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Hypoparathyroidism and hyperparathyroidism – what are signs and symptoms?

Hypoparathyroidism and hyperparathyroidism

Hypoparathyroidism and hyperparathyroidism

Hypoparathyroidism and hyperparathyroidism are rare hormone disorders caused by the parathyroid glands in the neck producing too little (hypo) or too much (hyper) parathyroid hormone.

Parathyroid glands

There are four parathyroid glands, each the size of a grain of rice, in your neck behind the thyroid gland, They produce parathyroid hormone (PTH) which helps control the levels of calcium, phosphorus and vitamin D within the bones and blood.

This is important because these levels can naturally fluctuate and need to be kept within a healthy range for the body to function properly. For example, calcium levels can rise if you eat a dairy-rich meal, and can fall if you take certain medication.

The parathyroid glands are nothing to do with the thyroid gland. ‘Parathyroid’ means ‘near the thyroid’. Parathyroid disorders shouldn’t be confused with an underactive thyroid or overactive thyroid.

Hypoparathyroidism

Hypoparathyroidism means the parathyroid glands produce too little PTH. This causes blood calcium levels to fall (hypocalcaemia) and blood phosphorus levels to rise (hyperphosphataemia).

You may need to take supplements for life to restore these levels. Read more about treating hypoparathyroidism.

Symptoms

The symptoms of hypoparathyroidism vary depending on the cause, the speed at which the condition develops and the effectiveness of treatment.

People who develop hypoparathyroidism quickly (for example, after neck surgery) can have the following symptoms:

a tingling sensation in the hands or feet or around the mouth (paraesthesia)

unusual muscle movements, such as jerking, twitching or muscle spasms

muscle cramps

feeling tired, irritable, anxious or depressed

People with long-lasting (gradually developing) hypoparathyroidism caused by other medical conditions can also have:

eye problems, particularly cataracts

dry, thick skin

coarse hair that breaks easily and can fall out

fingernails that break easily, with ridges that go from left to right

It’s possible that very low calcium levels can cause fits, but this is rare, particularly if you’ve had the condition for some time and are being treated with medication.

Anxiety can often make you breathe rapidly (hyperventilate). This could make you feel ill and cause your calcium level to fall even further, so it’s important to remain calm.

Many symptoms listed above aren’t specific to hypoparathyroidism. They can also be caused by other conditions.

Causes

Hypoparathyroidism is most commonly caused by accidental injury to the parathyroid glands during head and neck surgery. In about 12% of people undergoing surgery it lasts for only a short time, with less than 3% having permanent hypoparathyroidism.

Other causes include:

destruction of the parathyroid glands by the immune system in people with autoimmune diseases, where the body mistakenly attacks its own tissues

radiation therapy to the neck for thyroid cancer

surgical removal of the parathyroid glands as a result of cancer

low blood magnesium levels – for example due to alcohol misuse

Who’s affected

You’re more likely to develop hypoparathyroidism if you:

have had recent thyroid or neck surgery

have a family history of parathyroid disorder

have Addison’s disease

Children or adults with the inherited genetic disorder known as Di-George syndrome will also have hypoparathyroidism because their parathyroid glands are missing at birth.

Diagnosis

Hypoparathyroidism is diagnosed after a blood test shows:

low blood calcium levels

low blood PTH levels

high blood phosphorus levels

If you have hypoparathyroidism an electrocardiogram (ECG) may show abnormal heart rhythms and a urine test will show high levels of urinary calcium (too much calcium leaving the body).

Treatment

Treatment aims to bring the blood levels of calcium and other minerals back to normal.

The normal calcium range is around 2.1-2.50 millimoles per litre (mmol/L). You should aim to maintain your blood calcium levels at 1.80-2.25 mmol/L.

Calcium carbonate and vitamin D supplements – usually calcitriol (Rocaltrol) or alfacalcidol (One-Alpha) – can be taken to restore these levels. With the exception of people who have short-lived hypoparathyroidism after neck surgery, these supplements usually have to be taken for life. You’ll also need to have regular blood tests to monitor your blood levels. The aim of therapy is to relieve your symptoms and keep calcium in the near-normal or low-normal range.

