What are 5 Things to Know About Normohormonal Normocalcemic Hyperparathyroidism?

Hyperparathyroidism comes in a few different variants, and the management varies as well. One relatively common condition is Normohormonal Normocalcemic Hyperparathyroidism (NNHPT)—a subtle yet significant hormonal imbalance that can impact bone and kidney health. Here are five essential insights to help you understand and manage NNHPT effectively.​

1. What Is Normohormonal Normocalcemic Hyperparathyroidism?

NNHPT is a form of primary hyperparathyroidism characterized by elevated parathyroid hormone (PTH) levels while maintaining normal blood calcium levels. Unlike traditional hyperparathyroidism, which presents with high calcium levels, NNHPT often goes unnoticed due to the absence of abnormal lab values. Instead, the calcium and the PTH levels can remain mildly elevated for years before a problem is noticed. Over time, it can still lead to complications like bone density loss and kidney issues. ​

2. Accurate Diagnosis Requires Excluding Other Causes

Diagnosing NNHPT involves more than just identifying elevated PTH levels. Healthcare providers must rule out other conditions that can cause secondary hyperparathyroidism, such as:​

• Vitamin D deficiency
• Chronic kidney disease
• Renal Calcium Leak
• Certain medications (e.g., bisphosphonates, lithium)
• Calcium malabsorption disorders​

Only after these factors are excluded can a definitive diagnosis of NCHPT be made. ​

3. NNHPT Can Progress Over Time

While NNHPT may initially be asymptomatic, studies indicate that approximately 22% of individuals with this condition may develop elevated calcium levels over a four-year period. This progression underscores the importance of regular monitoring to detect any changes early and adjust treatment plans accordingly. Finally, the damage caused by losing calcium over time (such as bone loss caused by osteoporosis) can also be permanent.

4. Treatment Options Vary Based on Individual Needs

Management of NNHPT is personalized and may include:​

• Observation and Monitoring: Regular check-ups to track PTH and calcium levels. Bone scans should also be completed on a regular schedule.
• Lifestyle Modifications: Ensuring adequate intake of calcium and vitamin D, engaging in weight-bearing exercises, and avoiding smoking and excessive alcohol.
• Medications: In some cases, medications like bisphosphonates may be prescribed to improve bone density.
• Surgical Intervention: Parathyroidectomy may be considered for patients with significant symptoms or complications. ​

5. Picking the Right Team Is Crucial

Even in the absence of symptoms, NNHPT can affect bone and kidney health. Regular monitoring through blood tests and bone density scans is essential to manage the condition effectively and prevent potential complications. ​

For those who choose surgery, it is important to know that multi-gland disease (hyperplasia) is much more common in this group. This surgery is therefore more challenging, and any imaging that is completed is much less likely to be reliable. In this situation, the experience of the surgeon is the single most important variable to ensuring that you have successful treatment. The vast majority of surgeons who do parathyroid surgery do not have experience treating this condition, and surgical failure is more common in inexperienced hands. Having the right surgery the first time is the best thing you can do to have a good outcome.

Take Charge of Your Health

If you're experiencing unexplained fatigue, bone pain, or have concerns about your calcium or PTH levels, don't hesitate to reach out. At the Russell Center, we're committed to providing comprehensive evaluations and personalized care plans to support your health journey.​

Schedule your consultation today and take the first step towards proactive health management.​

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