The human body has four glands behind the thyroid. These four tiny glands are responsible for regulating calcium levels in the body, so problems with these glands can cause a deficiency of calcium in the bones or a flood of calcium in the blood.
An adenoma is a tumour of an organ or gland. These tumours are benign and do not pose a cancer risk, but they can cause serious problems with the organs or glands to which they attach. Parathyroid adenoma is the leading cause of hyperthyroidism.
Although the parathyroid glands do not produce the same hormones like the thyroid to which they are attached, they have essential hormones for heart and bone health. The amount of hormone produced by these tiny glands, located behind the thyroid, affects the hormone secreted by thyroid glands.
This article provides information about Parathyroid Adenomas -Diagnosis and treatment.
Location of parathyroid glands and their function?
The parathyroid glands are located in the neck, thyroid gland. Most people have four pea-sized parathyroid glands in an oval shape. Endocrine glands such as the thyroid and parathyroid glands secrete hormones, which are natural chemicals that regulate bodily functions. The parathyroid glands’ job is to secrete parathyroid hormone, controlling how the body uses calcium.
Calcium is needed by cells in almost all parts of the body – the brain, heart, nerves, bones and digestive system. Parathyroid hormone meets this need by taking calcium from the bone where it is stored and releasing it into the bloodstream.
The “communication” between the parathyroid glands and blood helps keep calcium at normal levels.
What is a parathyroid adenoma?
Sometimes benign (non-cancerous) growths called adenomas appear on one or more of a person’s parathyroid glands. The cause of most parathyroid adenomas is unknown. However, it is estimated that about 10 per cent are hereditary. Radiation exposure to the head and neck can also increase the risk of adenomas.
Adenomas cause the parathyroid glands to produce more parathyroid hormone than the body needs, a condition known as primary hyperparathyroidism. Too much parathyroid hormone disrupts the body’s average calcium balance, which increases the amount of calcium in the blood. Secondary hyperparathyroidism (A similar but less common condition) can occur in people with chronic kidney failure.
Women are twice as likely to develop pituitary adenoma than men and more frequently after menopause. Primary hyperparathyroidism can be caused by one adenoma, more than one adenoma (hyperplasia), or cancer (which is very rare).
Symptoms and causes
Too much calcium in the blood (hypercalcemia) can cause several symptoms and disorders. They include:
- Impaired memory and concentration.
- Depression, irritability, or mental confusion.
- Kidney stones.
- Bone and joint pain osteoporosis.
- Stomach ache.
- General pain for no apparent reason.
Many patients may think they have no symptoms. However, if the calcium level is high for several years, the patient may not tell if there are symptoms.
How is parathyroid adenoma diagnosed?
Parathyroid adenoma usually occurs when routine blood tests show above-average calcium levels, especially in people without symptoms. The doctor then confirms the diagnosis of primary hyperparathyroidism with tests showing that the blood’s parathyroid hormone level is higher than usual.
It is essential to understand that primary parathyroid disease is diagnosed only by considering calcium and parathyroid hormone levels. The presence or absence of symptoms does not help in diagnosis.
If I don’t have any symptoms, do I need surgery?
Surgery is the most common treatment for parathyroid adenoma, even in people who have no symptoms. In patients who have had high calcium levels for several years, it is difficult to know if they are truly asymptomatic.
Parathyroidectomy allows the patient to feel better and thus improves the overall quality of time. More importantly, this surgery parathyroidectomy can prevent patients from osteoporosis and kidney stones.
How is parathyroid adenoma treated?
The most common treatment is to remove the enlarged gland/glands. This process fixes the problem by up to 98% of the time.
For patients who are too sick to undergo surgery, treatment may be the only option. Various medications do not reduce the extra amount of parathyroid hormone in the blood. Instead, they fight back by preventing the loss of calcium from the bones. Hormone replacement therapy or other treatments for this condition should last your entire life.
What can I expect if I decide to have surgery?
A few weeks before surgery, the surgeon will order tests to find one or more of your overactive parathyroid glands. These tests can include:
- Neck ultrasound.
- The scan uses a drug called Tc-sestamibi.
If the image may be on the parathyroid gland, the surgeon will first look for the gland during surgery. However, all four parathyroid glands must be identified during the procedure. This imaging is crucial for surgical planning. Even if parathyroid does not appear on imaging, the diagnosis is still there, and surgeons will always recommend surgery.
What happens during surgery to remove parathyroid nodules?
- Under general anaesthesia, a small incision is made in the front of the neck.
- The doctor will examine the four parathyroid glands during the operation. The surgeon removes the abnormal parathyroid gland. If 1 or 2 abnormal parathyroid glands are found, these glands are removed, and other normal parathyroid glands can maintain normal calcium levels.
- If all four parathyroid glands are abnormal, 3½ glands are removed. Some of the parathyroid tissue needs to be left in the healthy body to maintain normal calcium levels in the blood.
- Intraoperative levels of parathyroid hormone are checked during surgery. If diseased parathyroid glands are removed, parathyroid hormone levels should decrease by at least 50% before removal after removal.
The parathyroid glands removed during surgery will be examined (frozen assessment) by a pathologist to ensure that the parathyroid glands are hyperactive. Locating the four parathyroid glands during surgery offers the highest long-term cure rates.
A parathyroid adenoma is a small, benign tumour in one or more of your four parathyroid glands. These tumours can cause a condition called hyperparathyroidism. This condition can cause fractures or kidney stones. In mild cases, your doctor can easily monitor your condition. Other treatments include medication or surgery.
It would be best if you meet an experienced surgeon to assess the situation and then decide about parathyroidectomy. This is a treatable problem, but it is best to work with a professional parathyroid specialist.
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