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The Parathyroid Glands00:59

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
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The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
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Calcium is not only the most abundant mineral in bone but also the most abundant mineral in the human body. Calcium ions are needed for bone mineralization, tooth health, heart rate regulation and strength of contraction, blood coagulation, the contraction of smooth and skeletal muscle cells, and the regulation of nerve impulse conduction. The average calcium level in the blood is about 10 mg/dL. When the body cannot maintain this level, a person will experience hypo or hypercalcemia.
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Related Experiment Video

Updated: Jun 11, 2025

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Primary Hyperparathyroidism With Undetectable Intact Parathyroid Hormone.

Zhixing Song1, Jessica McMullin2, Forest Huls3

  • 1Department of Surgery, Section of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.

Clinical Medicine Insights. Endocrinology and Diabetes
|October 9, 2024
PubMed
Summary

Primary hyperparathyroidism can cause hypercalcemia even with undetectable parathyroid hormone (PTH) levels. This case highlights a rare presentation and successful treatment of a parathyroid adenoma.

Keywords:
Primary hyperparathyroidismcase reportcinacalcetparathyroidparathyroid hormone

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Area of Science:

  • Endocrinology
  • Nephrology
  • Oncology

Background:

  • Hypercalcemia is a common electrolyte imbalance with diverse etiologies.
  • Primary hyperparathyroidism and non-parathyroid conditions are the main causes.
  • Undetectable parathyroid hormone (PTH) levels typically rule out hyperparathyroidism.

Observation:

  • A 65-year-old woman presented with hypercalcemia, fatigue, and brain fog, but undetectable PTH.
  • Extensive workup excluded malignancy and familial hypocalciuric hypercalcemia.
  • Imaging revealed a likely enlarged parathyroid gland.

Findings:

  • Cinacalcet treatment reduced calcium levels, implicating the parathyroid gland.
  • Parathyroidectomy confirmed a large parathyroid adenoma (1927 mg).
  • Post-surgery, calcium normalized, PTH became detectable, and symptoms resolved.

Implications:

  • Primary hyperparathyroidism can manifest with hypercalcemia and undetectable PTH.
  • Genetic mutations within parathyroid adenomas may cause suppressed PTH.
  • This case underscores the importance of considering hyperparathyroidism despite low PTH.