Name of the Condition

• Primary Hyperparathyroidism (PHPT)

Summary

Primary hyperparathyroidism is a condition characterized by excessive production of parathyroid hormone (PTH) by one or more of the parathyroid glands. This overproduction leads to elevated levels of calcium in the blood, which can have various health impacts.

Causes

• The primary cause is often a benign tumor on one of the parathyroid glands called a parathyroid adenoma.
• Hyperplasia (enlargement) of two or more parathyroid glands.
• Rarely, it may be due to parathyroid carcinoma (cancer).

Risk Factors

• Age: Most common in people over 50 years old.
• Gender: More prevalent in women, especially post-menopausal.
• Family history of hyperparathyroidism.
• Genetic conditions such as Multiple Endocrine Neoplasia (MEN) syndromes.

Symptoms

• Fatigue and weakness.
• Bone pain and frequent fractures.
• Kidney stones.
• Increased thirst and urination.
• Abdominal pain.
• Depression and memory problems.

Diagnosis

• Blood tests showing high levels of calcium and PTH.
• 24-hour urine tests for calcium.
• Bone density tests.
• Imaging studies like ultrasound or sestamibi scan to locate abnormal parathyroid glands.

Treatment Options

• Surgical removal of the affected parathyroid gland(s) is the most common treatment.
• Monitoring and regular check-ups if it’s mild and asymptomatic, often referred to as "watchful waiting."
• Medications such as bisphosphonates or hormone replacement therapy to manage symptoms or prevent complications.

Prognosis and Follow-Up

• Surgery often cures the condition with a good recovery.
• Regular follow-up is required to monitor calcium levels, especially if not surgically treated.
• Long-term management may include lifestyle changes and medications to manage calcium levels.

Complications

• Osteoporosis and bone fractures due to prolonged elevated calcium levels.
• Cardiovascular issues such as hypertension.
• Kidney damage from recurrent kidney stones or calcifications.

Lifestyle & Prevention

• Adequate hydration to prevent kidney stones.
• Maintaining an appropriate dietary intake of calcium and vitamin D.
• Regular physical activity to strengthen bones.
• Smoking cessation and moderation of alcohol intake.

When to Seek Professional Help

• Sudden, severe bone pain or fracture.
• Kidney stone symptoms like severe back or abdominal pain.
• Signs of high calcium levels such as extreme thirst, nausea, and sudden confusion.

Additional Resources

• National Institutes of Health (NIH)
• Hormone Health Network
• The American Association of Endocrine Surgeons

Tips for Medical Coders

• Ensure to differentiate between primary and secondary hyperparathyroidism (E21.1).
• Check for additional complications and code these conditions if present.
• Be cautious with surgical codes and correlate them with the correct diagnosis.