Symptomatic patients present with manifestations that are reflective of hypercalcemia. Features include lethargy, fatigue, polydipsia, polyuria, myalgia, abdominal pain, constipation, nausea, and emesis. Also, patients may exhibit mental status changes and depression. Complications include nephrolithiasis, osteoporosis, cardiac arrhythmias, coma, and possibly even death.

• Weakness

  Other complications are less common, but may include: Nephrocalcinosis (calcium deposits in the kidneys that can reduce kidney function) Osteitis fibrosa cystica (softened, weak areas in the bones) Complications from surgery include: Damage to a nerve [nlm.nih.gov]

  Introduction Adenomas of the parathyroid gland typically present with symptoms of hyperparathyroidism, manifested by fatigue, bone pain, abdominal pain, weakness, dyspepsia, nephrolithiasis and skeletal bone disease. [ncbi.nlm.nih.gov]

  Symptoms may include any of the following: Confusion Constipation Lack of energy ( lethargy ) Muscle pain Nausea or decreased appetite Urinating more often at night Weak bones or fractures Exams and Tests Blood tests may be done to check levels of: PTH [ufhealth.org]

• Fatigue

  Features include lethargy, fatigue, polydipsia, polyuria, myalgia, abdominal pain, constipation, nausea, and emesis. Also, patients may exhibit mental status changes and depression. [symptoma.com]

  A 43-year-old woman with no significant medical or family history presented with fatigue and was diagnosed with primary hyperparathyroidism; however, preoperative imaging including sestamibi scan and ultrasound was unable to identify the hyperfunctioning [ncbi.nlm.nih.gov]

  Other non-specific symptoms include depression, muscle weakness, and fatigue. Every effort is made to medically treat or control these conditions prior to surgery. [medicinenet.com]

• Thyroid Nodule

  Parathyroid adenomas may occur within the thyroid, clinically simulating thyroid nodules. [ncbi.nlm.nih.gov]

  The subsequent ultrasound study could not distinguish between a parathyroid adenoma within or immediately adjacent to, the right lobe of the thyroid and a thyroid nodule. [healio.com]

  The case demonstrated here also showed the presence of multiple nodules within the thyroid. [sonoworld.com]

• Soft Tissue Mass

  A 69-year-old woman presented with neck hematoma and dysphagia and was found to have a soft tissue mass adjacent to her thyroid gland as seen on MRI and neck ultrasound. [ncbi.nlm.nih.gov]

  tissue mass suggesting a remnant adenoma. [pmj.bmj.com]

  A hypervascular soft-tissue mass near the expected location of the parathyroid glands is considered to represent a parathyroid adenoma. [emedicine.com]

• Weight Loss

  The patient was a 41-year-old female who presented anorexia, weight loss, polydipsia, polyuria, and constipation, bone pain particularly in the pelvis, lacrimation, and burning sensation of the eyes. She also had repeated urinary infections. [omicsonline.org]

  Loss of appetite. Weight loss for no known reason. Being much more thirsty than usual. Urinating much more than usual. Constipation. Trouble thinking clearly. [cancer.gov]

• Aspiration

  Ultrasound guided fine needle aspiration biopsy of parathyroid gland and lesions. Cyto Journal. 2006;3:1-7. Doppman JL, Krudy AG, Marx SJ, et al. Aspiration of enlarged parathyroid glands for parathyroid hormone assay. Radiology. 1983;148:31-35. [healio.com]

  Fine-needle aspiration cytology revealed a follicular neoplasm comprising oncocytic cells (Hürthle cells). [ncbi.nlm.nih.gov]

  It has been effective but is associated with the risk of subsequent fibrosis and recurrent laryngeal nerve palsy. 1 If aspiration cannot be done safely or the cyst recurs after successful aspiration, surgical excision should be done. 5 References 1. [asean-endocrinejournal.org]

• Abdominal Pain

  Introduction Adenomas of the parathyroid gland typically present with symptoms of hyperparathyroidism, manifested by fatigue, bone pain, abdominal pain, weakness, dyspepsia, nephrolithiasis and skeletal bone disease. [ncbi.nlm.nih.gov]

  You have nausea, vomiting, and abdominal pain. You cannot think clearly. When should I contact my healthcare provider? You have bone and joint pain. You have pain in your lower back, side, or stomach. [drugs.com]

  However, patients can experience common symptoms that can range from joint, muscle, and abdominal pain to slight discomfort. Additionally patients might be experiencing feelings of depression due to the hormonal imbalance. [en.wikipedia.org]

  Symptoms of parathyroid tumor includes aches and pains in the bones, kidney problems, nausea, abdominal pain, vomiting, fatigue, excessive urination, depression, In most cases, we do not know what causes the parathyroid gland to develop a tumor. [larianmd.com]