It’s also recommended that you follow a high-calcium, low-phosphorus diet.

Good sources of calcium include:

milk, cheese and other dairy foods

green leafy vegetables, such as broccoli, cabbage and okra, but not spinach

soya beans

tofu

soya drinks with added calcium

nuts

bread and anything made with fortified flour

fish where you eat the bones, such as sardines and pilchards

Phosphorus is found in:

red meat

dairy foods

fish

poultry

bread

rice

oats

If your blood calcium levels fall to a dangerously low level, or you keep having muscle spasms, you may need to be given calcium through a drip directly into your vein. Your heart rhythm will also be monitored until it’s stable. You’ll then continue treatment with supplements.

Complications

Hypoparathyroidism can sometimes lead to:

stunted growth

poorly developed teeth

slow mental development

cataracts

Sometimes, hypoparathyroidism can occur with other autoimmune conditions, such as Addison’s disease and pernicious anaemia.

Excessive calcium replacement can cause complications, such as kidney stones.

Hyperparathyroidism

Hyperparathyroidism is where the parathyroid glands produce too much PTH. This causes blood calcium levels to rise (hypercalcaemia) and blood phosphorus levels to fall (hypophosphataemia).

Symptoms

Hyperparathyroidism doesn’t always cause symptoms. It’s often diagnosed while having a blood test for another unrelated problem.

When high calcium levels do cause symptoms, they can be mild or general and include:

depression

fatigue

feeling thirsty and passing a lot of urine

feeling sick and losing your appetite

muscle weakness

constipation

tummy pain

loss of concentration

mild confusion

Left untreated, high blood levels of calcium can cause:

vomiting

drowsiness

dehydration

confusion

muscle spasms

bone pain or tenderness

irregular heart beat

high blood pressure (hypertension)

In severe cases, high calcium levels can lead to loss of consciousness and coma. They can also cause a number of other possible complications (see below).

The severity of your symptoms doesn’t always match up to the calcium level in your blood. For example, some people with a slightly raised calcium level may have symptoms while others with high levels can have little or no symptoms. Symptoms depend, in part, on the rate with which calcium levels become raised.

Causes

There are two main types of hyperparathyroidism. They are:

primary – when one or more of the parathyroid glands is enlarged or overactive, for reasons explained below, and the abnormality causing it is within the gland itself

secondary – when nothing is wrong with the gland, but there’s a condition, such as kidney failure or vitamin D deficiency, that lowers calcium; the body reacts by producing extra parathyroid hormone to stop calcium levels from falling to a very low level

Rarely, when secondary hyperparathyroidism goes untreated for too long, the gland remains overactive all the time. This is known as tertiary hyperparathyroidism. It’s most commonly seen in people who’ve had kidney failure for a long time.

The main cause of primary hyperparathyroidism is a non-cancerous tumour called an adenoma growing on one of the parathyroid glands, causing it to become overactive. Primary hyperparathyroidism may also result from two or more of the glands becoming enlarged (hyperplasia).

In rare cases, primary hyperparathyroidism can occur as a result of inherited genes and the diagnosis is made at a younger age. Very rarely, it’s caused by cancer of a parathyroid gland.

Who’s affected

Most cases of hyperparathyroidism occur in people with no family history of the condition. Only about 5% of cases can be linked to an inherited problem.

Women are twice as likely as men to develop hyperparathyroidism and the risk increases with age.

Diagnosis

Hyperparathyroidism is diagnosed after a blood test shows:

high levels of PTH

high levels of blood calcium

low levels of phosphorus

A DEXA scan (a bone density X-ray) can help detect bone loss, fractures or bone softening, and X-rays, CT scans or ultrasound scans may show calcium deposits or kidney stones. While scans may help plan management, they’re not essential for the diagnosis of the condition, which is based on blood tests.

