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Hyperparathyroidism occurs when an excess of parathyroid hormone is released by the parathyroid glands in the neck. It generally leads to high levels of calcium in the blood. This can cause various symptoms, commonly tiredness, feeling sick (nausea sick), being sick (vomiting), kidney stones and bone pains. It can usually be treated with surgery.

Parathyroid glands



Normally, parathyroid hormone release is triggered when the level of calcium in your blood is low. When the calcium level rises and is back to normal, the release of parathyroid hormone is suppressed.

Parathyroid hormone has a number of effects in your body:

  • It causes the release of calcium from your bones.
  • It causes calcium to be absorbed (taken up into your blood) from your gut (small intestine).
  • It stops your kidneys from excreting (getting rid of) calcium in your urine.
  • It causes your kidneys to excrete phosphate in your urine.


Calcium and phosphate combine to make calcium phosphate in your body. This is the chief material that gives hardness and strength to your bones and teeth. Calcium is also needed as part of the complex mechanism that helps your blood to clot after an injury. As well, it is needed for your muscles and nerves to work properly. Phosphate works in conjunction with calcium for these functions. Phosphate is also needed for the production of energy within your body.

Hyperparathyroidism is either primary, secondary or tertiary.

Primary hyperparathyroidism


  • A single parathyroid adenoma. This is the most common cause of primary hyperparathyroidism. There is a benign (non-cancerous) tumour of one of your parathyroid glands. This causes more parathyroid hormone to be released by the gland.
  • Hyperplasia affecting more than one parathyroid gland. This accounts for most other cases of primary hyperparathyroidism. Hyperplasia means that there is enlargement of a parathyroid gland. It usually affects more than one gland at the same time. As a result of the enlargement, more parathyroid hormone is released.

It is usually not clear why parathyroid adenoma or hyperplasia occurs. However, if you have had radiotherapy treatment to your head or neck in the past, you seem to have an increased risk of developing a parathyroid adenoma or carcinoma. Primary hyperparathyroidism seems to be more common in women than in men and most commonly affects women after the menopause.

Primary hyperparathyroidism does not usually run in families. However, in a small number of people, it can be the result of an inherited condition called familial isolated hyperparathyroidism. Also, rarely, it may be inherited as part of a syndrome (a collection of problems) called multiple endocrine neoplasia (MEN) which affects the parathyroids, the pancreas and the pituitary gland.

Secondary hyperparathyroidism

Secondary hyperparathyroidism is caused by other diseases or deficiencies that are affecting your body. These other conditions cause a long-standing low level of calcium in your blood. This means that your parathyroid glands are permanently being stimulated to try to raise your blood calcium level. As a result, your parathyroid glands enlarge and their output of parathyroid hormone increases. The raised levels of parathyroid hormone are appropriate due to your low blood calcium level. Some of the causes of secondary hyperparathyroidism include:

  • Kidney disease. This is the most common cause of secondary hyperparathyroidism. Secondary hyperparathyroidism occurs in nearly all people who are on long-term kidney dialysis because of kidney failure. Because you have kidney failure, your blood calcium level can become low and stay low.
  • Vitamin D deficiency (rickets/osteomalacia). This is another common cause. Vitamin D deficiency causes a long-standing low level of calcium in your blood.
  • Gut (intestinal) malabsorption. There are various diseases that can affect your gut and prevent the calcium that you eat from being taken up (absorbed) into your blood. This can cause your blood calcium level to become low and stay low..

Tertiary hyperparathyroidism

This type of hyperparathyroidism occurs as a result of prolonged secondary hyperparathyroidism. In tertiary hyperparathyroidism, the condition causing your low blood calcium level and the secondary hyperparathyroidism has been treated (or your blood calcium level has been corrected). However, your parathyroid glands continue to produce large amounts of parathyroid hormone. This is because they start to act by themselves (autonomously) and are no longer sensitive to your blood calcium level. They are not 'switched off' when your blood calcium level rises. This results in a high calcium level in your blood.

Tertiary hyperparathyroidism is typically seen in people who have chronic kidney failure. It can also persist even after a kidney transplant.



  • Tiredness
  • Weak and easily tired muscles
  • Constipation
  • Tummy (abdominal) pain
  • Feeling very thirsty and passing urine frequently
  • Depression/low mood




  • Kidney stones. Small stones may be passed in the urine without you noticing. Larger stones may get stuck, causing pain in your loin area that radiates to your groin. You may also notice blood in your urine. See separate leaflet called Kidney Stones for further details.
  • Corneal calcification. Calcium can collect (be deposited) in the cornea of your eye. This doesn't usually cause any symptoms.
  • Pancreatitis. This is inflammation of your pancreas gland. Rarely, a high level of calcium due to hyperparathyroidism can cause pancreatitis. This can cause upper tummy (abdominal) pain. See separate leaflet called Acute Pancreatitis for further details.
  • Stomach (peptic) ulceration. A high calcium level can stimulate the production of excess acid in your stomach and lead to stomach ulceration. See separate leaflet called Stomach (Gastric) Ulcer for more details.
  • Kidney damage. A prolonged high calcium level in your blood can damage your kidneys and cause kidney failure.