• Epigastric Pain

  Physical Examination Findings in Persons with Parathyroid Disorders System Finding Possible cause(s) Abdominal Flank pain, tenderness Nephrolithiasis from hypercalcemia Epigastric pain, tenderness Pancreatitis from hypercalcemia, or causing hypocalcemia [aafp.org]

• Tenderness in the Epigastric Region

  Abdominal examination showed mild tenderness in the epigastric region. Other systemic examination was normal. His serum amylase was 290 mg/dL and serum calcium was 11.3 mg/dL. [doi.org]

• Facial Angiofibroma

  Its clinical presentation includes MEN 1-related tumours such as parathyroid and anterior pituitary tumours in possible association with gonadal, adrenal, renal and thyroid tumours as well as facial angiofibromas, colagenomas and meningiomas. [ncbi.nlm.nih.gov]

• Osteoporosis

  Hormone replacement therapy (HRT) Postmenopausal women may be treated with HRT to prevent osteoporosis. Surgical excision of the adenoma is usually curative in 95% of patients. [symptoma.com]

  These efforts include avoiding calcium rich foods, proper hydration, and medications to avoid osteoporosis. As opposed to parathyroid adenoma, it should be noted that parathyroid cancer is very rare. [medicinenet.com]

  Bone scan showed patchy tracer uptake in almost entire skeleton with generalised osteoporosis and microfractures, suggestive of metabolic bone disease. [bjmp.org]

  Osteoporosis and the increased risk for bone fractures is the most common concern. [nlm.nih.gov]

  Primary hyperparathyroidism is a common endocrine condition in which one or more of the four parathyroid glands in the neck releases too much parathyroid hormone (PTH). this leads to excess calcium in the blood and if untreated it can cause osteoporosis [clinicaltrials.gov]

• Bone Pain

  We report one such incidence of a 14 years old girl who presented with bone pains short stature, and generalized muscle wasting. [ncbi.nlm.nih.gov]

• Arthralgia

  […] vision, insomnia, lethargy, weakness Possible diagnoses: corneal calcification, delirium, mild cognitive impairment Renal Polydipsia, polyuria, renal colic Possible diagnoses: nephrocalcinosis, nephrolithiasis, nephrogenic diabetes insipidus Skeletal Arthralgia [aafp.org]

• Genu Valgum

  She was found to have genu valgum at the knee joint, pectus carniatum, scoliosis and cystic changes in pelvis and calvarium. Biochemical investigations and parathyroid Tc-99mMIBI scan confirmed the diagnosis of a parathyroid adenoma. [ncbi.nlm.nih.gov]

• Breast Mass

  We describe a case of a 57-year-old woman who underwent parathyroid scintigraphy and F-FDG PET/CT in the same week due to hyperparathyroidism and an enlarging breast mass, respectively. [ncbi.nlm.nih.gov]

• Encephalopathy

  MB is a cationic thiazine dye with a variety of uses including treatment of drug-induced methaemoglobinaemia, septic shock, treatment and prevention of ifosfamide—induced encephalopathy ( 25, 26 ). [annalscts.com]

• Polyuria

  Initially, the patient experienced a sudden onset of gastrointestinal symptoms, polyuria, polydipsia, bone pain, renal dysfunction, nephrolithiasis, and acute pancreatitis, symptoms associated with hypercalcemia. Biochemical findings suggested PHPT. [ncbi.nlm.nih.gov]

  Features include lethargy, fatigue, polydipsia, polyuria, myalgia, abdominal pain, constipation, nausea, and emesis. Also, patients may exhibit mental status changes and depression. [symptoma.com]

  The patient was a 41-year-old female who presented anorexia, weight loss, polydipsia, polyuria, and constipation, bone pain particularly in the pelvis, lacrimation, and burning sensation of the eyes. She also had repeated urinary infections. [omicsonline.org]

  The incidence of parathyroid adenoma is reported to be about 85%. [3] The most frequent symptoms are weakness, fatigue, anorexia, nausea, vomiting, polydipsia and polyuria, loss of weight, dyspepsia, constipation, and headaches. [ijpmonline.org]

  The disease is usually detected with symptoms of hypercalcemia, including urinary calculus, bone lesion (osteoporosis), polyposia and polyuria, general malaise, vomiting, and constipation. [cardiothoracicsurgery.biomedcentral.com]

The clinical evaluation consists of the individual's history, physical exam, and appropriate studies.

Laboratory tests

Biochemical assessment should include measurements of the serum calcium and PTH levels.

Imaging

Once primary hyperparathyroidism has been demonstrated, imaging is obtained. Specifically, parathyroid ultrasonography is the initial study since it is noninvasive and inexpensive. This is followed by sestamibi parathyroid scintigraphy for detection and confirmation of the adenoma [4]. This scan exhibits a 90% sensitivity for locating the lesion. These studies are also recommended for preoperative planning [5] although other modalities may be utilized as well.

