Overview
Parathyroid glands
Parathyroid glands
The parathyroid glands lie behind the thyroid. They produce parathyroid hormone, which plays a role in regulating the body's blood level of calcium and phosphorus.
Hypercalcemia is a condition in which the calcium level in your blood is above normal. Too much calcium in your blood can weaken your bones, create kidney stones, and interfere with how your heart and brain work.
Hypercalcemia is usually a result of overactive parathyroid glands. These four tiny glands are situated in the neck, near the thyroid gland. Other causes of hypercalcemia include cancer, certain other medical disorders, some medications, and taking too much of calcium and vitamin D supplements.
Signs and symptoms of hypercalcemia range from nonexistent to severe. Treatment depends on the cause.
Treatment of parathyroid disease at Mayo Clinic
Here at the Mayo Clinic in Endocrine and Metabolic Surgery, we treat the full spectrum of parathyroid problems. And that ranges from the simplest primary hyperparathyroidism to the most complex cases.
What they are are four little glands that regulate the calcium. And most often, it's just one of them that develops a tumor of it.
We utilize multimodal imaging, meaning various types of imaging to identify where the abnormal parathyroid is located. And that can include various imaging techniques such as ultrasound, parathyroid sestamibi scan, which is a nuclear medicine imaging. We use four-dimensional CT scan, which is an advanced CT scan imaging of the neck and parathyroid glands. And finally, cutting-edge imaging such as choline PET scan.
So PET choline is one of the newest imaging modalities that's out there. It requires generation of a choline isotope onsite. And so this is not widely available. It's really only available at a few centers across the country. And so with this type of scan, we can find parathyroid glands that are otherwise missed by traditional imaging techniques.
Once that step is complete, then the patient can very confidently move towards the next step, which is treatment.
Patients can come into the office feeling a variety of symptoms that are generally nonspecific, but rather debilitating for them. In many of these cases, we're able to treat hyperparathyroidism and watch these symptoms literally go away.
What we strive for is really to have a very efficient and effective itinerary for patients and know they're going to be operated on by very high-volume, experienced parathyroid surgeons. You feel confident that they're going to come here and get the care they need and deserve.
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Symptoms
You might not have signs or symptoms if your hypercalcemia is mild. More-severe cases produce signs and symptoms related to the parts of your body affected by the high calcium levels in your blood. Examples include:
- Kidneys. Excess calcium makes your kidneys work harder to filter it. This can cause excessive thirst and frequent urination.
- Digestive system. Hypercalcemia can cause stomach upset, nausea, vomiting and constipation.
- Bones and muscles. In most cases, the excess calcium in your blood was leached from your bones, which weakens them. This can cause bone pain and muscle weakness.
- Brain. Hypercalcemia can interfere with how your brain works, resulting in confusion, lethargy and fatigue. It can also cause depression.
- Heart. Rarely, severe hypercalcemia can interfere with your heart function, causing palpitations and fainting, indications of cardiac arrhythmia, and other heart problems.
When to see a doctor
Contact your doctor if you develop signs and symptoms that might indicate hypercalcemia, such as being extremely thirsty, urinating frequently and having abdominal pain.
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Causes
Besides building strong bones and teeth, calcium helps muscles contract and nerves transmit signals. Normally, if there isn't enough calcium in your blood, your parathyroid glands secrete a hormone that triggers:
- Your bones to release calcium into your blood
- Your digestive tract to absorb more calcium
- Your kidneys to excrete less calcium and activate more vitamin D, which plays a vital role in calcium absorption
This delicate balance between too little calcium in your blood and hypercalcemia can be disrupted by a variety of factors. Hypercalcemia is caused by:
- Overactive parathyroid glands (hyperparathyroidism). This most common cause of hypercalcemia can stem from a small, noncancerous (benign) tumor or enlargement of one or more of the four parathyroid glands.
- Cancer. Lung cancer and breast cancer, as well as some blood cancers, can increase your risk of hypercalcemia. Spread of cancer (metastasis) to your bones also increases your risk.
- Other diseases. Certain diseases, such as tuberculosis and sarcoidosis, can raise blood levels of vitamin D, which stimulates your digestive tract to absorb more calcium.
- Hereditary factors. A rare genetic disorder known as familial hypocalciuric hypercalcemia causes an increase of calcium in your blood because of faulty calcium receptors in your body. This condition doesn't cause symptoms or complications of hypercalcemia.
- Immobility. People who have a condition that causes them to spend a lot of time sitting or lying down can develop hypercalcemia. Over time, bones that don't bear weight release calcium into the blood.
- Severe dehydration. A common cause of mild or transient hypercalcemia is dehydration. Having less fluid in your blood causes a rise in calcium concentrations.
- Medications. Certain drugs — such as lithium, used to treat bipolar disorder — might increase the release of parathyroid hormone.
- Supplements. Taking excessive amounts of calcium or vitamin D supplements over time can raise calcium levels in your blood above normal.
Complications
Hypercalcemia complications can include:
- Osteoporosis. If your bones continue to release calcium into your blood, you can develop the bone-thinning disease osteoporosis, which could lead to bone fractures, spinal column curvature and loss of height.
- Kidney stones. If your urine contains too much calcium, crystals might form in your kidneys. Over time, the crystals can combine to form kidney stones. Passing a stone can be extremely painful.
- Kidney failure. Severe hypercalcemia can damage your kidneys, limiting their ability to cleanse the blood and eliminate fluid.
- Nervous system problems. Severe hypercalcemia can lead to confusion, dementia and coma, which can be fatal.
- Abnormal heart rhythm (arrhythmia). Hypercalcemia can affect the electrical impulses that regulate your heartbeat, causing your heart to beat irregularly.
