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Primary hyperparathyroidism
Other Resources UpToDate PubMed

Primary hyperparathyroidism

Contributors: Joon B. Kim MD, Marilyn Augustine MD, Michael W. Winter MD
Other Resources UpToDate PubMed


Primary hyperparathyroidism is hyperfunction of the parathyroid glands resulting in overproduction of parathyroid hormone (PTH), which causes elevated blood calcium levels (see hypercalcemia). Primary hyperparathyroidism is caused by parathyroid adenoma, parathyroid hyperplasia, and parathyroid carcinoma (in rare cases).

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.


E21.0 – Primary hyperparathyroidism

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, Chronic 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.

Best Tests

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Management Pearls

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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.

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Last Reviewed:05/06/2019
Last Updated:08/05/2021
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Primary hyperparathyroidism
A medical illustration showing key findings of Primary hyperparathyroidism (Asymptomatic) : Ca elevated
Imaging Studies image of Primary hyperparathyroidism - imageId=7902630. Click to open in gallery.  caption: '<span>Subchondral/subligamentous  bone resorption at the sacroiliac joints and pubic symphysis, compatible  with hyperparathyroidism. Note the presence of a peritoneal dialysis  catheter.</span>'
Subchondral/subligamentous bone resorption at the sacroiliac joints and pubic symphysis, compatible with hyperparathyroidism. Note the presence of a peritoneal dialysis catheter.
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