In all types of hyperparathyroidism (including secondary hyperparathyroidism), the increased level of parathyroid hormone circulating in your blood causes high amounts of calcium to be released from your bones. This can cause weakness and thinning of your bones - a condition known as osteopenia. Your bones may become painful and more susceptible to breaks, or fractures.


If you have secondary hyperparathyroidism, your blood calcium level may be low or normal but you will still have a raised parathyroid hormone level. If you also have kidney disease, your blood phosphate level can be high because your kidney cannot get rid of (excrete) phosphate in your urine.


Once blood tests have shown that you have hyperparathyroidism, you doctor will usually want to confirm which type of hyperparathyroidism you have and to look for any cause. They may also want to look for any complications that you may have. You will usually be referred to a doctor who is a specialist for further tests. Investigations may include:

  • Further blood tests. These can include blood tests to check your kidney function, your pancreas gland, and your bones.
  • DEXA scan. Because hyperparathyroidism can cause thinning of your bones (osteopenia), you may be referred for a special scan to assess your bone thickness. This is called a dual-energy X-ray absorptiometry (DEXA) scan.
  • Kidney ultrasound scan. This can show any kidney stones.
  • Ultrasound, CT or technetium scan of your neck. These can show if you have an enlarged parathyroid gland or glands. A scan may be suggested if surgery is being considered as a treatment option (see below).

The treatment that you have depends on the type of hyperparathyroidism.

Primary hyperparathyroidism


  • Regular monitoring of your symptoms. If you have mild primary hyperparathyroidism, with a mildly raised calcium level and little in the way of symptoms, your doctor may just suggest that you be regularly monitored. The monitoring procedure usually includes blood tests to check your blood calcium level and kidney function, regular blood pressure checks and monitoring for any symptoms that you may have. It may also include dual-energy X-ray absorptiometry (DEXA) bone scanning as described above. This monitoring approach is considered controversial by some. You should discuss the pros and cons with your doctor.
  • Drug treatment. This is used in people with more severe hyperparathyroidism who choose not to have surgery, or who do not meet the guidelines for surgery. Treatment aims to improve bone thickness (density) and correct your high calcium level. Various drugs may be used. These include a group of drugs called bisphosphonates. Another drug called cinacalcet can help to reduce calcium and parathyroid hormone levels and increase the phosphate level in your blood but it does not seem to improve bone density. Sometimes hormone replacement therapy may be suggested in postmenopausal women who also have menopausal symptoms that they wish treatment for.

Secondary hyperparathyroidism

If you develop secondary hyperparathyroidism, it should be treated early to prevent bone complications from developing and also to reduce the chance of tertiary hyperparathyroidism. The underlying condition that is causing secondary hyperparathyroidism needs to be treated; for example, treating vitamin D deficiency with vitamin D supplements.

Chronic kidney disease is the most common cause of secondary hyperparathyroidism. Treatment in chronic kidney disease includes:

  • Cinacalet. This drug reduces the release of parathyroid hormone by the parathyroid glands. It is sometimes used if you have secondary hyperparathyroidism due to chronic kidney disease and other treatments have not been effective, and surgery is not an option for some reason.


Tertiary hyperparathyroidism



  • A low calcium level (hypocalcaemia). Sometimes after surgery, because your bones are 'hungry', calcium and phosphate can be rapidly taken up from your blood and deposited in your bones. This can lead to underactive parathyroid glands (hypoparathyroidism) and a low blood calcium level. The low blood calcium level goes back up to normal when your remaining normal parathyroid glands become sensitive again and can control your blood calcium level. However, sometimes hypoparathyroidism can persist and some people need long-term medication treatment with calcium and vitamin D supplements.

In primary hyperparathyroidism, after successful surgery to remove the parathyroid glands (parathyroidectomy), the outlook is usually excellent and most people are cured. If you do not have symptoms and are followed up without surgery, there is also generally a good prognosis. Significant bone loss and other symptoms may be absent for many years when you are followed up.

However, if you have secondary or tertiary hyperparathyroidism, the prognosis tends to be worse. This is because it is usually caused by underlying advanced chronic kidney failure.


  • Make sure that you drink plenty of fluids and do not become dehydrated.
Original Author:
Dr Michelle Wright
Current Version:
Peer Reviewer:
Dr John Cox
Document ID:
8458 (v4)
Last Checked:
Next Review:
The Information Standard - certified member
See also: Osteoporosis written for professionals