Since 10% of these tumors are ectopic, they can be discovered by the use of computed tomography (CT), magnetic resonance imaging (MRI), scintigraphy, single photon emission computed tomography (SPECT), and/or ultrasonography [6].

• Phosphate Decreased

  […] results in atrophy of remaining 3 Carcinoma is rare Presentation Symptoms "bones, stones, moans, and groans" see hyperparathyroidism Evaluation Histology sheets of chief cells no adipose tissue Serology serum calcium level elevated, PTH increased, and phosphate [medbullets.com]

• Calcium Increased

  […] parathyroid hormone, serum calcium increased Prognosis benign Other depression, psychosis, delirium, coma, ataxia Clin. [librepathology.org]

• Parathyroid Hormone Increased

  This means that your parathyroid glands are being stimulated all the time to try to increase your blood calcium level. As a result, your parathyroid glands enlarge and their output of parathyroid hormone increases. [patient.info]

Surgery

Parathyroidectomy is recommended for symptomatic patients and asymptomatic individuals below the age of 50 [7]. Some experts believe in expanding the criteria further [8].

Historically, bilateral neck exploration was the standard management for identification and excision of the lesion but this was replaced by unilateral exploration a few decades ago [9]. Due to modern advancements in imaging, parathyroidectomy may be minimally invasive [9]. Accurate site identification and intraoperative monitoring of PTH are crucial strategies for minimally invasive surgery [10].

Hormone replacement therapy (HRT)

Postmenopausal women may be treated with HRT to prevent osteoporosis.

Surgical excision of the adenoma is usually curative in 95% of patients.

The etiology has not been established although 10% of cases are regarded as inherited. Exposure to radiation is the main risk factor [1].

Approximately 80% to 85% of primary hyperparathyroidism cases are attributed to parathyroid adenoma. In rare cases, there is a presence of hormone-producing parathyroid adenoma without an increase in serum levels of parathyroid hormone (PTH) and calcium [2].

A parathyroid adenoma can arise from any of the four parathyroid glands. These glands release parathyroid hormone (PTH), which stimulate the release of calcium from bones. Consequently, this tumor will produce excess levels of PTH and calcium in serum [3]. Parathyroid adenoma has a negative impact on bone composition because of an excessive mobilization of calcium from bones.

Histological analysis reveals that the tumor is composed of chief cells which are surrounded by a rim of a normal parathyroid gland.

There is no prevention for parathyroid adenoma.

Parathyroid adenoma, a type of parathyroid proliferative disorder, is the leading cause of primary hyperparathyroidism. The diagnosis is achieved through the patient's history, physical exam, laboratory tests and imaging studies. Surgical excision is the mainstay of therapy.

What is parathyroid adenoma?

This is a benign tumor of the parathyroid gland, which is located behind the thyroid gland. The parathyroid gland normally releases the parathyroid hormone, which increases the calcium levels in the blood. Parathyroid adenoma releases excessive amounts of this hormone.

What are the symptoms?

The symptoms are related to high calcium blood levels, which include:

• Fatigue
• Confusion
• Constipation
• Abdominal pain
• Muscle pain
• Nausea and vomiting
• Frequent urination and thirst

How is it diagnosed?

Laboratory tests will usually show increased calcium and parathyroid hormone levels. Also, imaging studies of the parathyroid gland are very important to confirm and locate the tumor.

How is it treated?

Surgical removal of the tumor is the main treatment when indicated. It cures 95% of patients.

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2. Sekine O, Hozumi Y, Takemoto N, Kiyozaki H, Yamada S, Konishi F. Parathyroid adenoma without hyperparathyroidism. Japanese Journal of Clinical Oncology. 2004;34(3):155-158.
3. Felsenfeld AJ, Rodríguez M, Aguilera-Tejero E. Dynamics of parathyroid hormone secretion in health and secondary hyperparathyroidism. Clinical Journal of the American Society of Nephrology. 2007;2(6):1283-1305.
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5. Phillips CD, Shatzkes DR. Imaging of the parathyroid glands. Seminars in Ultrasound, CT and MRI. 2012; 33(2):123-129.
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7. National Institutes of Health. NIH conference. Diagnosis and management of asymptomatic primary hyperparathyroidism: consensus development conference statement. Annals of Internal Medicine. 1991; 114(7):593-597.
8. Eigelberger MS, Cheah WK, Ituarte PH, Streja L, Duh QY, Clark OH. The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: are they too limited?. Annals of Surgery. 2004; 239(4):528-535.
9. Bellantone R, Raffaelli M, DE Crea C, Traini E, Lombardi CP. Minimally-invasive parathyroid surgery. Acta Otorhinolaryngologica Italica. 2011;31(4):207-215.
10. Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Archives of Surgery. 2005; 140(5):472-8; discussion 478-479.