What is Hyperparathyroidism?

Hyperparathyroidism means having too much parathyroid hormone (PTH) in the blood. The disorder is classified as primary, secondary, or tertiary.

Primary hyperparathyroidism occurs when high PTH levels are caused by abnormal function of the parathyroid gland. Usually, high blood calcium levels also are present.

Secondary hyperparathyroidism occurs when high levels of PTH in the blood are a response to low blood calcium or other mineral levels.

Tertiary hyperparathyroidism can develop when the high levels of PTH that are caused by secondary hyperparathyroidism continue even after the initial cause has been addressed.

Primary Hyperparathyroidism

How Common Is Primary Hyperparathyroidism

Primary hyperparathyroidism is more than twice as common in women than in men [R].

The chance of developing it becomes greater with age as hyperparathyroidism is more common in postmenopausal than premenopausal women [R].

In one study, the incidence of hyperparathyroidism was highest among black Americans (1.38 per 1000), followed by whites (1.1 per 100), Asians (0.8 per 1000), and then Hispanics (0.66 per 1000) [R].

Causes of Primary Hyperparathyroidism

When parathyroid gland malfunctions, it’s most commonly due to a benign tumor (adenoma) [R].

The second most common cause is an increase in the size of the parathyroid gland (hyperplasia) [R].

Cancer of the parathyroid glands is only responsible for about 1% of cases [R].

Symptoms

Symptoms of primary hyperparathyroidism include [R, R, R]:

• Kidney stones
• Weak muscles
• Bad/slow digestion
• High blood pressure
• Bone fractures (especially in postmenopausal women)
• Impaired cognitive function
• Depression
• Heart problems

Testing

Your doctor can order the following tests to help diagnose hyperparathyroidism:

• Blood calcium levels (routine test) [R]
• PTH level (not a routine test)
• Bone density measurement [R]
• Medical imaging for kidney stones and vertebral fractures [R].

Consequences of Primary Hyperparathyroidism

High levels of PTH

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What Is Ceruloplasmin?

Ceruloplasmin (Cp) is a protein that is bound to and transports most of the copper in the blood. It also plays a role in iron metabolism [R, R].

Ceruloplasmin has a complex network of interactions in the body, playing a role in many aspects of maintaining health. It is known to interact with at least 125 other proteins [R].

It belongs to a group of proteins called “acute phase” proteins. This means that its levels will rise in inflammation and inflammatory diseases [R].

In addition, it acts as an antioxidant, with the ability to remove hydrogen peroxide and lipid peroxidases [R, R, R].

Ceruloplasmin blood tests are used in addition to copper tests to help diagnose Wilson’s disease and other disorders of copper metabolism [R, R].

How & Where Ceruloplasmin is Produced

Ceruloplasmin has a water-soluble form that circulates in the blood and is primarily made in the liver. It is produced to a much lesser extent in other parts of the body, including the lung, spleen, bladder, gut, and lymph nodes [R].

Production of ceruloplasmin in the liver is stimulated by thyroid hormones [R].

In obese people, up to 22% of the circulating ceruloplasmin is released by fat cells [R].

The second form of ceruloplasmin is anchored to membranes. It is made in the brain, liver, lungs, and kidneys. This form is believed to play an important role in iron transport out of brain and liver cells [R, R].

Human white blood cells produce both forms of ceruloplasmin, with peripheral blood lymphocytes having higher levels than all other lymphocyte subsets [R].

Ceruloplasmin Roles

Transports Copper

Ceruloplasmin must have copper attached to it to function.

Its main role is to transport copper throughout the body [R].

Between 70 and 95% of the copper in the blood is bound to ceruloplasmin [R, R].

Free, unbound copper concentrations in the blood tend to increase when ceruloplasmin levels are low.

Deficiencies in copper can cause low levels of blood ceruloplasmin because the

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What is Parathyroid Hormone (PTH)?

Parathyroid hormone (PTH) is produced by the parathyroid glands. Most people have 4 pea-sized parathyroid glands embedded in the back of the thyroid gland, but variations in their location and number sometimes occur.

PTH controls calcium, phosphorus, and magnesium levels in the blood.

Because calcium balance plays a critical role in many bodily functions, including muscle movement and nerve impulses, calcium levels are tightly controlled to stay within a narrow range in the blood.

PTH’s main function is to increase calcium levels when they are too low. It [R]:

• triggers the release of calcium from the bones to the blood
• decreases the loss of calcium in the urine
• increases calcium absorption from food

Measuring parathyroid hormone levels can help uncover the cause of abnormal calcium levels and can be used to monitor the progression of some diseases.

PTH Increases Blood Calcium

1) Via Bones

Bones act as a calcium reservoir, releasing calcium into the bloodstream when blood levels are low and taking up calcium when they are high. PTH communicates to bone cells what action is needed [R].

Parathyroid glands have calcium sensors. When calcium is low, the glands release more PTH. High PTH levels signal the bones to release more calcium into the blood [R].

When calcium levels in the blood are high, parathyroid glands release less PTH. Low PTH levels signal bones to take up calcium from the blood [R].

2) Via Kidneys

As blood is filtered through the kidneys, some amount is returned to the blood and some removed from the body in the urine. Parathyroid hormone influences the net balance of how much calcium and phosphorus are removed and how much is retained during that process [R].

When PTH is high, the kidneys retain more calcium. When PTH is low, more calcium is eliminated in the urine, decreasing the calcium concentration in blood

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