The most common cause of hypercalcaemia (raised calcium levels in the blood) is hyperparathyroidism. This is usually caused by a benign tumour (of the parathyroid gland) producing too much parathyroid hormone.
Parathyroid hormone stimulates the release of calcium from bones into the blood stream thereby making the bones brittle. Parathyroid hormone also reduces the amount of calcium lost in urine such that this calcium being retained in the blood. Lastly parathyroid hormone increases the amount of calcium absorbed from the intestine. All of these actions cause increased amounts of calcium in the blood (hypercalcaemia) resulting in a wide range of symptoms. Parathyroid hormone is produced by the parathyroid gland. Most people have four parathyroid glands which sit behind the thyroid gland in the lower part of the neck.
Most people who have a parathyroid adenoma and hypercalcaemia will be unaware of it as they would have no symptoms. The diagnosis is usually made incidentally on a routine blood test. On close questioning, a lot of people will probably agree that they have certain symptoms – tiredness, lethargy, weakness, mild aches and pains, anorexia, weight loss, low mood, stone formation, nausea/vomiting (often intractable), polyuria, excessive thirst, excessive passing of urine, abdominal pain, constipation, confusion, corneal calcification. So, hypercalcaemia may cause any of these symptoms but any of these symptoms may not necessarily be due to hypercalcaemia.
Diagnosing hyperparathyroidism is straight forward a lot of the time. What causes debate is which patients should be treated because the definitive treatment is surgery. Patients who have symptoms or very high calcium levels should be treated. Mr Olarinde also treats patients who have bone or kidney disease caused by high calcium levels. Mr Olarinde is also of the opinion that patients should be treated if they want to be, even in the absence of overt symptoms, as hypercalcaemia rarely gets better without treatment. Many times it progressively gets worse. Mr Olarinde will carefully go through the results of your blood tests and your symptoms for both of you to come to a decision about treatment
Treatment for hypercalcaemia caused by primary hyperparathyroidism (PHPT) is almost always surgical removal (excision) of a parathyroid adenoma. There are four parathyroid glands in the lower half of the neck and it is usually one of them that has developed into an adenoma. Occasionally more than one gland may have changed into an adenoma. Mr Olarinde works closely with radiologists (doctors who specialise in reporting x-rays and scans) who are very experienced at looking at scans to help determine which of the four glands is the culprit. The offending parathyroid gland is carefully removed at a relatively straightforward operation with most patients becoming eucalcalcaemic (normal calcium levels). Mr Olarinde enters results of his surgical work into a national audit database.