What Happens When You Have Hyperparathyroidism?

Primary hyperparathyroidism causes bone deterioration, kidney stones and abdominal pain, among other symptoms.

Primary hyperparathyroidism is a disorder that occurs when one or more of the parathyroid glands becomes overactive and secretes excess parathyroid hormone, causing high blood calcium levels (hypercalcemia). 

In secondary hyperparathyroidism, the parathyroid glands function normally, and are secreting extra hormones in response to low blood calcium levels in the body, caused by other health conditions such as kidney failure.

Symptoms of primary hyperparathyroidism are often referred to as the "bones, stones, abdominal groans, and psychic moans." 

“Bones” symptoms of primary hyperparathyroidism include: 

• Bone loss
• Bone pain
• Joint pain
• Pseudogout/gout
• Calcification of cartilage (chondrocalcinosis) 

“Stones” symptoms of primary hyperparathyroidism refer to kidney symptoms and include: 

• Increased production of urine
• Kidney stones
• Calcium in the urine (hypercalciuria)
• Increased calcium in the kidneys (nephrocalcinosis) (rare)

“Abdominal groans” symptoms of primary hyperparathyroidism refer to gastrointestinal symptoms and include: 

• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Constipation
• Peptic ulcer disease
• Acute pancreatitis

“Psychic moans” symptoms of primary hyperparathyroidism refer to neuromuscular and psychologic symptoms and include: 

• Muscle weakness and pain of muscles near the trunk of the body
• Easy fatigability
• Depression
• Inability to concentrate
• Memory problems 

Other symptoms of primary hyperparathyroidism include: 

• High blood pressure (hypertension)
• Slow heart rate
• Shortened QT interval (a measure of heart function)
• Left ventricular hypertrophy

In most cases, primary hyperparathyroidism is caused by a single benign tumor (adenoma) on the parathyroid gland. In a smaller number of cases there are multiple tumors, and in rare cases, hyperparathyroidism is caused by parathyroid cancer.

In many cases, people who have primary hyperparathyroidism do not have any symptoms, and the condition is discovered when they have blood work for other reasons.  

Primary hyperparathyroidism is diagnosed based upon levels of blood calcium and parathyroid hormone. 

Other tests used to assess primary hyperparathyroidism include:

• Bone density testing 
• X-ray of the spine 
• 24-hour urinary calcium excretion (to assess risk of kidney stones) 
• Serum creatinine (a test of kidney function) 
• Imaging to determine if kidney stones are present
• X-ray or
• Ultrasound 
• Computed tomography (CT) scan

The primary treatment for primary hyperparathyroidism is surgery to remove the gland(s) causing the problem. Surgery usually cures the condition. 

Medications that may be used to treat symptoms of high blood calcium include:

• Estrogen therapy in postmenopausal women 
• Bisphosphonates
• Calcimimetic drugs

Complications of primary hyperparathyroidism include:

• Kidney stones
• Osteoporosis
• Heart disease
• Pancreatitis

You may not be able to prevent primary hyperparathyroidism, but you may be able to prevent symptoms with lifestyle changes. 

• Stay hydrated to prevent kidney stones
• Exercise regularly to help keep calcium levels in check and to promote bone health
• Aim for 1000 mg of calcium daily, preferably from dietary sources versus supplements
• Talk to your doctor about your calcium intake needs
• Aim for 400 to 600 international units (IU) of vitamin D daily for bone health
• Avoid medications that affect calcium levels in the blood
• Avoid lithium if possible and thiazide diuretics 
• Get your blood calcium levels checked regularly