A parathyroid adenoma is a benign tumor that arises from the parathyroid gland.
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.
The clinical evaluation consists of the individual's history, physical exam, and appropriate studies.
Biochemical assessment should include measurements of the serum calcium and PTH levels.
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 . This scan exhibits a 90% sensitivity for locating the lesion. These studies are also recommended for preoperative planning  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 .
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 . Due to modern advancements in imaging, parathyroidectomy may be minimally invasive . Accurate site identification and intraoperative monitoring of PTH are crucial strategies for minimally invasive surgery .
Hormone replacement therapy (HRT)
Postmenopausal women may be treated with HRT to prevent osteoporosis.
The etiology has not been established although 10% of cases are regarded as inherited. Exposure to radiation is the main risk factor .
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 .
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 . 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.
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:
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.