[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Primary hyperparathyroidism [Conditions](https://durgical.com/en/conditions/) · [Head and neck](https://durgical.com/en/anatomy/region/head-and-neck/) # Primary hyperparathyroidism Primary hyperparathyroidism is when a parathyroid gland, usually a benign tumour, makes too much hormone and raises blood calcium. Updated 2026-10-29 ## Structures involved Tap one to see what it is and open it in 3D. - [Parathyroid glands](https://durgical.com/en/anatomy/parathyroid-glands/) - [Thyroid gland](https://durgical.com/en/anatomy/thyroid-gland/) - [Recurrent laryngeal nerves](https://durgical.com/en/anatomy/recurrent-laryngeal-nerve/) - [Inferior thyroid artery](https://durgical.com/en/anatomy/inferior-thyroid-artery/) ## In biochemistry - [Alkaline phosphatase (ALP) as a lab test](https://durgical.com/en/biochemistry/topics/alkaline-phosphatase-as-a-lab-test/) - [Vitamin D (calcitriol)](https://durgical.com/en/biochemistry/molecules/vitamin-d/) - [Calcium and phosphate](https://durgical.com/en/biochemistry/topics/calcium-and-phosphate/) ## In histology - [Ossification, growth plate and bone remodeling](https://durgical.com/en/histology/ossification-growth-plate-and-bone-remodeling/) - [Thyroid follicles, C cells and parathyroid](https://durgical.com/en/histology/thyroid-follicles-c-cells-and-parathyroid/) ## In physiology - [Calcium regulation: PTH, vitamin D and calcitonin](https://durgical.com/en/physiology/calcium-regulation-pth-vitamin-d-and-calcitonin/) - [Bone remodeling](https://durgical.com/en/physiology/bone-remodeling/) - [Phosphate and FGF-23](https://durgical.com/en/physiology/phosphate-and-fgf-23/) - [Renal handling of calcium, phosphate and magnesium](https://durgical.com/en/physiology/renal-handling-of-calcium-phosphate-and-magnesium/) ## Why it happens - [Pathologic calcification: dystrophic vs metastatic](https://durgical.com/en/general-pathology/pathologic-calcification-dystrophic-vs-metastatic/) - [Hereditary cancer syndromes: the table to know](https://durgical.com/en/general-pathology/hereditary-cancer-syndromes-the-table-to-know/) - [Frozen section: the intraoperative consultation](https://durgical.com/en/general-pathology/frozen-section-the-intraoperative-consultation/) - [Hyperplasia: physiologic and pathologic](https://durgical.com/en/general-pathology/hyperplasia-physiologic-and-pathologic/) ## What it is Excess parathyroid hormone made by one or more [parathyroid glands](https://durgical.com/en/anatomy/parathyroid-glands/), usually a single benign adenoma, causing high blood calcium. ## Who gets it A common cause of hypercalcaemia in outpatients, most often found by chance on routine blood tests; more frequent in postmenopausal women. ## Causes - Single parathyroid adenoma (most cases) - Hyperplasia of all four glands (including MEN 1 and MEN 2A) - Parathyroid carcinoma (rare) ## Risk factors - Female sex and older age - Neck irradiation - Long-term lithium therapy - Inherited syndromes (MEN 1, MEN 2A) ## Pathophysiology Autonomous PTH secretion raises calcium by increasing bone resorption, renal calcium reabsorption and vitamin D activation (more intestinal absorption). PTH also lowers renal phosphate reabsorption. The calcium load filtered by the [kidney](https://durgical.com/en/anatomy/kidney/) rises, favouring stones, and bone loss affects cortical bone most. ## Classification - Hypercalcaemic (classic) - Normocalcaemic - Symptomatic versus asymptomatic ## Symptoms and signs - Often none (found on routine tests) - Kidney stones and polyuria - Bone pain and fractures from osteoporosis - Abdominal pain, constipation, nausea, peptic ulcer or pancreatitis - Fatigue, depression and difficulty concentrating ## Red flags - Very high calcium with confusion, vomiting and dehydration (hypercalcaemic crisis) - Very high PTH and calcium with a palpable neck mass (consider parathyroid carcinoma) ## Diagnosis **Clinical** History of stones, fractures and medicines (thiazides, lithium); family history. **Tests** High calcium with high or inappropriately normal PTH; phosphate, creatinine, 25-hydroxy vitamin D and 24-hour urine calcium (to exclude familial hypocalciuric hypercalcaemia); ECG may show a short QT. **Imaging** Bone densitometry and renal imaging assess end-organ effects; neck ultrasound and sestamibi scan localise the gland before surgery (they do not make the diagnosis). ## Differential diagnosis - Hypercalcaemia of malignancy (low PTH) - Familial hypocalciuric hypercalcaemia - Thiazide- or lithium-associated hypercalcaemia - Vitamin D excess or granulomatous disease - Secondary or tertiary hyperparathyroidism ## Goal of treatment Cure the excess PTH where indicated and protect bones and kidneys. ## Treatment **Surgical** Parathyroidectomy, often a focused removal of a localised adenoma; the only cure. **Medical** Calcimimetics to lower calcium, and bisphosphonates to protect bone, when surgery is not done. **Acute** Hypercalcaemic crisis: intravenous fluids, then drugs that reduce bone resorption, in hospital. **Follow-up** Regular calcium, renal function and bone density in patients managed without surgery. ## Complications - Kidney stones and nephrocalcinosis - Osteoporosis and fractures (osteitis fibrosa cystica in severe disease) - Pancreatitis and peptic ulcer - Hypocalcaemia after surgery (hungry bone syndrome) ## Prognosis Surgery by an experienced surgeon cures most patients and improves bone density and stone risk. Many mild cases stay stable under follow-up. ## Test yourself Think of the answer, then tap the question to see it. ## What is the most common cause of primary hyperparathyroidism? A single parathyroid adenoma. ## What is the classic laboratory pattern? High calcium, high or inappropriately normal PTH and low or low-normal phosphate. ## Which condition is excluded with a 24-hour urine calcium? Familial hypocalciuric hypercalcaemia, where urine calcium is low. ## Which mnemonic summarises its symptoms? Stones, bones, abdominal groans and psychiatric moans. ## Does a sestamibi scan diagnose primary hyperparathyroidism? No; the diagnosis is biochemical. Imaging only localises the gland before surgery. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/primary-hyperparathyroidism/) ## Related conditions - [Kidney stones (urolithiasis)](https://durgical.com/en/conditions/kidney-stones/) - [Osteoporosis](https://durgical.com/en/conditions/osteoporosis/) - [Acute pancreatitis](https://durgical.com/en/conditions/acute-pancreatitis/) - [Peptic ulcer disease](https://durgical.com/en/conditions/peptic-ulcer-disease/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Primary Hyperparathyroidism](https://www.ncbi.nlm.nih.gov/books/NBK441895/) (StatPearls (NCBI Bookshelf), 2026). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/primary-hyperparathyroidism/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/primary-hyperparathyroidism/