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]

• Fatigue

  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]

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

  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]

  39 THE THYROID NODULE 374 HORMONE ERNEST L MAZZAFERRI 402 THYROID HORMONE RESISTANCE KENNETH D BURMAN 428 THYROID FUNCTION TESTS 329 and LEONARD WARTOFSKY 440 THYROID SONOGRAPHY COMPUTED and MARTIN 1 SURKS 454 ABNORMAL THYROID FUNCTION TEST 47 THYROID [books.google.com]

• Swelling

  Exploration of the carotid sheath revealed a fusiform swelling of the vagus nerve at the level of the carotid bifurcation. Longitudinal incision of the vagal perineurium revealed a 7-mm parathyroid adenoma, which was enucleated. [ncbi.nlm.nih.gov]

  Clinically there was a 3 x 2 cm midline swelling in the neck, cystic in consistency, moving with deglutition. Systemic examination was normal. [asean-endocrinejournal.org]

  In 1995, the patient recognized right cervical swelling that was left untreated because there were no other symptoms. [doi.org]

• Surgical Procedure

  The technique involved injecting 20 mCi MIBI 1 hour before the surgical procedure in patients who preoperatively had positive MIBI imaging. Patients had the choice of general or MAC anesthesia. [doi.org]

  A minimally invasive surgical procedure was performed to remove the mass, which was sent to the Department of Pathology, Emergency County Hospital, Tirgu Mures, Romania, as left PA. It was fixed and processed for microscopic evaluation. [ncbi.nlm.nih.gov]

  The following surgical procedures may be used: En bloc resection : Surgery to remove the entire parathyroid gland and the capsule around it. [cancer.gov]

  The following surgical procedures may be used: En bloc resection: Surgery to remove the entire parathyroid gland and the capsule around it. [northshore.org]

  Better patient outcomes have been reported when complex surgical procedures are performed at high-volume hospitals and centres of excellence. [annalscts.com]

• 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]

• 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]

  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 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]

• 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]

• Confusion

  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 Blood tests may be done to check levels of: PTH Calcium Phosphorus [nlm.nih.gov]

  OBJECTIVE: The aim of the study is to present the unusual changes that a lymph node metastasis of papillary thyroid carcinoma (PTC) underwent after radioiodine therapy, leading to the confusion with a parathyroid adenoma (PA). [ncbi.nlm.nih.gov]

  Snapshot A 45-year-old woman presents with pain and achiness in her joints and bones, as well as confusion and a dulled mental state. She also has had recurrent episodes of kidney stones, and in the ED they found QTc shortening on her EKG. [medbullets.com]

  Bone pain Kidney problems, including pain in the upper back and excessive urination Stomach pain History of gastroduodenal ulcers, which are ulcers found in the stomach and/or small intestine Weakness Difficulty speaking Vomiting Depression Fatigue Confusion [cancer.net]

• 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]

  Primary hyperparathyroidism is usually diagnosed as a result of chance finding of raised serum calcium or complications associated with hypercalcemia such as polyuria, polydipsia, muscle weakness, gastrointestinal upsets and renal stone formation. [bjmp.org]

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].

• Hypophosphatemia

  After undergoing parathyroidectomy, her hypercalcemia and hypophosphatemia rapidly normalized. Subsequent genetic testing revealed mutations of the TSC1 gene. [ncbi.nlm.nih.gov]

  This results in increased production of the parathyroid hormone subsequently causing hypercalcemia and hypophosphatemia. [sonoworld.com]

  Investigations (table–1) revealed hypercalcemia (12Mg/dl), hypophosphatemia (2.6Mg/dl) and elevated parathyroid hormone level (70 Pmmol/l). 25-hydroxyvitamin D value was in the lower limit of normal (22ng/ml). Renal parameters were normal. [bjmp.org]

• Hypophosphatemia

  After undergoing parathyroidectomy, her hypercalcemia and hypophosphatemia rapidly normalized. Subsequent genetic testing revealed mutations of the TSC1 gene. [ncbi.nlm.nih.gov]

  This results in increased production of the parathyroid hormone subsequently causing hypercalcemia and hypophosphatemia. [sonoworld.com]

  Investigations (table–1) revealed hypercalcemia (12Mg/dl), hypophosphatemia (2.6Mg/dl) and elevated parathyroid hormone level (70 Pmmol/l). 25-hydroxyvitamin D value was in the lower limit of normal (22ng/ml). Renal parameters were normal. [bjmp.org]

• Calcium Increased

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

  Treatment with calcitriol or its analogs increased the serum calcium concentration and increased the set point of calcium, shifting the PTH–calcium curve to the right in both disorders. [doi.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.
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