Symptoms of hypercalcemia and its relationship with hyperparathyroidism in Puerto Rico

Hypercalcemia is a medical condition that occurs when calcium levels in the blood rise above the normal range. In Puerto Rico, a frequent cause of this imbalance is primary hyperparathyroidism, a disease in which one or more parathyroid glands produce an excess of parathyroid hormone (PTH). This overproduction disrupts the body’s calcium balance and can cause symptoms that are often mistaken for other illnesses. In this article, we explore the symptoms of hypercalcemia, how to identify hyperparathyroidism, and the diagnostic and treatment options available.

Left inferior parathyroid adenoma.

What is hypercalcemia and why is it important to recognize it?

Calcium is an essential mineral for vital functions such as muscle contraction, blood clotting, and nerve transmission. However, when calcium levels in the blood are too high, multiple organs and systems can be negatively affected. Hypercalcemia can be mild and go unnoticed at first, but if untreated, it can lead to serious complications such as kidney damage, osteoporosis, and heart problems.

In Puerto Rico, primary hyperparathyroidism is one of the most common causes of hypercalcemia. This condition occurs when one or more parathyroid glands produce too much PTH, the hormone that regulates calcium levels in the blood. PTH increases calcium release from bones, intestinal absorption, and kidney reabsorption—raising calcium levels in the bloodstream.

Common symptoms of hypercalcemia

Symptoms of hypercalcemia vary depending on the severity and duration of elevated calcium. Early signs may be mild and confused with other conditions, but they tend to worsen over time if the underlying cause is not treated.

The most common symptoms include:

• Extreme fatigue

Persistent tiredness is one of the most frequent signs. People often feel exhausted even after resting.

• Muscle and bone pain

Excess calcium can weaken bones and cause discomfort in muscles and joints.

• Memory loss and difficulty concentrating

Hypercalcemia can affect brain function, leading to memory issues and reduced concentration.

• Depression or anxiety

Mood changes may signal an imbalance in calcium regulation.

• Nausea or constipation

The digestive system can be affected, causing stomach discomfort and difficulty with bowel movements.

• Excessive thirst and frequent urination

The body attempts to eliminate excess calcium through urine, leading to dehydration and increased thirst.

• Kidney stones

Calcium buildup can form renal stones, which cause severe pain and urinary complications.

These symptoms may develop gradually and are often attributed to other causes, making it essential to consult a doctor if multiple symptoms persist.

What causes primary hyperparathyroidism?

Primary hyperparathyroidism is the most common cause of hypercalcemia in Puerto Rico. In most cases, it is due to a parathyroid adenoma, a benign tumor in one of the parathyroid glands. This tumor produces uncontrolled amounts of PTH, raising calcium levels in the blood.

Less common causes include:

• Hyperplasia of the parathyroid glands (enlargement of all glands)

• Parathyroid carcinoma (a malignant tumor, very rare)

• Genetic syndromes affecting parathyroid function

Early diagnosis is essential to prevent long-term complications such as irreversible kidney damage and significant bone loss.

How is hyperparathyroidism diagnosed?

To confirm the presence of hyperparathyroidism and hypercalcemia, doctors perform several specific tests:

• Total calcium and ionized calcium

These tests measure both the total calcium level and the active free calcium circulating in the blood.

• Parathyroid hormone (PTH)

High PTH levels combined with hypercalcemia indicate hyperparathyroidism.

• Vitamin D

Evaluated to rule out deficiencies that may affect calcium metabolism.

How is the abnormal parathyroid gland located?

Different imaging methods are used to try to identify the affected gland:

• Neck ultrasound

Allows visualization of the parathyroid glands and detection of possible adenomas or enlargement.

• Sestamibi scan

A nuclear medicine scan that helps detect active parathyroid adenomas.

• 4D CT scan of the parathyroid glands

A more specialized form of CT that improves detection of abnormal glands, such as parathyroid adenomas, for more precise diagnosis.

These combined studies provide a clearer diagnosis and help plan appropriate treatment. It is important to emphasize that if imaging studies fail to locate the abnormal gland, surgery is still required.

What if imaging studies fail to identify the abnormal gland?

These tests help clarify the diagnosis and guide treatment planning. However, even when localization studies do not precisely identify the abnormal gland, the patient still requires surgery. In such cases, surgical exploration remains the gold standard to identify and treat the diseased gland, ensuring safe and definitive management.

Treatment options for hyperparathyroidism

The only definitive cure for primary hyperparathyroidism is parathyroid surgery. This procedure involves removing the adenoma or affected gland, which normalizes PTH and calcium levels in the blood.

Surgery is safe and highly effective, offering benefits such as:

• Reduced risk of kidney damage

• Prevention of bone fractures

• Improvement in symptoms such as fatigue, pain, and cognitive problems

In situations where surgery is not possible or is contraindicated, medications may be used to control calcium levels, but they do not replace surgery.

Importance of early detection in Puerto Rico

In Puerto Rico, the prevalence of primary hyperparathyroidism and hypercalcemia makes early detection essential to prevent serious complications. Many people do not recognize the symptoms or attribute them to stress or aging, delaying diagnosis.

If you experience several of the symptoms mentioned—especially excessive thirst, fatigue, and bone pain—it is recommended to consult an endocrinology specialist. Timely diagnosis can significantly improve quality of life and prevent irreversible damage.