Restoring Hormonal Balance

March 31, 2014

Hyperparathyroidism can make your hormones go awry, but it doesn’t have to.

Whoever said big things come in small packages might have had the parathyroid glands in mind. Four of these tiny glands, each no bigger than a pea, sit behind the thyroid gland, two on each side of the neck, controlling the calcium levels in our blood. When they act up, the consequences can be costly in terms of osteoporosis risk and fractures. This is especially important for women, who are at greater risk both for parathyroid disorders and osteoporosis.

Here is what happens when the parathyroid glands make too much parathyroid hormone (PTH)—and what Providence Health & Services, Southern California, can do to help.

What Is Hyperparathyroidism?

In the majority of parathyroid disorders, the main diagnosis is primary hyperparathyroidism. “In 90 to 95 percent of cases, this is caused by a single gland having an adenoma, a benign tumor of the parathyroid that’s overproducing hormone,” says Marc Cohen, M.D., M.S., FACS, a surgeon with Providence Tarzana Medical Center.

PTH helps absorb calcium and regulates the level of calcium in the blood. “When there is too much PTH, it causes bones to break down to release calcium into the blood,” Dr. Cohen says.

How Is It Treated?

If left untreated, this hormonal disorder can lead to kidney stones, the breakdown of bones and other “moans and groans” The good news is that it’s highly treatable by surgery.

“Since 95 percent of cases are due to one gland or one adenoma being responsible, by simply removing the gland you can cure the disease,” Dr. Cohen says.

At Providence Tarzana, this process is made more precise by using an injectable tracer to highlight the hyperactive gland—and then double-checking that the correct gland has been located by doing an intraoperative PTH level test during surgery. “We send blood to the lab while the patient is asleep. Ten minutes later the lab can tell us if the parathyroid hormone level has returned to normal,” Dr. Cohen says.

Providence Holy Cross Medical Center also prides itself in presurgery precision. “If the PTH is high, it’s not guaranteed that you know which one of the glands is abnormal,” says Kamyar Amini, M.D., a Providence Holy Cross surgeon experienced in minimally invasive parathyroid removal. “The interventional radiologists on staff and I have identified tests—including ultrasound localization—to isolate the problem gland.”

Both Providence Tarzana and Providence Holy Cross offer minimally invasive surgery. “We can send the vast majority of patients home the same day,” Dr. Amini says.

What Causes Hyperparathyroidism?

In nine out of 10 cases, an adenoma is the culprit for hyperparathyroidism.

“An adenoma is an abnormal growth of a gland, a genetic alteration. A single cell begins to grow and divide, grow and divide, and you end up with this large parathyroid that’s producing hormone and not listening to the body’s normal control mechanisms,” Dr. Amini says. “It’s just kind of a bad luck tumor.”

In rare instances, hyperparathyroidism is caused when two or more of the glands are overactive. This is called parathyroid hyperplasia.

Who Is at Risk for Hyperparathyroidism?

“Women with hyperparathyroidism outnumber men three to one,” Dr. Cohen says, noting that it generally affects postmenopausal women in their early 50s. “This is very important for women, because women are more susceptible to osteoporosis as well.”

Hyperparathyroidism is hereditary and is also common in people who have a vitamin D deficiency.