Parathyroid hyperplasia

Parathyroid Hyperplasia is a medical condition characterized by the enlargement of all four parathyroid glands, which are small glands located behind the thyroid in the neck. This condition leads to an overproduction of parathyroid hormone (PTH), resulting in elevated calcium levels in the blood, a condition known as hypercalcemia. Parathyroid hyperplasia can be primary, secondary, or tertiary, each with distinct causes and implications for treatment.

Causes

Primary parathyroid hyperplasia is often idiopathic, meaning its exact cause is unknown. However, it can be associated with genetic conditions such as Multiple Endocrine Neoplasia type 1 (MEN1) and type 2A (MEN2A), which are inherited disorders affecting multiple endocrine glands.

Secondary parathyroid hyperplasia results from chronic low blood calcium levels, often due to chronic kidney disease. The parathyroid glands enlarge and produce more PTH in an attempt to increase blood calcium levels.

Tertiary hyperplasia occurs when the parathyroid glands continue to produce excessive amounts of PTH even after the correction of the condition that led to secondary hyperplasia, such as after a successful kidney transplant.

Symptoms

Symptoms of parathyroid hyperplasia are primarily related to hypercalcemia and include:

• Fatigue
• Kidney stones
• Osteoporosis
• Psychiatric disturbances
• Peptic ulcer disease
• Increased thirst and urination

Diagnosis

Diagnosis involves a combination of blood tests, imaging, and sometimes genetic testing. Blood tests measure levels of calcium, PTH, and phosphorus. Imaging tests, such as ultrasound or Sestamibi scan, help visualize the enlargement of the parathyroid glands and assess their function.

Treatment

Treatment options for parathyroid hyperplasia include surgical removal of the enlarged glands (parathyroidectomy) and medical management. The surgical approach depends on the type of hyperplasia; for primary hyperplasia, all four glands may be examined, with the surgeon removing the glands that are visibly enlarged and possibly performing a subtotal parathyroidectomy or total parathyroidectomy with autotransplantation. In secondary and tertiary hyperplasia, medical management aims to control the underlying condition, such as kidney disease, and may include calcium and vitamin D supplementation.

Prognosis

The prognosis for individuals with parathyroid hyperplasia varies depending on the underlying cause and the effectiveness of treatment. Surgical treatment can be curative in many cases of primary hyperplasia, while management of secondary and tertiary forms focuses on controlling symptoms and the underlying conditions.

See Also

• Hyperparathyroidism
• Calcium metabolism
• Vitamin D