Page 18 - Boca Club News - October '23

Page 18, Boca Club News
Medical Matters:

Hyperparathyroidism

By Richard Nagler, M.D., a member a benign growth called an adenoma and can be removed. urine and a Sestambi scan (nuclear medical imaging) and
of Broken Sound Club and retired Cancer is very rare. a 4-dimensional CT scan of the neck to detect any growth
physician. After graduating from In secondary hyperparathyroidism the normal glands or enlargement of a parathyroid gland.
the University of Pennsylvania and respond to another condition—causing a loss of calcium If symptoms are mild, with calcium levels only slightly
New York University’s School of such as kidney failure and severe vitamin D deficiency—by elevated, patients can be monitored every six months to a
Medicine, Dr. Nagler served his increasing PTH production to keep calcium levels normal. year by following calcium levels, kidney function and blood
internship and residency at Baltimore In the early stages of this disease there may be no pressure. They should be well hydrated, exercise more to
City Hospital and Johns Hopkins. He symptoms, and the diagnosis inadvertently made by keep bones strong, avoid thyazide diuretics or lithium—
followed that with a Fellowship in discovering increased levels of calcium in the blood. Mild which can increase calcium in the blood—and take vitamin
Gastroenterology at Yale University School of Medicine, symptoms include joint pain, muscle weakness, fatigue, D supplements.
and was then Chief of Gastroenterology at Fitzimmons depression, loss of concentration and anorexia. More Biophosphates such as fosamax, zometa and bonival help
General Army Hospital in Denver. He returned to the Yale severe symptoms include nausea and vomiting, confusion, prevent loss of calcium from bones. If patients have severe
Medical School for one year as an Assistant Professor of increased urination, increased thirst, constipation and bone disease with an adenoma or hyperplasia, especially those
Medicine before opening his own successful private practice pain. Patients will exhibit decreased kidney function, kidney over age 50, with osteoporosis, vertebral fractures, kidney
in Internal Medicine and Gastroenterology. During that stones, osteoporosis and hypertension. stones, a GFR (glomerular filtration rate) less than 60 and
time, he also served for ten years as Chief of Medicine at The diagnosis is made by blood test revealing increased an excessive 24-hour urinary removal rate of calcium over
Huntington Hospital in Huntington, N.Y. calcium and PTH levels. Additional tests should be done 300 mg, surgical removal of the affected gland is strongly
There are four very small parathyroid glands which lie such as a bone density, an ultrasound of the kidneys advised, with a 95% cure rate expected. The remaining
just under the thyroid gland. Their function is to regulate (looking for stones), kidney function tests, vitamin D glands readily make up for the reduction of PTH returning
calcium levels in the blood. Hyperparathyroidism occurs levels, a 24-hour test for the amount of calcium in the it back to normal levels.
when one or more of these glands produce too much PTH
(parathyroid hormone), which causes hypercalcemia (too
much calcium in the blood) derived from our bones where
most calcium is stored.
Our body uses calcium to maintain healthy bones, and
is critically important in keeping nerves, muscles, heart and
blood vessels in working order. When calcium is lost from
the bones the result is weakening of them, thus increasing
the risk of fractures. At the same time, the body tries to
absorb more calcium from food. The kidneys, instead of
flushing excess calcium into the urine, will retain it with
the result of increased calcium deposited in the kidneys and
a high risk of developing kidney stones. There are 100,000
cases of this disease annually in the United States with
postmenopausal women most at risk.
There are two types of hyperparathyroidism–primary
and secondary. In the much more common primary form
of the disease, these glands produce too much of the PTH
hormone (Hyperplasia) with an increase of calcium in the
blood. Just one of the four glands may be responsible, with