Primary Hyperparathyroidism (PHPT) is third most common endocrine disorder after diabetes mellitus and thyroid disorders. The prevalence of primary hyperparathyroidism varies from 1 in 400 to 1 in 1000 persons in western populations. The clinical manifestations of primary hyperparathyroidism ranges from asymptomatic hypercalcemia detected during routine testing to classic manifestations traditionally associated with disease. Fuller Albright in 1930 described pentad of primary hyperparathyroidism which includes bone pains, renal stones, abdominal groans, psychic moans and fatigue overtones. The PHPT is biochemically characterized by inappropriately elevated parathyroid hormone (PTH) in the presence of hypercalcemia. It is also associated with low serum phosphate and elevated alkaline phosphatase. Primary hyperparathyroidism is also associated with increased urinary calcium and phosphate excretion.
You may be at an increased risk of PHPT if you:
Symptoms may be so mild to severe and nonspecific that they don’t seem at all related to parathyroid function. The range of signs and symptoms include:
PHPT occurs because of some problem with one or more of the four parathyroid glands:
Primary hyperparathyroidism is usually nonfamilial, but some people inherit a gene that causes the disorder.
Complications of hyperparathyroidism are primarily related to the long-term effect of too little calcium in your bones and too much calcium circulating in your bloodstream. Common complications include:
After the clinical evaluations, the diagnosis of PHPT is made by blood tests.Serum calcium levels are elevated, and the parathyroid hormone level is abnormally high compared with an expected low level in response to the high calcium. Biochemical confirmation of primary hyperparathyroidism is following by investigations to localize the enlarged gland. Tc99 sestamibi scan of head, neck and upper thorax is the most commonly used test for localizing parathyroid adenomas. Ultrasonography is also a useful test in localizing suspicious parathyroid lesions.
Surgical removal of adenomatous gland is the first line of the treatment for PHPT.