Calcium, Bone & Parathyroid Disorders

The Parathyroid Glands

What are Parathyroid Glands

The parathyroid glands are four small glands embedded in back of the thyroid gland in the neck. There is usually a parathyroid gland at the top and lower pole of each lobe of the thyroid. The parathyroid gland secretes parathyroid hormone (PTH) that is responsible for maintaining normal calcium, phosphorous, and vitamin D levels and maintaining normal bone mass. Bone is the storage organ for calcium. When PTH levels are too high (hyperparathyroidism), calcium is leached out of the bone and vitamin D levels increase resulting in elevated levels of calcium in the blood (hypercalcemia). This can also cause the bones to be lose calcium and become more brittle. In the early stages of low bone density this is called osteopenia and when it progresses to a more serious state it is call osteoporosis. A much rarer condition is caused by low PTH (hypoparathyroidism). This causes low calcium (hypocalcemia) and if not treated can result in serious problems such as seizures.

Hypercalcemia

There are many causes of hypercalcemia. Some medications can cause hypercalcemia and high levels of calcium can be associated with some cancers, infections and inflammations. These calcium levels are sometimes very high and require immediate medical attention, as well as treating the underlying disorder. However, the most common cause that an endocrinologist is likely to see is hyperparathyroidism. These patients may have fatigue, bone pain, kidney stones, peptic ulcer disease, or no symptoms at all. Calcium levels are routinely measured in almost everyone who sees a doctor for a physical exam or for many other complaints and when the calcium levels return high, it may be surprising. These patients are evaluated by blood and urine tests to determine the cause. When hyperparathyroidism is suspected, a parathyroid scan may be ordered. If this reveals an enlarged parathyroid gland and the patient is symptomatic with a moderately high level of calcium, surgery may be performed and the disease may be cured. If the scan does not yield clear results, or the calcium is minimally elevated and the patient has few or no symptoms, often observation only may indicated. These options are reviewed in detail with our patients and all questions answered to keep the patient informed as to his or her best option.

Multiple Endocrine Neoplasia

Although rare, hyperparathyroidism may run in families and is associated with other tumors of the endocrine system. These syndromes are called Multiple Endocrine Neoplasia Type 1 and Type 2 (MEN-1, MEN-2). It is particularly important that these families access an experienced endocrinologist.

Hypoparathyroidism

These patients may have an inborn error of PTH synthesis or may have low PTH from previous surgery. They often require large doses of calcium and vitamin D in various forms. It is the only endocrine deficiency that does not have a synthetic or animal extracted hormone available with which to treat the patient. One is under review now at the FDA and may be available in the future. We see many of these patients and have been very successful in keeping them out of the hospital, which could occur if the hypocalcemia is not adequately treated.

Vitamin D Deficiency

This is a serious condition that occurs commonly in our northern latitude. Sources of Vitamin D include sunlight, fish and certain foods. We are also seeing more vitamin D deficiency as well as other nutrient deficiencies in patients who have had weight loss surgery and diseases associated with mal-absorption such as celiac disease related to gluten sensitivity. Although there is no firm consensus, most experts in metabolism and endocrinology believe that vitamin D deficiency may cause some symptoms such as fatigue and low energy and is associated with diseases as wide ranging as cancer and diabetes. Vitamin D needs to be replaced to prevent metabolic bone disease and maintain good health. We can assess vitamin D levels and discuss various options for treatment.

Osteoporosis

Osteoporosis is a serious disease that can affect both men and women. Post menopausal women have a high likelihood of this disease, but it can occur in men with low testosterone. Many other conditions can be associated with low bone mass and are usually evaluated by an endocrinologist. The diagnosis is usually confirmed by a bone density test (DXA scan). There are many medications that can be used to treat osteoporosis and many more are being developed. It is one of the most active areas of endocrine research, since bone fractures can be so debilitating and result in prolonged hospitalization with significant mortality. Every patient needs adequate amount of calcium and vitamin D (preferably from a healthy diet), but not all patients need prescription medication. We look at the DXA scan and other metabolic tests carefully to assess the patient’s need for medication. We recommend these medications only when there is a high risk of fracture because of the potential side effects of these meds. We individually assess the benefit/risk ratio for each patient based on the latest computerized models. In this way we can feel confident we are doing what is best for the patient.

Contact Stonesifer Endocrine Care & Clinical Research

Schedule your appointment with Dr. Stonesifer by calling 253-927-4777. We serve all patients with parathyroid disorders in Seattle, Federal Way, Tacoma and surrounding areas.