Hyperparathyroidism: Etiology and Risk Factors

Hyperparathyroidism is a condition characterized by excessive secretion of parathyroid hormone (PTH), leading to hypercalcemia and associated complications.

Etiology

The causes of hyperparathyroidism are classified into primary, secondary, and tertiary forms:

• Primary Hyperparathyroidism: Often due to a parathyroid adenoma, hyperplasia, or, rarely, carcinoma.
• Secondary Hyperparathyroidism: Caused by chronic kidney disease, vitamin D deficiency, or malabsorption disorders.
• Tertiary Hyperparathyroidism: Persistent hyperparathyroidism following prolonged secondary hyperparathyroidism, commonly seen in dialysis patients.

Risk Factors

• Genetic predisposition: Familial primary hyperparathyroidism or MEN syndromes.
• Chronic kidney disease: Leading to secondary hyperparathyroidism.
• Prolonged vitamin D deficiency: Resulting in compensatory PTH secretion.
• Radiation exposure: Past neck radiation therapy increases risk.
• Age and gender: More common in postmenopausal women.

Clinical Presentation

Symptoms of hyperparathyroidism may include:

• Fatigue and muscle weakness
• Bone pain and osteoporosis
• Kidney stones and polyuria
• Gastrointestinal disturbances such as nausea and constipation
• Neuropsychiatric symptoms like depression and cognitive dysfunction

Diagnosis and Management

Diagnosis involves biochemical testing, including serum calcium, PTH, and vitamin D levels, alongside imaging studies such as ultrasound or Sestamibi scans.

Management strategies include:

• Surgical: Parathyroidectomy for primary hyperparathyroidism.
• Medical: Vitamin D and phosphate binders for secondary hyperparathyroidism.
• Monitoring: Regular blood tests to manage asymptomatic cases.