In a large number of cases there are no symptoms and the diagnosis is made by chance. Routine blood testing of calcium in middle-aged individuals is common, and is a regular source of discovering parathyroid tumours. Such patients are said to have "asymptomatic hyperparathyroidism" and account for at least 50% of all cases of parathyroid disease. It is rare for a parathyroid tumour to be visible in the neck, but it can occur.
Palpable parathyroid tumour in left side of neck
Patients with hyperparathyroidism may have the following symptoms:
When symptoms become severe the condition is a medical emergency, and initially the patients should be re-hydrated with saline infusions and given biphosphonate drugs to lower their calcium. They should be operated on as soon as the abnormal gland has been localised and the patient is fit for surgery. Finding a parathyroid cancer is common in these circumstances.
A recent study has used a special technique known as single-photon emission computed tomography (SPECT) to look at cerebral blood flow and cerebral metabolism in patients with treated and untreated primary hyperparathyroidism. Reduced regional cerebral blood flow has been demonstrated in patients with depression and chronic fatigue. These symptoms are common in primary hyperparathyroidism, and the study has shown that there is reduced cerebral blood flow in patients with untreated primary hyperparathyroidism. The results of this study may influence the case for surgical treatment in the future.