Stones, bones, abdominal groans along with psychic overtones

Hyperparathyroidism is a condition that affects about 1 in 500 women and 1 in 2 000 men. With symptoms that range from depression to abdominal complaints, it’s a complex condition that can be treated reasonably easily.

The Mayo Clinic hyperparathyroidism as “an excess of parathyroid hormone in the bloodstream due to over-activity of one or more of the body's four parathyroid glands”.

According to Prof Justus Apffelstaedt, Associate Professor of Surgery at the University of Stellenbosch, the parathyroid glands are responsible for the production of the parathyroid hormone, which helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning.

While we all know that the mineral calcium is vital for bones and teeth, it also aids in the transmission of signals in nerve cells, and it's involved in muscle contraction.

Phosphorus, another mineral, works in conjunction with calcium in these areas.

Overproduction of the parathyroid hormone leads to high levels of calcium in the blood and urine, with too little phosphorus, or too little calcium in bones.

The result is a range of signs and symptoms that often leave the sufferer feeling generally unwell. This includes:

• Fragile bones that easily fracture (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

Diagnosis of the condition involves a blood calcium test first. Based on the result, a range of tests to determine whether it’s primary hyperparathyroidism follow. Primary hyperparathyroidism is most commonly (85 % of cases) due to a single hyper-functioning gland. This gland can be localized through a number of imaging investigations. Most commonly used here, are isotope scans. These give a rather fuzzy image but allow for functional-anatomical correlation.

“We have recently adopted ultrasound which gives a very detailed image of the neck but has no functional component,” Apffelstaedt says. “In the other cases, hypertrophy of all four parathyroid glands or multiple adenomas are found. In less than 1% of cases, parathyroid cancer is the cause.”

Primary hyperparathyroidism can easily be treated with minimally invasive surgery via a “buttonhole” incision in the neck. A minimally invasive parathyroidectomy takes about 15 minutes from start to finish.

Undiagnosed or untreated hyperparathyroidism can progress to irreversible complications such as renal failure and hypertension with secondary detrimental effects. It is therefore important that patients educate themselves on the symptoms and signs to look out for and should ask as many questions as possible of their General Practitioner. – [email protected]; www.apffelstaedt.com