Hyperparathyroidism
Primary hyperparathyroidism is excess parathyroid hormone, usually from a benign parathyroid tumor, causing elevated blood calcium, per the Fifth International Workshop (2022) guidance.
Symptoms
Often asymptomatic, found on routine bloodwork. When present, symptoms include fatigue, bone pain, kidney stones, constipation, and mood changes -- the classic "stones, bones, groans, and psychiatric overtones."
Causes and risk
A single benign parathyroid adenoma causes most cases; rarely, multiple gland involvement or, very rarely, genetic syndromes are the cause.
How it is evaluated
Elevated calcium with an inappropriately high or normal PTH confirms the diagnosis; imaging is used for surgical planning, not diagnosis.
Treatment
Surgery (parathyroidectomy) is curative and indicated per the 2022 Workshop criteria: calcium more than 1 mg/dL above normal, a T-score of -2.5 or lower, a vertebral fracture, reduced kidney function, elevated urine calcium, kidney stones, or age under 50. For those who don't meet surgical criteria or decline surgery, monitoring, calcium/vitamin D management, and cinacalcet (for calcium) or antiresorptives (for bone) are options -- though they don't cure the disease.
When to seek care
Hypercalcemic crisis -- severe calcium elevation with confusion, dehydration, and multiorgan dysfunction -- is a medical emergency requiring inpatient treatment.