Treatment

Primary hyperparathyroidism can only be treated with surgery to remove the adenoma from the parathyroid gland. Surgery is effective in curing about 97% of hyperparathyroidism cases.

Bisphosphonate medicines are sometimes used to lower very high calcium levels. It’s usually given as an intravenous drip (directly into the vein). Bisphosphonates may also be used to treat osteoporosis.

Make sure you have a healthy, balanced diet. You don’t need to avoid calcium altogether, and a lack of dietary calcium is more likely to lead to a loss of calcium from your skeleton, resulting in brittle bones (osteoporosis). However, you should avoid a high-calcium diet and drink plenty of water to prevent dehydration.

Treatment of secondary hyperparathyroidism depends on the underlying cause. Kidney disease is the most common cause of secondary hyperparathyroidism (read more about treating chronic kidney disease). In some people with secondary hyperparathyroidism caused by kidney disease, a tablet called cinacalcet may be used to help control the condition.

Complications

Complications of hyperparathyroidism are rare but include:

osteoporosis and bone fractures

kidney stones and blockage, and kidney damage or failure

peptic ulcers

pancreatitis (inflammation of the pancreas)

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Cushing’s syndrome – what are the signs and symptoms of Cushing’s syndrome

Cushing's syndrome

Cushing’s syndrome

Introduction

Cushing’s syndrome (hypercortisolism) is a collection of symptoms caused by very high levels of a hormone called cortisol in the body.

The symptoms of Cushing’s syndrome include:

weight gain

thinning skin that bruises easily

reddish-purple stretch marks on the thighs, stomach, buttocks, arms, legs or breasts

fat deposits that develop in the face, causing it to become round

muscle or bone weakness

decreased interest in sex (loss of libido)

What causes Cushing’s syndrome?

Cushing’s syndrome often develops as a side effect of treatment with corticosteroids. Corticosteroids are widely used to reduce inflammation and treat autoimmune conditions (where the immune system malfunctions and attacks healthy tissue).

People taking high doses of corticosteroids long-term often have a build-up of cortisol in their blood. This type of Cushing’s syndrome is sometimes called iatrogenic Cushing’s syndrome.

A less common cause of Cushing’s syndrome is where a tumour (growth) develops inside one of the body’s glands, causing it to produce an excessive amount of hormones. This is known as endogenous Cushing’s syndrome.

Read more about the causes of Cushing’s syndrome.

Diagnosing Cushing’s syndrome

Cushing’s syndrome can be difficult to diagnose because the symptoms are similar to those of other more common conditions, such as an underactive thyroid gland and high blood pressure.

Your GP will need to know whether you’ve been taking medication, and you’ll probably need to have a urine test, blood test, or saliva test to measure the levels of cortisol in your body.

Read more about how Cushing’s syndrome is diagnosed.

Treating Cushing’s syndrome

The main treatment for iatrogenic Cushing’s syndrome is to decrease or withdraw the use of corticosteroids. However, this must be done gradually to avoid any unpleasant side effects.

For endogenous Cushing’s syndrome, surgery to remove the tumour is usually recommended. If surgery is unsuccessful or it’s not possible to remove the tumour safely, medication can be used to counter the effects of the high cortisol levels.

Although treatment is effective, it can take some time to bring the symptoms under control – any time from a few weeks to a few years in some cases.

Left untreated, Cushing’s syndrome can cause high blood pressure, which increases the risk of heart attack and stroke.

Read more about treating Cushing’s syndrome.

Who’s affected?

Cushing’s syndrome is very rare, affecting around 1 in 50,000 people. Anyone can get it, although it tends to affect adults aged from 20 to 50 years. Women are three times more likely to develop the syndrome than men.

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Acromegaly – what are the signs, symptoms , causes and treatments of Acromegaly?

Growth hormone complications

Growth hormone complications

Acromegaly is a condition in which the body produces too much growth hormone, leading to the excess growth of body tissues over time.

