Primary Hyperparathyroidism in the Elderly

Lisa Pierce

October 12, 2015

Professor Cressy

Informative Outline

Title: Primary Hyperparathyroidism in the Elderly

General Purpose:  To inform

Specific Purpose:  To inform the audience of the effects of primary hyperparathyroidism and the cure for the condition.

Central Idea:  Primary hyperparathyroidism causes vague symptoms in the elderly, is statistically found more often in elderly women than in elderly men, although it effects all ages, and it quite often goes undiagnosed or misdiagnosed for other conditions mostly due to a lack of knowledge of the condition throughout the medical profession.

I.        INTRODUCTION

A.        It is benign, yet will slowly kill you within about twenty years if left untreated.  It is one of the most underdiagnosed, undertreated and underreported endocrine conditions in the world, especially among the elderly, according to university studies performed at UCLA and Second University of Naples, Italy, Tulane Medical Center Department of Endocrinology, Norman Parathyroid Center in Tampa, Florida and the Center for Endocrine Surgery at Cleveland Clinic.  Very noticeable symptoms in the young can seem quite vague in the elderly.  So, what is it?  It’s called primary hyperparathyroidism.

B.        Though there are two types of hyperparathyroidism, primary and secondary, I am going to focus on primary hyperparathyroidism for the purpose of this discussion as it is the most common according to the American Association of Clinical Endocrinologists.  Our four parathyroid (PT) glands, each normally the size of a grain of rice, are usually located in the neck on the backside of the thyroid gland, but have also been found higher or lower in the neck and chest area.  So as to not confuse the two, the PT and the thyroid glands have completely different functions even though they are usually physically connected to one another.  Our PT glands regulate calcium levels in our blood and bones by either increasing, decreasing, or temporarily halting production of parathyroid hormone (PTH) based on the body’s needs.  During normal increases in PTH, very small amounts of calcium is leached out of the bones and released into the bloodstream, so when the blood calcium has reached a safe level, the parathyroid (PT) glands slow the pace of PTH production back down to normal.  However, in the case of primary hyperparathyroidism (PHPT), tumor growth on one or more of the PT glands causes a continuous overproduction of PTH without ever slowing down which, in turn, causes leaching of very high amounts of calcium from bone into the bloodstream (hypercalcemia).  Over time this process results in osteopenia, osteoporosis, hardening of the arteries, decrease in cognitive function, risks for breast, colon, kidney and prostate cancer, organ failure and ultimately, death.  

C.        In 2006 my grandmother was rushed to the emergency room with symptoms of severe dehydration.  Her blood tests came back with a slightly elevated serum calcium level.  Her doctor administered three bags of intravenous fluids and retested her calcium level.  The level had not decreased, but since he treated the dehydration to the point of no more symptoms he released her with orders to take in plenty of fluids, but told her to see her primary care physician for further evaluation.  When my grandmother told me what happened, I immediately started researching high calcium levels and the two main causes that kept coming up were cancer and hyperparathyroid disease.  I called her and asked her about specific symptoms she was having and I was pretty sure I figured it out.  I told my aunt, gram’s caregiver, to ask her primary care physician about hyperparathyroidism.  She said he had heard of the disease, but he would have to refer her to an endocrinologist for an accurate diagnosis.  Sure enough the diagnosis was confirmed, but unfortunately this particular endocrinologist did not recommend surgery as he was not experienced in minimally invasive procedures.    My aunt did not seek a second opinion.  At the time of diagnosis my Gram was eighty-six years of age, but had been having symptoms of the condition for several years prior to diagnosis.  She is now ninety-six and in fourth stage renal failure due to the ignorance and stubbornness of her caregiver, so I feel if I can help shed some light on this condition with others it might help save someone else’s life down the line.

D.        In order to give you a clearer understanding of the disease I will focus on three areas of concern.  First, primary hyperparathyroidism causes very vague symptoms in the elderly as opposed to younger individuals.  Secondly, statistics show it is more prominent in women than in men.  Lastly, the condition often goes undiagnosed or is misdiagnosed as other conditions and is therefore left untreated mainly due to lack of knowledge about the disease throughout the medical profession with the exception of endocrinologists.

II.         BODY

A.        In order to diagnose primary hyperparathyroidism physical and physiological symptoms are usually key factors, but if physiological symptoms are so vague that they’re just written off as signs of aging, then physical symptoms usually become apparent only when the disease is already in its advanced stages.  

1.        Physiological symptoms can include one or more of the following; weakness, fatigue, joint and bone pain, muscle aches and spasms, fractures, constipation, acid reflux, frequent urination, depression, confusion, memory problems, hair loss, anxiety and heart palpitations.

2.        Physical symptoms can include one or more of the following; osteopenia, osteoporosis, kidney stones, kidney failure, high blood pressure, high blood calcium and low vitamin D levels, atrial fibrillation, blood clots, stroke, heart attack, heart failure, and cancers of the breast, prostate, colon and kidneys.

a.        According to an article in Surgery Magazine in December of 2013, “High calcium levels in the blood increases the risk of stroke, heart

attack and heart failure due to the aggressive build-up of calcium in the arteries.”^[1]

b.        According to an article on researchgate.net regarding a study at the Second University of Naples, Italy in August of 2014, “Primary hyperparathyroidism is the leading cause of high blood calcium levels and is responsible for nearly ninety percent of all cases. Once the tumor or tumors are removed symptoms begin to disappear, blood calcium levels drop and bone begins the regeneration process.”^[2]

B.        Statistics from studies performed at UCLA, primary hyperparathyroidism is more prominent in women than men, but even more so in the elderly.