What is primary hyperparathyroidism (PHPT)?
PHPT is a disease that occurs due to excessive secretion of parathyroid hormone (PTH) due to a problem in the parathyroid gland(s).
PHPT occurs in 0.1-0.3% of the general population. It is four times more common in women than in men.
Increased PTH production;
By increasing calcium absorption from the intestinal tract,
By increasing the production of Vitamin D3 and
It reduces calcium excretion from the kidneys, causing calcium levels to increase in the blood.
What are the causes of primary hyperparathyroidism (PHPT)?
The exact cause of PHPT is unknown .
Possible reasons include;
Exposure to low dose radiation for treatment purposes,
familial predisposition,
various foods,
Insufficient use of sunlight,
Calcium leak in the kidney,
Kidney function decreases with age and
It is thought to be a lithium treatment.
In approximately 80% of patients, uncontrolled size increase ( hyperplasia ) and benign tumor ( adenoma ) are detected in a single parathyroid tissue.
15-20% of patients have multiple adenomas or hyperplasia.
Parathyroid cancer is detected in 1% of patients.
What are the symptoms of primary hyperparathyroidism (PHPT)?
Patients with PHPT usually ;
Weakness,
Tiredness,
excessive thirst,
frequent urination,
Increased frequency of urination at night,
Bone and joint pain,
Constipation,
decreased appetite,
Nausea,
heartburn,
Itching,
Depression
Insomnia and
presents with complaints of memory loss.
How is primary hyperparathyroidism (PHPT) diagnosed?
An increase in serum calcium and PTH without a decrease in urinary calcium excretion is sufficient for the diagnosis of PHPT.
Patients with PHPT also typically have a decrease in serum phosphate (-50%) and an increase in 24-hour urine calcium (-60%).
Elevated alkaline phosphatase levels may be found in approximately 10% of patients.
Additionally, a decrease in phosphate and magnesium levels in the blood may occur. In contrast, 1-25 dehydroxy vitamin D levels are found to be normal or increased .
In very suspicious cases, various bone films may be taken to determine bone density .
How is primary hyperparathyroidism (PHPT) treated?
If complications develop and “classic” findings of PHPT are present, treatment is surgical removal of the problematic parathyroid tissue (parathyroidectomy) .
If the patients do not have any symptoms ( asymptomatic ), that is, if there are no complaints related to the "bone, kidney, gastrointestinal or muscular" system, it is controversial whether the treatment will be surgical or medication.
Conditions that require surgery even though they do not have classic symptoms are:
Serum calcium is above the upper limits of normal, 1 mg/dL,
Renal filtration rate below 60 mL/minute; 24-hour urine calcium over 400 mg/d, kidney stones detected on films
Decreased bone density (T score less than -2.5, fracture in the spine detected on films)
The patient is less than 50 years old and
Long-term medical follow-up of the patient is not possible.