Typical features include:

  • abnormally large hands and feet
  • large, prominent facial features
  • an enlarged tongue
  • abnormally tall height (if it occurs before puberty)

Growth hormone is produced and released by the pituitary gland, a pea-sized gland just below the brain.

When growth hormone is released into the blood, it stimulates the liver to produce another hormone – insulin-like growth factor 1 (IGF-1) – which causes growth of muscle, bones and cartilage throughout the body.

This process is essential for growth and repair of body tissues.

What happens in people with acromegaly?

Acromegaly is caused by excessive production of growth hormone.


This usually occurs as the result of a benign (non-cancerous) brain tumour in the pituitary gland called an adenoma, but rare cases have been linked to tumours elsewhere in the body, such as in the lungs and pancreas.

Although acromegaly does very occasionally run in families, most adenomas are not inherited – they usually develop spontaneously as a result of a genetic change within a cell of the pituitary gland. This genetic change switches on a signal that tells cells in the pituitary gland to divide and secrete growth hormone.

The tumour almost never spreads to other parts of the body, but it may grow to more than 1cm in size and compress the surrounding nerves and normal pituitary tissue, which can affect the production of other hormones, such as thyroid hormones released from the thyroid gland.

Who is affected

It’s not clear exactly how many people are affected by acromegaly, although it’s been estimated that around 4 to 13 in every 100,000 people may have the condition.

This means there is likely to be between 2,500 and 8,300 people in the UK with the condition.

Acromegaly can affect people of any age, but it is rare in children. The average age at which people are diagnosed is around 40-45.

Problems caused by acromegaly

Acromegaly can cause a wide range of symptoms that tend to develop slowly over time.

Typical symptoms include:

Some of the above symptoms are the result of the tumour compressing nearby tissues – for example, headaches and vision problems may occur if the tumour squashes nearby nerves.

If you think you have acromegaly, see your GP straight away. Acromegaly can usually be successfully treated with brain surgery and medication, but early diagnosis and treatment is important to prevent the symptoms getting worse and to reduce your chance of getting complications.

Possible complications

If acromegaly is left untreated, you may be at risk of the following health problems:

Left untreated, these complications can become serious and fatal.

Diagnosing acromegaly

Blood tests

If your doctor suspects acromegaly from your symptoms, they will order blood tests to measure your levels of human growth hormone.

Levels of growth hormone naturally vary from minute to minute as it is released from the pituitary gland in spurts. Therefore to accurately diagnose acromegaly, growth hormone needs to be measured under conditions that normally suppress growth hormone secretion.

To ensure an accurate result, you may be referred to a hospital doctor for a glucose tolerance test. This involves testing your blood after drinking a solution or drink containing the sugar glucose.

In most people, drinking the glucose solution will suppress the release of growth hormone, but in people with acromegaly, the level of growth hormone in the blood will remain elevated.

Your doctor will also measure your level of IGF-1, which should increase with the level of growth hormone. An elevated IGF-1 level almost always indicates acromegaly.

Brain scans

You may then have a magnetic resonance imaging (MRI) scan of your brain to locate and define the size of the pituitary gland tumour causing your acromegaly.  A computerised tomography (CT) scan can be carried out if you are unable to have an MRI scan.

Treating acromegaly

Treatment aims to:

  • reduce excess growth hormone to normal levels
  • relieve the pressure the tumour is exerting on the surrounding structures
  • treat any hormone deficiencies
  • improve the symptoms of acromegaly

This is usually achieved through surgical removal of the tumour and medication.

Brain surgery

In most cases, surgery is recommended to remove the adenoma from your pituitary gland. This is effective in most people, although sometimes the tumour is too large to be removed completely.

Under a general anaesthetic, the surgeon will make an incision inside your nose or behind your upper lip to access the gland. An endoscope (a long, thin, flexible tube that has a light source and a video camera at one end) and surgical instruments are then passed through the incisions to remove the tumour.

Removing the tumour promptly relieves the pressure on the surrounding structures and leads to a rapid lowering of growth hormone levels. Facial appearance and swelling often improve within a few days.

