Hyperparathyroidism

Hyperparathyroidism is when the parathyroid glands make too much parathyroid hormone. The condition is rare in children.

The parathyroid glands are 4 tiny glands located on the back of the thyroid. The hormone they make helps manage levels of calcium in the bloodstream. High levels of the hormone lead to high levels of calcium. This happens because bone breaks down and releases calcium, and the kidneys and the intestines increase their calcium absorption. Minerals from the bone are released into the blood also causing high levels of calcium. This process can cause thinning bones (osteoporosis). High calcium levels also increase the risk of crystallization with phosphate, which results in kidney stones. Kidney stones are hard mineral crystals that get stuck in the urinary system.

Causes of Hyperparathyroidism

Causes can include:

• Tumors on the parathyroid glands that aren’t cancer (benign)
• Enlargement of the parathyroid glands (usually all 4 of them)
• Vitamin D deficiency (secondary hyperparathyroidism)
• Chronic kidney disease

The condition in children is more often part of a syndrome, such as multiple endocrine neoplasia.

Children Who Are at Risk for Hyperparathyroidism

A child is at risk for hyperparathyroidism if they have any of these:

• Tumors on the parathyroid glands that aren’t cancer (benign)
• Enlargement of the parathyroid glands
• Multiple endocrine neoplasia (endocrine syndrome)

Symptoms of Hyperparathyroidism

Some children do not have symptoms. If symptoms occur, they can be a bit different in each child. Symptoms are mainly caused by hypercalcemia, and they can include:

• Kidney pain, from kidney stones
• Bone pain, from thinning bones
• Joint aches and pains
• Belly (abdominal) pain
• Nausea
• Vomiting
• Tiredness
• Urinating a lot
• Thirst
• Confusion
• Muscle weakness
• Broken bones
• Weight loss
• Diarrhea
• Constipation
• Depression
• Headache

The symptoms of hyperparathyroidism can be like other health conditions. Make sure your child sees their doctor for a diagnosis.

Diagnosing Hyperparathyroidism

The condition can be hard to diagnose. The doctor will ask about your child’s symptoms and health history. They may also ask about your family’s health history. Your child will have a physical exam and tests, such as:

• Blood tests. These are done to measure calcium, phosphorus, magnesium, and hormone levels in the blood. The first sign of a parathyroid condition may be a higher-than-normal level on a calcium blood test.
• X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the bones to check for thinning.
• Genetic testing. Your child may need this test if hyperparathyroidism or other related hormone conditions run in the family.
• Ultrasound (sonography). This test uses sound waves and a computer to create images of blood vessels, tissues, and organs. This may be done to look at the parathyroid gland.
• Nuclear medicine test. This type of test uses small amounts of radioactive material to create images of the inside of the body. A test that adds radioactive material to a protein called sestamibi may be done. This material is picked up by the overactive parathyroid and helps tell the difference between an overactive parathyroid and a normal gland.
• CT scan. This test uses a series of X-rays and a computer to make detailed images of the body. A CT scan can show bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.
• MRI. This test uses large magnets and a computer to make detailed images of tissues in the body.

Treating Hyperparathyroidism

Your child's doctor will consider your child's age, overall health, and other factors when advising treatment. Your child may need to see a pediatric endocrinologist. This is a doctor with extra training in treating children with hormone problems. Treatment usually includes surgery. This is done to remove some or all of the parathyroid glands.

Possible Complications of Hyperparathyroidism

If untreated, the condition can lead to serious complications, including:

• Thin bones (osteoporosis or osteopenia)
• Broken bones
• Other bone problems
• Kidney stones
• Kidney disease
• Inflammation of the pancreas (pancreatitis)
• High blood pressure
• Heart problems including arrhythmias
• Enlarged ventricles in the heart
• Heart valve damage
• Depression
• Memory problems

How to Help Your Child Live with Hyperparathyroidism

Your child will need specialty care from a healthcare team. Even after surgery, a child may need lifelong checking for symptoms of high calcium levels in the blood. Work with your child's doctors to create an ongoing plan to manage your child’s condition.