Primary Hyperparathyroidism and Kidney Stones

Dr. Nicholas Kaloudis

The body’s parathyroid glands, four pea-sized glands in the neck, produce parathyroid hormone(PTH).

Primary hyperparathyroidism is a condition in which an overactive parathyroid gland makes too much PTH.

PTH keeps calcium at a normal level in the blood, so it can do its job in the body. For instance, calcium helps nerves work properly and, maintains a healthy blood pressure. When blood calcium gets low, PTH brings it back to normal by moving calcium from the bones, kidneys, and intestines into the blood. Too much PTH causes more calcium to be released from the bones, and raises levels of calcium in the blood and urine above normal. Over time, this can result in osteoporosis, kidney stones, and a decline in kidney function.

The most common cause is a single non-cancerous growth called an adenoma on one of the parathyroid glands. An adenoma caused the gland to become overactive and make more PTH.

Less often, all four parathyroid glands become enlarged and produce too much PTH. In a small number of cases, people inherit a gene that leads to this, and rarely parathyroid cancer causes hyperparathyroidism as well.

Signs and symptoms consistent with primary hyperparathyroidism are: fatigue, depression, generalized aches and pains, nausea and vomiting, bone pain, increased thirst and urination, constipation, forgetfulness and flank pain or blood in the urine from kidney stones.

Some people have no symptoms at all with this condition, and it is incidentally discovered with blood tests that detect high calcium and PTH levels. When Primary Hyperparathyroidism is found further testing is performed, such as: kidney function tests, a urinary calcium collection over a 24 hour period, vitamin D testing to see if a low vitamin D level is affecting this disease, and a bone mineral density test called a DXA scan to check for bone strength.

The treatment for primary hyperparathyroidism is chosen by the endocrinologist based on a patient’s age, test results, and which signs or symptoms are present.

For patients without signs and symptoms, the care is medical with regular  follow-up and testing which should include blood calcium levels, kidney function tests, and checks of bone density. The doctor may also prescribe medications called calcimimetics  which basically tell the body to make less PTH, helping to lower blood calcium levels, and bisphosphonates, which help keep bones strong, by keeping calcium in the bones.

Surgical removal of adenomas is recommended for all patients under the age of 50, whether they have symptoms or not. This is because young people tend to develop more complications overtime if they are untreated.

Surgery also is suggested for people with: osteoporosis or kidney stones, very high levels of blood calcium and impaired kidney function.

Surgical removal is safe and provides a definitive cure.