Accessory toe

Disease Description (Causes and Symptoms)

• Definition and pathophysiology: A condition in which excessive parathyroid hormone (PTH) is secreted by the parathyroid glands, increasing blood calcium levels. It is mainly caused by primary hyperparathyroidism (parathyroid adenoma, hyperplasia, and, rarely, cancer). Secondary and tertiary forms caused by conditions such as chronic kidney failure may also occur. Excess PTH releases calcium from the bones, increases calcium retention by the kidneys, and indirectly affects calcium absorption in the intestines.
• Main causes: ① Single or multiple parathyroid adenoma (most common) ② Parathyroid hyperplasia ③ Parathyroid cancer (rare) ④ Hereditary causes (e.g., MEN syndrome) ⑤ Chronic kidney failure (secondary/tertiary)
• Main symptoms: Most cases are asymptomatic and are detected through screening blood tests. When symptoms occur, they present as symptoms related to hypercalcemia.
  • Digestive system: Nausea and vomiting, loss of appetite, constipation, abdominal pain
  • Kidneys: Polyuria, dehydration, kidney stones (urinary tract stones), decreased kidney function
  • Bones and muscles: Osteoporosis, bone pain, muscle weakness, easy fatigue
  • Neuropsychiatric: Depression, decreased memory, confusion
  • Cardiovascular: Hypertension, increased risk of arrhythmia
  • Severe: Hypercalcemic crisis (dehydration, coma, electrocardiographic abnormalities)

Treatment Methods

• Basic principles
  • If asymptomatic and mild: Regular monitoring (blood calcium, PTH, kidney function, bone mineral density tests, etc.)
  • If symptoms or complications (kidney stones, osteoporosis, marked hypercalcemia, etc.) are present, active treatment is required
• Surgical treatment
  • The definitive treatment is parathyroidectomy (removal of a localized adenoma or selective resection). The location of the lesion is identified before surgery (neck ultrasound, Tc-99m sestamibi, 4D-CT, etc.).
  • Indications for surgery: Symptomatic patients, blood calcium above a certain threshold (guidelines vary by institution), age <50 years, kidney or bone complications, etc.
  • Postoperative precautions: Monitoring for hypocalcemia (especially hungry bone syndrome) and calcium and vitamin D supplementation may be necessary.
• Medication/conservative treatment
  • Acute hypercalcemia: Fluid administration (normal saline), diuretics (loop diuretics; furosemide) to promote calcium excretion, and, when necessary, intravenous bisphosphonates (e.g., zoledronic acid), calcitonin, etc.
  • Chronic management: The calcimimetic cinacalcet can suppress PTH secretion and lower blood calcium levels (when surgery is not possible or as an adjunct before or after surgery).
  • Osteoporosis management: Bisphosphonates, used selectively (when bone mineral density is decreased).
  • Vitamin D supplementation (in cases of deficiency) should be done cautiously and according to a doctor’s instructions.
• Lifestyle management and medication precautions
  • Drink sufficient fluids (to prevent dehydration), and avoid excessive calcium/vitamin D supplementation and indiscriminate medication use (e.g., thiazide diuretics may cause hypercalcemia).
  • Detect complications early through regular testing.

Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)

• Items to bring
  • A list of all medications currently being taken (including prescription medications, OTC medications, and supplements)—especially calcium and vitamin D supplements, diuretics, lithium, etc.
  • Copies of previous blood test results (total and ionized calcium, PTH, creatinine, etc.), bone mineral density (BMD) results, and urine test results (24-hour urine calcium)
  • A recent symptom record (nausea, constipation, polyuria, bone pain, changes in memory, etc.), including notes on when symptoms began, their frequency, and aggravating factors
  • A history of previous surgery and family history (especially endocrine tumors and MEN syndrome), and whether there are plans for pregnancy
• Items useful to confirm in advance at the outpatient visit
  • Recent blood calcium and PTH levels, kidney function (creatinine), and 24-hour urine calcium, if available
  • Whether a bone mineral density test has been performed and kidney imaging results (whether stones are present)
• Sample questions (items to ask during the consultation)
  • What are the side effects of this medication?
  • What are the criteria for recommending surgery?
  • How often should follow-up tests be performed?
  • How should calcium be managed after surgery?

General Sample Questions to Ask the Doctor

• What are the current levels of calcium and PTH in my blood? Is surgery necessary?
• Can it be controlled with medication (e.g., cinacalcet) instead of surgery? What are the advantages and disadvantages?
• What are the risks of surgery (complications), and what benefits can be expected (symptom improvement and recurrence rate)?
• If I am planning a pregnancy, how will the treatment strategy change?

Disease-Specific Sample Questions

• In my case (based on my levels, age, and symptoms), is parathyroidectomy recommended, or is it safe to continue observation?
• What preparations (such as calcium and vitamin D supplementation) are needed to prevent or treat postoperative hypocalcemia (especially hungry bone syndrome)?

(Note: Specific decisions regarding symptoms, test results, and treatment indications should be made through consultation with the treating doctor.)