hyperparatyreoosi

Hyperparatyreoosi, also known as hyperparathyroidism, is a disorder characterized by excessive production of parathyroid hormone (PTH) by the parathyroid glands. The result is hypercalcemia and altered mineral metabolism that can affect bone, kidney, and other organ systems. There are three main forms: primary hyperparathyroidism, secondary hyperparathyroidism, and tertiary hyperparathyroidism.

Primary hyperparathyroidism arises from autonomous PTH secretion, most commonly due to a parathyroid adenoma, but it can also result from parathyroid hyperplasia or, rarely, carcinoma. Secondary hyperparathyroidism occurs in response to chronic hypocalcemia or phosphate retention, most often due to vitamin D deficiency, malabsorption, or chronic kidney disease. Prolonged secondary stimulation can lead to tertiary hyperparathyroidism, where PTH secretion becomes autonomous despite normalized calcium levels.

Clinical features vary. Many individuals are asymptomatic and detected through routine blood tests showing elevated calcium. When symptoms occur, they may include bone pain or fractures, kidney stones, excessive thirst and urination, fatigue, depression or cognitive changes, and gastrointestinal discomfort. Complications can include osteoporosis, nephrolithiasis, nephrocalcinosis, and cardiovascular issues.

Diagnosis relies on laboratory testing. The hallmark is elevated serum calcium with inappropriately elevated or inappropriately normal PTH for that calcium level. Corrected calcium should be used if albumin is low. Other tests include phosphate, 25-hydroxy vitamin D, renal function, and 24-hour urinary calcium. Imaging (ultrasound, sestamibi scan, CT, or MRI) may be used to localize disease before surgery in primary cases but is not required for diagnosis.

Treatment depends on the type. Primary hyperparathyroidism is commonly treated with surgical removal of the affected gland(s). Indications for surgery include symptomatic disease, complications, or certain biochemical thresholds. Secondary hyperparathyroidism is managed by addressing the underlying cause (eg, vitamin D deficiency, CKD) and may involve phosphate binders, active vitamin D analogs, or calcimimetics. Tertiary hyperparathyroidism is usually treated surgically. Regular follow-up and management of bone and renal health are important in all forms.