Can high calcium and low vitamin D cause hyperparathyroidism?

Question

Hello doctor,

My mother is 71 years old. She started having joint and bone pain. She has osteoporosis, and she recently took a retest last year. Her doctor ordered blood tests and then referred her to an endocrinologist and a rheumatologist. He thinks it is hyperparathyroid.

The rheumatologist gave her a shot for her hip pains and said she had bursitis. She also told my mother to make sure the doctor tests her vitamin D levels, as this could be the cause. My mom got excited as it did not seem serious. But then the endocrinologist called back and said she has hyperparathyroidism, and she should consult with a surgeon.

I spoke to her primary doctor to ask some questions. Her vitamin D level is 28, and her calcium level is 10.7. From the doctor's website information, it seems as if she has hyperparathyroidism. However, I have read some conflicting reports and wanted to see if my mom should get a second opinion.

It also seems to contradict what the rheumatologist said. My question is, do you think she has hyperparathyroidism from the calcium and vitamin D levels? Also, after reading the website, it seems there is quite a lot of variability in the quality of the surgeon.

Is this something I should be concerned about? It seems that the surgeon should be able to find the bad hyperparathyroid gland before the surgery.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Joint pain, bone pain, and osteoporosis are very frequently seen in hyperparathyroidism. But the very essential component in the diagnosis of hyperparathyroidism is serum parathormone (PTH) levels, which need to be elevated. It can be normal in the case of secondary hyperparathyroidism. So I want to know what her PTH level is.

Calcium levels can be normal or elevated in hyperparathyroidism. It is difficult to tell only from reports on calcium and vitamin D levels, as calcium levels also depend on serum albumin levels. But I personally feel she has hyperparathyroidism.

Now coming to the surgery, hyperparathyroidism can be due to tumors in parathyroid glands which requires surgery but there are other causes of hyperparathyroidism which do not require surgery. Ask your endocrinologist if he has evaluated the cause and then referred you to a surgeon?

If not, I advise you to get nuclear medicine scanning with radiolabeled sestamibi of the parathyroid glands and revert back to me.

If you could upload all the reports done till now, it would be very helpful, and I can advise you even better.

I hope this helps you.

Thank you.