Primary hyperparathyroidism
Alerts and Notices
Synopsis
High-risk populations include postmenopausal women and patients who have had chronic and serious calcium or vitamin D deficiency, have a rare genetic disease, have undergone radiation therapy, or have taken lithium.
The disorder is most prevalent in individuals between 50 and 60 years of age. Females are more frequently affected.
Patients are usually asymptomatic. Symptomatic patients have variable presentations. In mild cases, common symptoms include fatigue, lethargy, depression, muscle weakness, and muscle pain. In severe cases, symptoms include anorexia, nausea, vomiting, constipation, confusion, memory impairment, frequent urination, and bone thinning and fractures. Sustained hyperparathyroidism can lead to osteitis fibrosa cystica, forming cystlike tumors in the bones.
Complications are dependent on the long-term effects of insufficient calcium in a patient's bones and excessive calcium circulating in the bloodstream. Common complications include osteoporosis, kidney stones, cardiovascular disease, and hypoparathyroidism of the neonate in pregnant individuals with untreated hyperparathyroidism.
Treatment is dependent on the course of the disease and will vary depending on individual cases. Patients who are asymptomatic may not require any treatment and should be closely monitored by their physicians. Medications such as bisphosphonates may help with bone health, and estrogen therapy may benefit postmenopausal women. Patients with primary hyperparathyroidism due to familial hypocalciuric hypercalcemia may need parathyroidectomies.
Codes
ICD10CM:E21.0 – Primary hyperparathyroidism
SNOMEDCT:
237653008 – Familial primary hyperparathyroidism
36348003 – Primary hyperparathyroidism
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Secondary hyperparathyroidism – serum calcium levels low or low-normal (see hypocalcemia)
- Hypercalcemia of malignancy and other causes of hypercalcemia (milk-alkali syndrome, granulomatous disease, vitamin D excess, etc) – typically PTH levels are suppressed
- Familial hypocalciuric hypercalcemia – low urine calcium excretion
- Lithium use can result in hypercalcemia with elevated PTH that may be reversible if the duration of lithium use has been fairly short.
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:05/06/2019
Last Updated:08/05/2021
Last Updated:08/05/2021
Primary hyperparathyroidism