Excess PTH causes bony calcium mobilization, stimulation of renal calcium reabsorption, and inhibition of renal phosphate absorption. Primary hyperparathyroidism is associated with pancreatitis, ephrolithiasis, nephrocalcinosis, gout, pseudogout, hypertension, and peptic ulcer disease. Secondary and tertiary hyperparathyroidismm occur in patients with renal disease. Pseudohyperparathyroidism occurs in oat cell and squamous carcinomas that produce PTH like proteins. Hyperparathyroidism occurs in MEN I and MEN IIa.
Primary hyperparathyroidism is treated surgically, with identification and excision of the adenoma.
If parathyroid hyperplasia is found, the treatment is either removal of three complete glands and much of the fourth, or removal of all four parathyroid glands with or without autotransplantation of some parathyroid tissue into muscle of the forearm. Complications of parathyroidectomy include hypercalcemia, hypoparathyroidism, and recurrent laryngeal nerve injury. The parathyroid glands are found in front of the thyroid gland. There are two small pea-sized glands on either side, just behind the thyroid gland. The parathyroid glands regulate blood levels of calcium.