In a new study, nearly all patients with primary hyperparathyroidism (PHP) who had a preexisting diagnosis of fibromyalgia (FM) experienced improvement in their FM symptoms following parathyroid surgery, and 1 in 5 were able to drop all of their FM-related medications.
The finding suggests that a [SMALL] subset of patients diagnosed with FM actually have unrecognized PHP, which can be cured with surgery. The implication is that screening for the endocrine condition should be included as part of the fibromyalgia workup, which it currently is not, Kelly L. McCoy, MD, assistant professor of surgery at the University of Pittsburgh, Pennsylvania, said here at the American Association of Endocrine Surgeons (AAES) 2013 Annual Meeting.
The diagnostic confusion between PHP and FM arises because there is a large symptom overlap between the 2 conditions: in both, patients experience fatigue, musculoskeletal pain, headache, cognitive dysfunction, and mood disturbance. Both conditions are also far more common in women than in men, and both increase with age.
In a recent small study presented at the American College of Rheumatology (ACR) meeting in October 2013, unsuspected PHP was found in 10% of patients diagnosed with FM, in contrast to just 0.1% of the general population.
In the United States, about 100,000 people develop the disorder each year. Women outnumber men two to one, and risk increases with age. In women 60 years and older, two out of 1,000 will develop hyperparathyroidism each year.
When symptoms do appear, they are often mild and nonspecific, such as a feeling of weakness and fatigue, depression, or aches and pains. With more severe disease, a person may have a loss of appetite, nausea, vomiting, constipation, confusion or impaired thinking and memory, and increased and urination.
What are the parathyroid glands?
The parathyroid glands are four pea-sized glands located on the thyroid gland in the neck. Occasionally, a person is born with one or more of the parathyroid glands embedded in the thyroid, in the thymus, or located elsewhere around this area. In most such cases, however, the glands function normally.
Though their names are similar, the thyroid and parathyroid glands are entirely different glands, each producing distinct hormones with specific functions. The parathyroid glands secrete PTH, a substance that helps maintain the correct balance of calcium and phosphorus in the body. PTH regulates the level of calcium in the blood, release of calcium from bone, absorption of calcium in the intestine, and excretion of calcium in the urine.
When the level of calcium in the blood falls too low, the parathyroid glands secrete just enough PTH to restore the blood calcium level.
If the parathyroid glands secrete too much hormone, as happens in primary hyperparathyroidism, the balance is disrupted: Blood calcium rises. This condition of excessive calcium in the blood, called hypercalcemia, is what usually signals the doctor that something may be wrong with the parathyroid glands.
In 85 percent of people with primary hyperparathyroidism, a benign tumor called an adenoma has formed on one of the parathyroid glands, causing it to become overactive. Benign tumors are noncancerous. In most other cases, the excess hormone comes from two or more enlarged parathyroid glands, a condition called hyperplasia. Very rarely, hyperparathyroidism is caused by cancer of a parathyroid gland.
This excess PTH triggers the release of too much calcium into the bloodstream. The bones may lose calcium, and too much calcium may be absorbed from food.
Proper Diagnosis of Hyperparathyroidism May Be Missed
According to endocrinologist and parathyroid expert, Dr. Jim Norman patients are often suffering from parathyroidism but aren’t properly diagnosed;
“It is very rare for an adult (over 30) to have persistent calcium levels above 10.1 or below 9.2. It is OK to have a calcium level in the low to mid 10’s on occasion (infrequently), but usually when checked again it will be back in the 9’s. Calcium levels that are consistently in the low to mid 10’s (in an adult over 30) is almost never normal and will almost always be caused by a parathyroid tumor.
It is classically taught that the diagnosis of hyperparathyroidism requires a high calcium and a high PTH level at the same time. Unfortunately, about 20-25% of patients will not follow this pattern, with some having high calcium levels and all normal PTH levels (16%), while others have normal calcium levels with high PTH levels (4-6%). This will be looked into extensively below. A high calcium and a high PTH at the same time is absolutely NOT required to diagnose primary hyperparathyroidism!”
I continue to find elevated or high normal blood calcium levels in many of my fibro and CFS/ME patients, often they had past labs that showed elevated levels-again simply ignored by their past doctors.
Elevated blood calcium levels on a lab test, even high normal, those above 10 for an adult, should raise red flags. If your calcium is 10, please make sure your doctor does the follow up tests including reordering additional calcium levels every few months and at least one PTH level.
In the last few years I’ve found a couple dozen cases of “missed” hyperparathyroidism. Some required surgery, some saw a great deal of improvement, others only minor improvement in their fibro symptoms. Symptom improvement or not, this is a condition that should be addressed since it can lead to numerous health problems.
You can read more about Dr. Norman’s perspective on diagnosing hyperparathyroidism at https://yourfibrodoctor.com/what-is-hyperparathyroidism/
The Mayo Clinic’s take on hyperparathyroidism can be found here http://www.mayoclinic.org/diseases-conditions/hyperparathyroidism/basics/definition/con-20022086
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