secondary or tertiary hyperparathyroidism may experience the same symptoms as the most common first variant. The exact symptoms, however, depend on the underlying condition.

causes

The causes of hyperparathyroidism and concomitant parathyroid overproduction may be primary or secondary. In most cases, these are primary causes that exclusively relate to parathyroid function disorders (pHPT). Diseases such as a benign hormone-producing tumor (adenoma), an enlargement and functional overproduction of the parathyroid gland (hyperplasia) and very rarely a malignant carcinoma (parathyroid cancer) come into question. Mostly only one epithelial body is affected. The unregulated or autonomous (independent) overproduction of the parathyroid hormone is followed by hypercalcaemia.

Very rarely, the hereditary disease of multiple endocrine neoplasia type 1 (MEN1 syndrome) is identified as the cause. In this disease occur simultaneously several tumors of hormone-producing organs, as well as non-endocrine tumors (for example, lipomas). The parathyroid glands are most commonly affected and over 90 percent of those with MEN1 develop hyperfunction. Typically, at least two organs are affected, often still the pancreas and the gut or the pituitary gland (pituitary) get sick. Hypercalcaemia and hyperparathyroidism may also occur in multiple endocrine neoplasia type 2 (MEN2 syndrome).

The catalyst for calcium and phosgenergic dysfunction and other consequences of hyperparathyroidism is over-secreted parathyroid hormone. (Image: Kateryna_Kon / fotolia.com)

Secondary causes (sHPT) include underlying diseases of other organs which, as a downstream consequence, trigger an excessive production of parathyroid hormone. The most common secondary cause is chronic kidney disease or renal insufficiency.

But also inflammatory bowel disease or cirrhosis of the liver may be causative in this context. For various reasons (increased calcium loss, lack of calcium and vitamin D intake), these diseases cause calcium deficiency in the blood (hypocalcaemia) and, in the further course, also phosphate deficiency and vitamin D deficiency or vitamin D utilization disorders. This in turn stimulates parathyroid hormone production and hyperplasia occurs, affecting all four epithelial bodies.

Very rarely, these Unterversorgungen and deficiency symptoms occur due to improper diet.

If there is a secondary hyperfunction over a very long period, it can also come in addition to an adenoma equal to the primary form. This combination of causes is then the tertiary form of the disease.

diagnosis

It is not uncommon for the condition to be suspected or suspected during a routine check-up. The blood values ​​in the primary variant typically show an elevated calcium level (serum calcium level), a decreased phosphate level and a high parathyroid hormone level. On the other hand, if the calcium level is low, with a high level of parathyroid hormone detection, these laboratory values ​​provide an indication of the presence of the secondary variant.

If there is a suspicion of hyperparathyroidism, specialist care especially for endocrinology is advisable. In this context, then carried out a further clarification and accurate diagnosis. This includes, among other things, a determination of the urinary calcium over 24 hours. An ultrasound examination (sonography) and scintigraphy of the parathyroid gland are used to detect possible pathological tissue changes.

In addition to blood values, imaging techniques such as ultrasound and scintigraphy provide important information for diagnosis. (Image: Africa Studio / fotolia.com)

With the help of thyroid scintigraphy, normal areas can be distinguished from those with a reduced or increased metabolic activity. In this study, it is possible to differentiate benign tumors (so-called "hot knots") from cancers. In some cases, there are also other imaging techniques such as magnetic resonance imaging or computed tomography. The latter are mainly used when the cause of other organs is suspected.

To further clarify whether it is a secondary form, the renal function (determination of serum creatinine) and the vitamin D supply in the body (vitamin D metabolites, 25-OH cholecalciferol) is checked. Other blood levels can extend general laboratory diagnostics, such as alkaline phosphatase.

treatment

In general, the therapy is based on the present form of hyperparathyroidism and the respective cause. The general goal is to return the calcium level to a normal level. The secondary variant focuses on measures to treat the underlying disease. Even the rare multiple endocrine neoplasia requires a special therapy concept.

The treatment and cure of a primary and tertiary disease usually requires an operative procedure, in which the affected tissue of the parathyroid gland is removed. Medicines are used in this condition only under certain conditions, but in principle do not lead to a cure.

Surgical therapy

If only one of the four parathyroid glands is affected, the adenoma is removed by means of a minimally invasive procedure. The remaining healthy glands in the body take over the entire function after a short time, so that usually no further sequelae are expected.

If all four glands are affected it is a major intervention and skin incision in the neck area. In principle, all epithelial bodies would have to be removed. Due to a lack of hormone replacement therapy, however, this would lead to a permanent lack of parathyroid hormone and calcium in the blood. In order to avoid this, an attempt is made to obtain sufficiently healthy parathyroid tissue.

There are two surgical methods: incomplete removal of the parathyroid glands (subtotal parathyroidectomy or 3 1/2 resection) and complete removal (total parathyroidectomy) with autotransplantation of parathyroid fragments, for example, into the muscles of one arm. The remaining parts of the parathyroid gland (also elsewhere in the body) can take over the entire function of hormone production after a certain time.

Often, surgery is the only treatment option. If all four glands are affected, an incision in the neck, as known from thyroid surgery, must be performed. (Image: tolikoff2013 / fotolia.com)

drugs

Medicinal it is possible by means of the drug Cinacalcet to increase the sensitivity of the calcium receptor and thus to effect a reduced release of the parathyroid hormone. However, this drug should only be given under the control of the calcium and parathyroid hormone levels. This is a symptomatic treatment and usually surgery is preferred.

If the parathyroid function could not be maintained after an operation, it leads to hypofunction (hypoparathyroidism) and to a calcium deficiency. In this case, the calcium level must be regulated by medication. This is the calcium supplement in combination with vitamin D supplements. However, a lack of parathyroid hormone impedes the production of the metabolically active vitamin D form.

If there is a so-called hypercalcemic crisis in the course of the disease, there is a life-threatening medical emergency, which leads to death in about half of all those affected. Because of this, emergency measures are necessary, which also require the administration of drugs such as bisphosphonates (pamidronate, neridronate) and calcitonin.

Naturopathy

With regard to secondary over-functioning, naturopathic diagnosis and treatment may provide an alternative option for those affected. Clinically not immediately apparent relationships of regulatory disorders of the vitamin D, calcium and phosphate balance can be determined using bioenergetic diagnostic procedures from natural medicine and alternative medicine. In addition, there are numerous natural remedies that can effectively compensate for such fine (also energetic) regulatory and functional disorders. In this context, the methods of electroacupuncture, biofunction diagnostics, vegatest and kinesiology should be mentioned.

If other treatment options are excluded, an alternative therapy is used to relieve the symptoms. This consists primarily of taking a lot of fluid, low in calcium and nourish the phosphate rich and possibly take under medical supervision vitamin D and phosphate tablets. (jvs, cs; Updated on 17.12.2018)

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Hyperthyroidism
Hypothyroidism
Swollen thyroid gland