Hamburg- The parathyroid glands are hardly bigger than a lentil and yet their function in the body is vital. When the parathyroid cannot function, the result is often muscle cramps. If the parathyroid is overactive, it can cause fatigue, depression or high blood pressure, and only an operation can help correct the problems.
The parathyroid has one simple task: to produce a hormone that is important for the regulation of calcium in the body, said professor Jochen Kussmann, head of the clinic for endocrinologic surgery at Eilbek Hospital in Hamburg. In order to work, the hormone requires vitamin D.
As with the thyroid, if the parathyroid is overactive, producing too much of the hormone or underactive, producing too little, an illness can result either way. The hormone produced by the parathyroid is called parathormone or PTH. If there is too little, the level of calcium in the blood sinks.
One cause of this is the small glands, which are attached to the thyroid, sometimes are removed during surgery on the thyroid.
The consequences of failing to treat an underfunctioning parathyroid are serious. They include bad muscle cramps all over the body, stomach cramps and parts of the brain and heart muscle can calcify.
The therapy is difficult because the PTH cannot functionally be replaced, said parathyroid endocrinologist Reinhard Santen of Frankfurt.
"I have to take a detour and can only treat the effects," said Santen. People who undergo a long-term therapy must reckon with taking vitamin D and calcium for the rest of their lives.
An overactive parathyroid or hyperparathyroidism, is more common than an underactive one. The cause of this in four out of five cases is a mostly benign cell proliferation that leads to an increase in the secretion of PHT.
The classic complaints of patients with hyperparathyroidism are bone and stomach pain as well as kidney and gallstones caused by too much calcium in the blood. The calcium loss weakens the bones and stomach lining hurts because the high level of PTH leads to a higher level of acid.
But it need not advance to that stage. There are simple tests to measure the level of PTH in the blood to detect the illness early.
To be certain, Kussmann said patients should have their urine tested for calcium and have a test in which they are given a weak injection of radioactive liquid that accumulates in the parathyroid. Ultrasound also can be used to detect enlarged glands.
Thanks to current diagnostic techniques, new symptoms are being attributed to the condition overactive parathyroid such as fatigue, pain in the bones and joints, pain in the upper stomach, heartburn and high blood pressure. Depression also can begin with an increase in PHT production, which is why Kussmann calls PTH the sadness hormone.
An enlarged parathyroid usually requires surgery, and it takes experience to find the small glands as they can wander, according to Kussmann. If a patient is too old or too ill to undergo an operation, doctors commonly rely on osteoporosis medications, which are supposed to impede bone loss and reduce the calcium level.
