What Women Need to Know About Garry Shandling’s Parathyroid Disease
Comedian Garry Shandling is becoming known for something besides than his unique style of humor: hyperparathyroidism.
As reports came in about his death on March 24, 2016—which was believed to have been caused by a massive heart attack—HollywoodLife revealed that as of March 26, Shandling’s doctor had refused to sign Garry’s death certificate. He stated an investigation was underway to determine the exact cause of death.
Amidst the delays, sources revealed that Shandling was suffering from hyperparathyroidism, a disorder of the parathyroid glands—four pea-sized glands located on or near the thyroid in the neck. These glands produce parathyroid hormone (PTH), which helps keep calcium levels balanced in the body.
When these glands become overactive, which is what happens in people with hyperparathyroidism, calcium levels rise above normal, causing a number of problems throughout the body—some of which can lead to heart attack. Many healthcare experts now suspect that the disorder had something to do with Shandling’s death. Meanwhile, as the investigation continues, Shandling has managed, unwittingly, to bring new attention to this dangerous health condition.
Women More Likely to be Affected by Parathyroid Disease
We’re bringing the news to you here at Women’s Health because women are actually at a much higher risk for the disease than men. According to the Norman Parathyroid Center, though the overall incidence of the disease is rare, affecting one in 80 people in their lifetime (more than 1 percent), the rate is much higher in women over the age of 50—one in 50.
A 2013 study reported that the incidence of the disease fluctuated between 34 and 120 per 100,000 person years among women, and only 13 to 36 among men. The incidence was highest among African American women, followed by whites, Asians, and Hispanics. By the age of 75, twice as many women were affected as men.
Unfortunately, the symptoms of this disease can be subtle, and often mirror other conditions, so the disease may go undiagnosed for years. That’s dangerous, as it can lead to serious complications such as those Shandling experienced. Treatment involves surgical removal of the affected gland, which usually solves the problem and eliminates symptoms.
Meanwhile, the overall incidence of the disease appears to be increasing, with studies performed in Denmark and in Scotland showing alarming upward trends over the past few decades. A 2001 study also indicated an increase of cardiovascular diseases in people with hyperparathyroidism.
It’s time to increase awareness of this dangerous condition, and encourage more women to get tested for it. A simple blood test is all that’s required, along with a medical examination and an evaluation of symptoms. A diagnosis could add years to your life.
What is Hyperparathyroidism?
Hyperparathyroidism describes a condition in which there is an excess of parathyroid hormone (PTH) in the bloodstream, caused by the overactivity of one or more of the four parathyroid glands. In general, there considered to be two types of the disease:
- Primary Hyperparathyroidism: In this form, the problem starts in the parathyroid glands. The enlargement of one or more of the glands causes an overproduction of the hormone, which in turn, raises calcium levels. Causes may include a noncancerous growth on the gland (the most common), enlargement of the gland, or a cancerous tumor on the gland (rare).
- Secondary Hyperparathyroidism: In this form, another condition that depletes calcium levels causes the parathyroid glands to increase their output of PTH, as they try to compensate. Possible causes include severe calcium deficiency, severe vitamin D deficiency (which affects calcium levels), or chronic kidney failure.
Women are likely to be familiar with “hyperthyroidism,” but that is a different condition. Whereas hyperthyroidism describes overactivity in the thyroid gland, “hyperparathyroidism” describes overactivity in the parathyroid glands, which are different glands with different functions.
All of these glands are located in the neck and secrete hormones, but the thyroid hormones have an effect in nearly all cells of the body, and regulate how the body uses energy, whereas the parathyroid glands affect mainly the amount of calcium, phosphorus, and magnesium in the blood.
What are the Symptoms of Hyperparathyroidism?
This is where the disease can get tricky, as the symptoms are typically so common that women will blame them on something else, like common fatigue or the aches and pains associated with aging.
In his segment with Jerry Seinfeld called “Comedians in Cars Getting Coffee,” filmed not long before his death, Shandling mentioned he’d been diagnosed with the disorder, stating, “The symptoms are so much like being an older Jewish man, no one noticed!”
The symptoms have also been known as “moans, groans, stones, and bones,” a fitting description since the disease can cause the following:
- Frequent headaches
- Kidney stones
- High blood pressure
- Inability to concentrate
- General aches and pains
- Frequent heartburn
- Bone and joint pain
- Loss of appetite
- Memory problems
- A general sense of not feeling well
The following factors can increase risk:
- Genetics—it runs in families
- Menopause (postmenopausal women are more at risk)
- Vitamin D deficiency
- Lithium medication (used to treat bipolar disorder)
- Neck radiation treatments
How do you know if you need to see your doctor for a blood test? If you have any of the symptoms or risk factors above and feel like you’re just not at your best, it’s important to get a check-up. According to the Norman Parathyroid Center, the disease will decrease life expectancy in all patients by about 5-6 years if it goes untreated.
