Some patients become conspicuous by complaints on the bone. The osteoclasts activated by the parathyroid hormone described above lead to the mobilization of calcium from the bone, which gradually loses its stability. In extreme and long untreated cases, the patient’s bones can become so unstable that fractures can result.
This disease is called osteoporosis. When a bone is found, patients complain of increased bone pain, which should also substantiate the suspicion of hyperparathyroidism. You can find more about osteoporosis under our topic: Osteoporosis.
A manifestation of the gastrointestinal system is also possible. Increased calcium absorption from food can result in loss of appetite, nausea, constipation, flatulence and weight loss. An increased incidence of gallstones in patients with hyperparathyroidism is also noticeable.
Less frequently, inflammation of the stomach lining or pancreas occurs. The following rule of thumb makes it easier to remember the symptoms of hyperparathyroidism: “Stone, leg, stomach pain“. This can manifest itself in confusion, vomiting, increased thirst, increased urge to urinate and even coma. The symptoms of secondary hyperparathyroidism (hyperparathyroidism) usually refer to the underlying disease. Bone pain caused by osteoporosis may also occur.
Therapy
In symptomatic primary hyperparathyroidism (hyperparathyroidism), surgical removal of the parathyroid epithelial corpuscles should be attempted. In asymptomatic disease, surgery should be performed if the serum calcium level exceeds 0.25 mmol/l, decreases renal function, decreases bone density, increases urinary calcium level by 400 mg in 24 hours, or if the patient is younger than 50 years of age. During surgery all enlarged epithelial bodies should be visualized and removed.
If all pathologically working epithelial corpuscles have been removed, the measured parathyroid hormone level should decrease by 50% during the operation. The removed epithelial corpuscles are frozen after the operation in order to be reinserted in rare cases of permanent calcium deficiency. After the operation, increased attention must be paid to the calcium content of the blood, as a suddenly reduced parathormone secretion can lead to an extreme lack of calcium.
Here calcium must be supplied to the patient. If no operation can be performed, the patients should drink a lot, not take any medication to flush out water (thiazide diuretics) and no cardiac-strengthening medication from the group of digitalis. In addition, a medicinal osteoporosis prophylaxis should not be forgotten in menopausal women. Regular monitoring of the calcium level at three-month intervals should be ensured. In case of secondary hyperparathyroidism (overactive parathyroid gland), the underlying disease should be treated first, and the administration of calcium and vitamin D3 should be considered.