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The release of PTH is turned on and off depending on the levels of calcium in your blood. For example, if the blood level of calcium becomes low, the parathyroid glands will release more PTH.

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More PTH will cause the bones to release calcium and the blood calcium level will rise. Secondary hyperparathyroidism occurs when the parathyroid glands become enlarged and release too much PTH, causing a high blood level of PTH. There are several reasons why this happens in patients with kidney disease:. Secondary hyperparathyroidism can cause bone disease.

It can also cause calcium to build up in tissues and organs such as the heart and blood vessels. Your bones are in a constant state of change. There are cells that build new bone and cells that remove old bone. This means that the cells that remove bone are working more quickly than the cells that build new bone, causing your bones to become weak and brittle.

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This can increase your chances of having bone pain and fractures. There are several treatments for secondary hyperparathyroidism including drugs, surgery an operation , and controlling your blood phosphorus levels. There are three 3 types of drugs for secondary hyperparathyroidism—vitamin D supplements, active vitamin D or vitamin D analogs and cinacalcet.

If you have secondary hyperparathyroidism, talk to your healthcare provider about the treatment that is right for you. You need active vitamin D to absorb calcium from your intestines into your blood. Without enough active vitamin D, your calcium level drops and the parathyroid glands release too much PTH.

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Therefore, you will need to take vitamin D supplements if your blood level of vitamin D also called hydroxy vitamin D is too low. You may also need a vitamin D analog if your kidneys can no longer make active vitamin D also called 1,dihydroxy vitamin D. Your healthcare provider will tell you the type and amount of vitamin D that is best for you. Once doctors diagnose hyperparathyroidism, a hour urine collection can help find the cause. This test measures certain chemicals, such as calcium and creatinine, a waste product that healthy kidneys remove. You will collect your urine over a hour period and your health care professional will send it to a lab for analysis.

Results of the test may help tell primary hyperparathyroidism from hyperparathyroidism caused by a kidney disorder. The test can also rule out familial hypocalciuric hypercalcemia, a rare genetic disorder, as a cause. Once doctors diagnose primary hyperparathyroidism, they may use other tests to look for bone weakness, kidney problems, and low levels of vitamin D. During the test, you will lie on a padded table while a technician moves the scanner over your body. A bone expert or radiologist will read the scan.

During a DXA scan, you will lie on a padded table while a technician moves the scanner over your body. Ultrasound uses a device called a transducer that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician does the procedure.

A radiologist reads the images, which can show kidney stones. Abdominal x-ray. An abdominal x-ray is a picture of the abdomen that uses low levels of radiation and is recorded on film or on a computer. During an abdominal x-ray, you lie on a table or stand up. A radiologist reads the x-ray, which can show the location of kidney stones in the urinary tract.

Treating hyperparathyroidism in patients with chronic kidney disease

Not all stones are visible on an abdominal x-ray. Computed tomography CT scans. CT scans use a combination of x-rays and computer technology to create images of your urinary tract. CT scans sometimes use a contrast medium—a dye or other substance that makes structures inside your body easier to see.

How Common Is It?

A radiologist reads the images, which can show the size and location of a kidney stone. Health care professionals test for vitamin D levels because low levels are common in people with primary hyperparathyroidism. In patients with primary hyperparathyroidism, the low vitamin D level can further stimulate the parathyroid glands to make even more parathyroid hormone. Also, a very low vitamin D level may cause a secondary form of hyperparathyroidism, which resolves when vitamin D levels are returned to normal. Guidelines help doctors to decide whether or not parathyroid surgery should be recommended.

You might be a candidate for surgery if you meet any of these guidelines. Doctors most often recommend parathyroid surgery, particularly if the patient meets one or more of the guidelines noted above. It is also not inappropriate to recommend surgery in those who do not meet guidelines as long as there are no medical contraindications to surgery. If there is evidence for progressive disease e. For patients who are not going to have parathyroid surgery, even though guidelines are met, doctors can prescribe medicines to control the high blood calcium or improve the bone density.

Surgery to remove the overactive parathyroid gland or glands is the only sure way to cure primary hyperparathyroidism. Doctors recommend surgery for people with clear symptoms or complications of the disease. In people without symptoms, doctors follow the above guidelines to identify who might benefit from parathyroid surgery. Surgeons often use imaging tests before surgery to locate the overactive gland or glands to be removed. The tests used most often are sestamibi, ultrasound, and CT scans.


In a sestamibi scan, you will get an injection, or shot, of a small amount of radioactive dye in your vein. The overactive parathyroid gland or glands then absorb the dye. The surgeon can see where the dye has been absorbed by using a special camera. Minimally invasive parathyroidectomy. Also called focused parathyroidectomy, surgeons use this type of surgery when they think only one of the parathyroid glands is overactive.

Guided by a tumor-imaging test, your surgeon will make a small incision, or cut, in your neck to remove the gland.

Primary Hyperparathyroidism

The small incision means you will probably have less pain and a faster recovery than people who have more invasive surgery. You can go home the same day. Your doctor may use regional or general anesthesia during the surgery. Bilateral neck exploration. This type of surgery uses a larger incision that lets the surgeon find and look at all four parathyroid glands and remove the overactive ones. If you have bilateral neck exploration, you will probably have general anesthesia and may need to stay in the hospital overnight.

When performed by experienced surgeons, surgery almost always cures primary hyperparathyroidism. Parathyroid surgery is safe. Rarely, problems can occur after surgery. In about 1 out of every people, the nerves controlling the vocal cords are damaged during surgery, which most often results in hoarseness. Low calcium levels in the blood may occur after surgery but usually return to normal in a few days or weeks. On rare occasions, not enough parathyroid tissue is left to make PTH, which can result in hypoparathyroidism.

Some people who have mild primary hyperparathyroidism may not need surgery right away, or even any surgery, and can be safely monitored.

PHP (primary hyperparathyroidism) - General Practice Notebook

Long-term monitoring should include regular doctor visits, a yearly blood test to measure calcium levels and check your kidney function, and a bone density test every 1 to 2 years. Cinacalcet is a medicine that decreases the amount of PTH the parathyroid glands make and lowers calcium levels in the blood. Cinacalcet does not improve bone density. If you have bone loss, your doctor may prescribe alendronate or other medications to help increase bone density. You will need to take a vitamin D supplement if your vitamin D levels are low.