Possible complications of surgery include damage to the healthy parts of the pituitary gland, leakage of cerebrospinal fluid (which surrounds and protects the brain), and  meningitis, though this is rare. Your surgeon will discuss these risks with you and answer any questions you have.

Radiotherapy

If surgery is not possible, or surgery and medication do not cure the condition, radiotherapy aimed at the adenoma may be an option.

This can eventually lead to a reduction in growth hormone levels, although it may not have a noticeable effect for several years and you may need to take medication in the meantime.

There are two main types of radiotherapy for acromegaly:

  • Stereotactic radiosurgery – where a high-dose beam of radiation is precisely aimed at the tumour, requiring you to wear a rigid head frame to keep your head still. This can sometimes be done in a single session.
  • Conventional radiotherapy – where the tumour is targeted with external beams. This can potentially damage the surrounding pituitary gland and brain tissue, so small doses of radiation are given over four to six weeks, giving normal tissue time to heal in between treatments.

Stereotactic radiosurgery is generally preferred to conventional radiotherapy because it minimises the risk of damage to nearby healthy tissue, although it is not always widely available.

Radiotherapy can have a number of side effects. For example, the treatment will often cause a gradual decline in the production of other hormones from your pituitary gland, so you’ll usually need to take hormone replacement therapy for the rest of your life. There’s also a risk it will impair fertility. Speak to your doctor about the risks involved.

Bowel cancer screening

There is some evidence acromegaly may increase your risk of bowel cancer, so guidelines recommend having a colonoscopy when you are diagnosed with the condition, and regular colonoscopy screening from the age of 40.

A colonoscopy is an examination of your entire large bowel using a type of endoscope called a colonoscope that is inserted into your bottom. See bowel cancer tests for more information about what a colonoscopy involves.

Outlook

Treatment is often effective at stopping the excessive production of growth hormone and improving problems caused by the condition. Treatment can also increase life expectancy to around that of someone without acromegaly.

Some treatments can take a long time to have a noticeable effect and you may need to take medication for a long period of time.

After treatment, you’ll need regular follow-up appointments with your specialist for the rest of your life. These will be used to monitor your pituitary function, check you are on the correct hormone replacement treatment, and to ensure the condition does not return.

Without treatment, acromegaly can cause long-term problems and may reduce life expectancy by a number of years.

[Original article on NHS Choices website]

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Testosterone Deficiency Syndrome – What is it? What are it’s signs and how can it be treated?

 

Testosterone Deficiency Syndrome

Testosterone Deficiency Syndrome

A survey has lifted the lid on how men really feel when it comes to talking about sensitive topics, with nearly half of British men (49%) more comfortable discussing difficult financial matters than sensitive health issues such as loss of libido.

With only 4 in 10 (41%) regularly speaking with their partner about their physical and mental health, sensitive issues are proving to be a harder topic for today’s man to tackle, even in 2016.

However, experts are concerned that men’s lack of openness about their health may be stopping them from tackling any issues they are facing.

One such issue is  testosterone deficiency syndrome or TDS, which affects around 700,000 men aged between 50 and 79 in the UK.

So we decided to interview Dr Douglas Savage who is both a GP and men’s health expert to find more about testosterone deficiency syndrome.  What are the signs and symptoms of testosterone deficiency syndrome?  How is testosterone deficiency syndrome treated?  Who is affected by testosterone deficiency syndrome?  Find out more in this fascinating interview below!

Patient Talk – From a clinical point of view, what is testosterone deficiency syndrome?


Dr Doug Savage – It’s a combination of a lower level of testosterone than normal and typical symptoms, the typical symptoms are what we call sexual and non-sexual ones, the sexual ones may be, erection problems and the non-sexual ones which are often actually more striking than the sexual ones , excessive fatigue, poor concentration, the patient often uses the word brain fog , they tend to find it difficult to think things through , they may have a depressed moods, they may be irritable , some of them get excess sweating but I would say the most striking one is the fatigue they often say it’s ridiculous as they could sit down and go straight to sleep.

