Hyperparathyroidism (cont.)
How is hyperparathyroidism diagnosed?
Hyperparathyroidism is diagnosed when tests show that blood levels of calcium and parathyroid hormone are too high. Other diseases can cause high blood calcium levels, but only in hyperparathyroidism is the elevated calcium the result of too much parathyroid hormone. A blood test that accurately measures the amount of parathyroid hormone has simplified the diagnosis of hyperparathyroidism.
Once the diagnosis is established, other tests may be done to assess complications. Because high PTH levels can cause bones to weaken from calcium loss, a measurement of bone density can help assess bone loss and the risk of fractures. Abdominal images may reveal the presence of kidney stones and a 24-hour urine collection may provide information on kidney damage, the risk of stone formation, and the risk of familial hypocalciuric hypercalcemia.
How is hyperparathyroidism treated?
Surgery to remove the enlarged gland (or glands) is the main treatment for the disorder and cures it in 95 percent of operations.
Calcimimetics are a new class of drug that turns off secretion of PTH. They have been approved by the Food and Drug Administration for the treatment of hyperparathyroidism secondary to kidney failure with dialysis, and primary hyperparathyroidism caused by parathyroid cancer. They have not been approved for primary hyperparathyroidism, but some physicians have begun prescribing calcimimetics for some patients with this condition. Patients can discuss this class of drug in more detail with their physicians.
Some patients who have mild disease may not need immediate treatment, according to panels convened by the National Institutes of Health (NIH) in 2002. Patients who are symptom-free, whose blood calcium is only slightly elevated, and whose kidneys and bones are normal may wish to talk with their physicians about long-term monitoring. In the 2002 recommendation, periodic monitoring would consist of clinical evaluation, measurement of serum calcium levels, and bone mass measurement. If the patient and physician choose long-term follow-up, the patient should try to drink lots of water, get plenty of exercise, and avoid certain diuretics, such as the thiazides. Immobilization (inability to move) and gastrointestinal illness with vomiting or diarrhea can cause calcium levels to rise. Patients with hyperparathyroidism should seek medical attention if they find themselves immobilized, vomiting, or having diarrhea.
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