Hyperparathyroidism is often diagnosed before apparent signs or symptoms occur. When symptoms do occur, they are a result of damage in other organs due to high calcium levels in the blood/urine or too little calcium in bones

Symptoms are usually mild and nonspecific. They include:

• Osteoporosis
• Kidney stones
• Excessive urination
• Abdominal pain
• Tiring easily or weakness
• Depression or forgetfulness
• Bone and joint pain
• Frequent complaints of illness with no apparent cause
• Nausea, vomiting or loss of appetite
• Pathological fractures

Primary hyperparathyroidism

• A noncancerous growth (adenoma) of a parathyroid gland is the most common cause
• Enlargement (hyperplasia) of two or more parathyroid glands
• A cancerous tumor is a very rare cause

Secondary hyperparathyroidism

• Severe calcium deficiency
• Severe vitamin D deficiency
• Chronic kidney failure

Complications of hyperparathyroidism are related to the long-term effects of too little calcium in the bones and too much calcium in the bloodstream. Common complications include:

• Osteoporosis
• Kidney stones
• Cardiovascular diseases
• Neuropsychiatric manifestations

1.    Biochemical confirmation

       Blood tests – High calcium, low phosphorous and raised parathyroid hormone levels

2.    Assess end organ damage

• Bone mineral density test
• Ultrasound abdomen
• 24hour urinary calcium excretion

3.    Imaging tests before surgery to localize the enlarged parathyroid gland

• Sestamibi parathyroid scan
• High resolution ultrasonography of neck
• 4-D Computed tomography

Surgery

Surgery is the most common treatment for primary hyperparathyroidism and provides a permanent cure in most cases. Only those glands that are enlarged or have a tumor will be removed

If all four glands are affected, only three glands and a portion of the fourth gland are removed, leaving some functioning parathyroid tissue