Patient Talk – Who is affected by testosterone deficiency syndrome?

Dr Doug Savage – This can occur in men of all ages but it’s defiantly like a lot of other things most common as you get older and the reason it gets common as you get older is there is obviously a slight falling of testosterone with age so it’s often related to lifestyle deterioration as one gets older, it’s the same as putting weight on around the middle and as weight goes on around the middle this lowers testosterone and they often get into a vicious cycle as the more fat that goes on there lowers testosterone further and also lack of exercise, so once again this is a condition in many men related to lifestyle but it isn’t all that mainly slim men who exercise but it can get it but its commoner with people with poor lifestyle.

Patient Talk – And what are the main causes of TDS and are there other common co-commodities

Dr Doug Savage – Right so we’ve been into that already it often part of lifestyle or poor lifestyle so excess fat particular around the middle , lack of exercise but it’s also associated with typical medical conditions the commonest one being type  2 diabetes and it can occur in about 40% in those patients, its commoner in man with high blood pressure , cardiovascular disease so many who have had heart attacks, it’s also quite common in men with chronic  diseases so what we call in nowadays CODP or what the public often call chronic bronchitis, people with poor kidney function and liver function and deterioration, HIV patients and also the thing that people may not be aware of is people who use chronically powerful pain relievers, it can occur there and often missed there because people just think that they feel sleepy because of the medication .

Patient Talk – Ok and what are the treatments of TDS?

Dr Doug Savage – There are many which will obviously will be discussed with the doctor in detail but generally like so many other conditions it starts with lifestyle modification, reducing that weight and increasing exercise but other treatments are several and would be discussed with your physician.

Patient Talk – And how effective are these treatments?

Dr Doug Savage – The great majority of men do improve both with rising level of testosterone and deduction in their symptoms and I would say there is quite a variation in the speed of recovery , you really do you know working as a doctor in this field many years you do get what I call miracle men and you know within two or three weeks they have just transformed, they will often say ‘god I feel 20 years younger ‘ so that’s the dramatic improvement which is unusual to be honest with you it’s generally a more slow improvement over months and for a few people it’s really a long time until they get fully well maybe even a year or so. We have established one of the reasons of that is connected with what we call ‘deficiency of the testosterone sector ‘basically it’s one thing improving the level of testosterone in the blood stream but obviously what matters is how their body uses that testosterone and its now been shown that peoples efficiency various from one person to another which can’t be predicted but I do warn all patient that this may take some time but be patient.

Patient Talk – Ok and what is the general prognosis of TDS and what changes in lifestyle that someone with TDS expect?

Dr Doug Savage – Well its great in the sense of that many patients we see will say ‘ oh I’ve tried this diet , I’ve tried this and I can’t seem to lose weight’ well what is amazing is often it’s a combination of lifestyle intervention so that’s obviously eating more appropriate food and less of it and medical treatment and if you put the two together that often does produce great improvements in symptoms and the waistline and there are definite trails showing that waist measurement can reduce on treatment and indeed in men improvement of a diabetic control for a diabetic, improvement of blood pressure as if they are losing weight than obviously that will improve so a combination of lifestyle and other treatments can have a great response.

Patient Talk – Ok and what advice would you give to someone who has just been diagnosed with TDS?

Dr Doug Savage – Well to follow the doctor’s advice as I said, the problem is as we know we never, patients particularly men are terrible at taking following up appointments, getting blood tests and you know I do feel sorry for patients as like everybody else we have such busy lives and obviously it’s too tempting to not go back for review so it is very important that a patient attends follow up appointments and the appropriate blood tests.

Patient Talk  – Ok and where can people go for more information?

Dr Doug Savage – Right well there is a very good website its especially about TDS and that is called www.whatistds.com and they can obviously google TDS deficiency symptoms and there is a lot of information there, there is loads of information out there and that’s one thing men are least good at they are not very good at talking about things but they are very good at doing the research online and there is plenty of information.

Patient Talk – Ok Dr Savage thank you very much.