What Does Hyperparathyroidism Do to the Body?
As the levels of PTH go up, the hormone goes to the bones and pulls calcium from them. In other words, the bones leach calcium, and the excess in calcium clogs the arteries and kidneys, making the patient feel generally unwell.
Over time, the condition destroys body tissues, and without treatment, it can cause other complications, including:
- Kidney stones
- Osteoporosis and bone fractures
- High blood pressure
- Heart failure and heart attack
- Neonatal hyperparathyroidism—low levels of calcium in newborns
- Some types of cancer, including breast, prostate, colon, kidney, and prostate
- Increased risk of mortality
In fact, having high calcium levels in your blood is considered much more dangerous than having high cholesterol levels. Fortunately, treatment is relatively simple and highly successful.
How is Hyperparathyroidism Treated?
If you get a blood test and it shows high calcium levels, realize that it’s not normal, and should not be dismissed. Your doctor may look for other causes, but keep in mind that hyperparathyroidism is a good possibility.
If a blood test shows a high calcium and a high level of PTH, it most always reveals a parathyroid problem. Some patients may have high calcium levels but normal PTH levels, however, which can make diagnosis a bit more complicated. It may also be that one test shows high calcium levels, but another taken at a later date show normal levels.
In general, if you have high calcium levels, be on the alert for the disease, as it is the most common cause. And hyperparathyroidism never gets better—it only gets worse—so don’t be soothed by a later test that shows normal calcium levels. To make a diagnosis, your doctor may look at your symptoms, at any other medical problems (like osteoporosis or kidney stones), and perform more lab tests to get at least two showing elevated calcium and at least one showing elevated PTH.
If you are diagnosed with this disease, understand that it can be cured with surgical treatment. Your doctor finds and removes the tumor that’s causing the problem. Once the affected gland is removed, all the problems it was causing are too, and you are no longer at risk for the complications mentioned above.
With few exceptions, patients describe feeling much better after the surgery, and wish they hadn’t waited to go through with treatment. James Fallows, who wrote an article for The Atlantic on his own experience with the disease, said:
“If I had known ten years ago what I know now, I would have had the surgery as soon as the diagnosis was confirmed. The problem was not going to cure itself, and it made me a little sicker and weaker every day that I delayed.”
James Fallows, “Garry Shandling and the Disease You Didn’t Know About,” The Atlantic, April 1, 2016, http://www.theatlantic.com/health/archive/2016/04/garry-shandling-hyperparathyroidism/476445/.
Samantha Wilson, “Garry Shandling: Coroner Investigates After Doctor Refuses to Sign Death Certificate,” HollywoodLife.com, March 26, 2016, http://hollywoodlife.com/2016/03/26/garry-shandling-death-certificate-doctor-refuses-to-sign-investigation-coroner/.
“Hyperparathyroidism: Disease of the Parathyroid Glands.” Parathyroid.com, Norman Parathyroid Center, http://www.parathyroid.com/parathyroid-disease.htm.
Yeh MW, et al., “Incidence and prevalence of primary hyperparathyroidism in a racially mixed population,” J Clin Endocrinol Metab., March 2013; 98(3):1122-9, http://www.ncbi.nlm.nih.gov/pubmed/23418315.
Abood A, Vestergaard P, “Increasing incidence of primary hyperthyroidism in Denmark,” Dan Med J., February 2013; 60(2):A4567, http://www.ncbi.nlm.nih.gov/pubmed/23461985.
“Primary hyperparathyroidism,” YourHormones, March 17, 2015, http://www.yourhormones.info/endocrine_conditions/primary_hyperparathyroidism.aspx.
N Yu, et al., “A ten-year epidemiological study of prevalence and incidence of primary hyperparathyroidism in Tayside, Scotland,” Endocrine Abstracts, 2009; 19:p2, http://www.endocrine-abstracts.org/ea/0019/ea0019p2.htm.
Raue, “Increased incidence of cardiovascular diseases in primary hyperparathyroidism—a cause for more aggressive treatment?” European Journal of Clinical Investigation, 1998; 28:277-278, http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2362.1998.00290.x/abstract;jsessionid=2F24B3B78DE45B4E1F2D1CC02B7E8868.f01t04.
Mayo Clinic Staff, “Hyperparathyroidism,” Mayo Clinic, December 24, 2015, http://www.mayoclinic.org/diseases-conditions/hyperparathyroidism/basics/definition/con-20022086.
James Norman, M.D., “Hyperparathyroidism: Overactivity of the Parathyroid Gland,” Vertical Health LLC, September 3, 2015, http://www.endocrineweb.com/conditions/hyperparathyroidism/hyperparathyroidism#Symptoms_of_Hyperparathyroidism.