Babak Larian, MD, FACS, is known around the world for his parathyroid expertise and frequently has patients fly in from out of town for consultations and surgery at the CENTER for Advanced Parathyroid Surgery.
Hyperparathyroidism, caused by too much parathyroid hormone produced by overactive parathyroid glands, occurs when one or more of the four parathyroid glands become abnormal. This can lead to problems with the bones, muscles, nervous system, kidneys and other organs in the body.
The disease causes the parathyroid glands to lose its control mechanism, and the abnormal gland continues to make large amounts of parathyroid hormone without paying attention to how high the blood calcium level is. Even when the calcium level is abnormally high, the abnormal parathyroid gland keeps making hormone when it should not be making any hormone at all. This happens in most cases, because the parathyroid glands developed an abnormal calcium level sensor. This sensor is very much like a thermostat in a heater; when the thermostat is set to a level, let's say 72 degrees, the heating systems stops working at 72 degrees and above, but when the thermostat stops working properly the heater will continue to work at higher temperatures because it is not being told to stop.
Sometimes, people suffering from hyperparathyroidism will be able to identify symptoms within the first year. In other cases, patients can go for many years without experiencing obvious symptoms, but be in the process of developing kidney stones, neurologic problems, and osteoporosis.
Hyperparathyroidism occurs more often in women than men by roughly a 3 to 1 ratio, which means women are 3 times more likely to get this disease. It can occur at any age beginning in the teen years all the way to old age. It occurs most often, or is diagnosed most often in people in the ages of 50's and 60's. The treatment is always the same at any age, and that is a minimally invasive parathyroidectomy.
The most common cause of hyperparathyroidism is the development of a benign tumor in one of the parathyroid glands. This enlargement of a parathyroid gland is called parathyroid adenoma, and it accounts for roughly 90% of all patients with primary hyperparathyroidism. This small abnormal gland can produce a lot of hormone as in the picture to the right. Occasionally, more than one gland will have adenomas (multiple adenomas); the signs and symptoms are the same as when there is one adenoma, the calcium and PTH levels will be the same as well. In some cases, surgery to remove the parathyroid tumor may be required if it is causing symptoms and having animpacts on the body.
While the tumor will always continue to grow, the remaining normal glands stop working because the calcium levels are too high and in time they start to shrink. The typical patient with a parathyroid adenoma will be cured of the disease when the tumor is removed as the calcium level will go back to normal within hours. Patients will be able to live a completely normal life with their three remaining parathyroid glands.
In a small percentage of the cases all four glands are abnormal, and all four will produce extra PTH. These cases can run in families and be part of a syndrome called MEN (multiple endocrine neoplasia). The laboratory values for these patients are the same as the ones for parathyroid adenoma.
The four glands will always continue to malfunction and produce too much PTH. The treatment is to remove three and a half glands, and leave a half a gland to take over the calcium balance.
Cancer in the parathyroid glands is extremely rare. Typically the PTH and calcium levels are extremely high. Treamtent is also parathyroid tumor surgery but involves removal of not only the gland but the adjacent thyroid and lymph nodes.
Chief of Head & Neck Surgery at Cedars-Sinai
Assistant Clinical Professor of Surgery at UCLA
By Babak Larian, MD FACS Privacy Notice © 2013 Babak Larian, MD FACS. All Rights Reserved.
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