Hyperparathyroidism

The Adult Endocrinology Clinic provides diagnosis and follow-up for adult patients with an endocrine problem, i.e. a condition affecting the secretion of a hormone (excessive or insufficient secretion) and/or the gland that secretes it. The department therefore manages conditions affecting the thyroid, parathyroid glands, adrenal glands, gonads (ovaries and testicles) and pituitary gland.

Since 2016, the Erasme Hospital Endocrinology Department, together with the Queen Fabiola Children’s University Hospital (HUDERF) for paediatric care, has been part of ENDO-ERN (European Reference Network for Rare Endocrine Conditions), the European Reference Network for rare endocrine diseases.

The mission of this network is to improve access to high-quality care for patients with rare endocrine disorders. It supports clinical research and contributes to the creation of registries listing patients monitored for rare conditions, in order to promote knowledge-sharing and improve clinical practices. 

The management of rare endocrine diseases is multidisciplinary. Regular case discussions are organised for complex cases with numerous specialists within our institution, as well as through virtual consultations with recognised European experts via the ENDO-ERN network or during international multidisciplinary case conferences (France).

Some endocrine diseases begin at birth or during childhood and require lifelong treatment and follow-up. Transition consultations have been provided for many years with our paediatric colleagues at HUDERF to ensure the smoothest possible transition from paediatric to adult care.

Primary hyperparathyroidism results from overactivity (hyperfunction) of the parathyroid glands, located behind the thyroid gland in the neck. These glands secrete parathyroid hormone (PTH), a hormone that is essential for regulating calcium levels in the blood. Primary hyperparathyroidism is the third most common endocrine disorder.

In the vast majority of cases, this overactivity is caused by a parathyroid adenoma, that is, a small benign tumour that develops in one of the four parathyroid glands. More rarely, several glands are affected (referred to as hyperplasia or multiglandular disease), particularly in certain genetic disorders (for example, multiple endocrine neoplasia type 1 [MEN1]) or in patients with severe chronic kidney disease.

Excess parathyroid hormone causes an increase in the level of calcium in the blood (hypercalcaemia). This increase may cause various symptoms, such as excessive thirst, nausea, vomiting, constipation or kidney stones.

In the longer term, excess parathyroid hormone may affect the bones (osteopenia, osteoporosis and an increased risk of fractures) and the kidneys (nephrocalcinosis and kidney failure).

Today, primary hyperparathyroidism is increasingly detected at an early stage, during a simple blood test performed for another reason. Even in the absence of symptoms, a complete assessment is necessary to evaluate the effects of the disease on the bones and kidneys. Appropriate management can prevent complications and sustainably improve patients’ quality of life.

Surgery of the parathyroid gland or glands responsible for the hypersecretion is the standard treatment for primary hyperparathyroidism and leads to a cure in the majority of cases.

The indication for surgery and the optimal timing of the procedure are determined after a comprehensive assessment of any potential complications, taking the patient’s age and various clinical and biological criteria into account.

Management must be multidisciplinary and involves endocrinologists, surgeons specialising in parathyroid surgery, radiologists and nuclear medicine physicians, in order to precisely locate the abnormal glands before surgery. Depending on the situation, geneticists, nephrologists and rheumatologists may also be involved in the patient’s care.

At our centre, a multidisciplinary meeting dedicated to parathyroid disorders is held every month to discuss complex cases and define the most appropriate treatment strategy.

The aim is to support each patient in understanding their condition, provide personalised care and sustainably improve their quality of life.

Multidisciplinary team

• Adult endocrinology: see the doctors responsible for the condition
• Nuclear medicine: Dr Magdalena Mileva
• Parathyroid surgery: Dr Maria Ruiz
• Nephrology: Dr Caroline La, Dr Delphine Kemlin
• Radiology: Dr Isabelle Delpierre, Dr Yolène Lefebvre
• Rheumatology: Prof. Muhammad Soyfoo, Dr Joëlle Margaux
• Genetics: Dr Isabelle Vandernoot

A balanced diet, adequate hydration (at least 2 litres of water per day), moderate salt consumption, correction of any vitamin D deficiency, and regular physical activity all contribute to maintaining good mineral balance. In the event of unusual acute symptoms (feeling unwell, palpitations, severe pain, haematuria), it is recommended that you promptly consult an Emergency Department. If you have any doubts or questions, the medical team remains your preferred point of contact to adapt your care.

Patients are cared for by a specialist endocrinologist. Hormone assays and genetic analyses are performed in a reference laboratory. Specialist on-call cover is provided 24 hours a day.

Our centre is actively involved in improving the diagnosis and management of primary hyperparathyroidism, notably through the creation of a dedicated diagnostic unit for thyroid nodules and parathyroid disorders.

This “fast-track” outpatient unit, located within the Nuclear Medicine Department of the Jules Bordet Institute, makes it possible to perform the main examinations required for the assessment on the same day: cervical ultrasound targeting the parathyroid glands, renal ultrasound, fluorocholine PET (a tracer offering excellent sensitivity for detecting parathyroid adenomas) and bone densitometry. The results are then discussed during the consultation with the endocrinologist in order to establish an accurate diagnosis and propose the most appropriate treatment strategy.