Parathyroid adenoma

The first signs of a parathyroid adenoma and the resulting primary hyperparathyroidism can include bone fractures and urinary calculi such as kidney stones.

Often, a parathyroid adenoma is diagnosed by an incidental finding on blood tests that reveal high calcium levels.(2012) The New York Times, Health Guide{{vs|date=April 2014}} Patients may not be experiencing any noticeable symptoms but could be producing excessive amounts of calcium and eventually experience problems later in life if untreated. However, if symptomatic, patients can experience: pain or discomfort in the joints, muscles, and abdomen; depression and mood changes due to the hormonal imbalance.;{{cite web |url=http://my.clevelandclinic.org/disorders/parathyroid_disease/hic_parathyroid_adenoma_diagnosis_and_treatment.aspx |date=June 11, 2012 |title=Parathyroid adenoma: Diagnosis & treatment |publisher=Cleveland Clinic}} constipation; exhaustion; and kidney damage.

Parathyroid adenoma can be associated with overexpression of the cyclin D1 gene.{{cite journal |vauthors=Hsi ED, Zukerberg LR, Yang WI, Arnold A |title=Cyclin D1/PRAD1 expression in parathyroid adenomas: an immunohistochemical study |journal=The Journal of Clinical Endocrinology and Metabolism |volume=81 |issue=5 |pages=1736–9 |date=May 1996 |pmid=8626826 |doi=10.1210/jcem.81.5.8626826|doi-access=free }} It is also associated with multiple endocrine neoplasia (MEN).{{cite web |url= https://www.lecturio.com/concepts/multiple-endocrine-neoplasia/| title= Multiple Endocrine Neoplasia

|website=The Lecturio Medical Concept Library |access-date= 11 August 2021}}

File:Parathyroid adenoma low mag.jpg of a parathyroid adenoma (left) and normal parathyroid gland (right). H&E stain.]]

Hyperparathyroidism is confirmed by blood tests such as calcium and PTH levels. A specific test for parathyroid adenoma is sestamibi parathyroid scintigraphy, often referred to as sestamibi scan or, more colloquially, MIBI scan. This nuclear imaging technique reveals the presence and location of pathological parathyroid tissue.{{cite journal |vauthors=Goldstein RE, Billheimer D, Martin WH, Richards K |title=Sestamibi scanning and minimally invasive radioguided parathyroidectomy without intraoperative parathyroid hormone measurement |journal=Annals of Surgery |volume=237 |issue=5 |pages=722–30; discussion 730–1 |date=May 2003 |pmid=12724639 |pmc=1514518 |doi=10.1097/01.SLA.0000064362.58751.59}} In cases where ^99mTc-sestamibi scintigraphy or SPECT delivers inconclusive results, other imaging modalities and tracers can be applied. For detection of multiple parathyroid adenomas, positron emission tomography (PET) using the radiopharmaceutical ⁶⁸Ga-Trivehexin{{cite journal | vauthors = Quigley NG, Steiger K, Hoberueck S, Czech N, Zierke MA, Kossatz S, Pretze M, Richter F, Weichert W, Pox C, Kotzerke J, Notni J | display-authors = 6 | title = PET/CT imaging of head-and-neck and pancreatic cancer in humans by targeting the "Cancer Integrin" αvβ6 with Ga-68-Trivehexin | journal = European Journal of Nuclear Medicine and Molecular Imaging | volume = 49 | issue = 4 | pages = 1136–1147 | date = March 2022 | pmid = 34559266 | doi = 10.1007/s00259-021-05559-x | doi-access = free | pmc = 8460406 }} has demonstrated a higher detection rate (94.1%) than ^99mTc-sestamibi imaging (58.8%).{{cite journal | vauthors = Kuyumcu S, Denizmen D, Has-Simsek D, Poyanli A, Uzum AK, Buyukkaya F, Isik EG, Onder S, Aksakal N, Ozkan ZG, Sanli Y | display-authors = 6 | title = ⁶⁸Ga-Trivehexin PET/CT: a promising novel tracer for primary hyperparathyroidism | journal = European Journal of Nuclear Medicine and Molecular Imaging | volume = 51 | issue = 13 | pages = 3912–3923 | date = July 2024 | pmid = 39028425 | doi = 10.1007/s00259-024-06846-z | doi-access = free | pmc = 11527967 }}

4DCT is used as second line investigation to diagnose parathyroid adenoma. In addition to the three dimensional imaging of a conventional CT scan, 4DCT provides imaging on the changes of iodinated contrast enhancement over time and present them in a video format (from plain imaging to arterial to venous and delay phases). Parathyroid adenoma would show low density on non contrast image, with peak enhancement during the arterial phase, then slowly fade away until the delay phase.{{Cite journal |last1=Hoang |first1=Jenny K. |last2=Sung |first2=Won-kyung |last3=Bahl |first3=Manisha |last4=Phillips |first4=C. Douglas |date=January 2014 |title=How to Perform Parathyroid 4D CT: Tips and Traps for Technique and Interpretation |url=http://pubs.rsna.org/doi/10.1148/radiol.13122661 |journal=Radiology |language=en |volume=270 |issue=1 |pages=15–24 |doi=10.1148/radiol.13122661 |pmid=24354373 |issn=0033-8419}}

Surgery is the only cure for parathyroid adenomas. It is successful about 95% of the time. Parathyroidectomy is the removal of the affected gland(s). The standard of treatment of primary hyperparathyroidism was formerly a surgical technique called bilateral neck exploration, in which the neck was opened on both sides, the parathyroids were identified, and the affected tissue was removed.{{cite journal |vauthors=Bellantone R, Raffaelli M, DE Crea C, Traini E, Lombardi CP |title=Minimally-invasive parathyroid surgery |journal=Acta Otorhinolaryngologica Italica |volume=31 |issue=4 |pages=207–15 |date=August 2011 |pmid=22065831 |pmc=3203720}} By the 1980s, unilateral exploration became more common. Parathyroidectomy can now be performed in a minimally invasive fashion, mainly because imaging techniques can pinpoint the location of the tissue. Minimally invasive techniques include smaller open procedures, radio-guided and video-assisted procedures, and totally endoscopic surgery.

Before surgery is attempted, the affected glandular tissue must be located. Though the parathyroid glands are usually located on the back of the thyroid, their position is variable. Some people have one or more parathyroid glands elsewhere in the neck anatomy or in the chest. About 10% of parathyroid adenomas are ectopic, located not along the back of the thyroid but elsewhere in the body, sometimes in the mediastinum of the chest.{{cite journal |doi=10.4103/0973-0354.96061 |title=Ectopic parathyroid adenoma |journal=Thyroid Research and Practice |volume=9 |issue=2 |pages=68–70 |year=2012 |last1=Dsouza |first1=Caren |last2=Gopalakrishnan |last3=Bhagavan |first3=KR |last4=Rakesh |first4=K |doi-access=free }} This can make them difficult to locate, so various imaging techniques are used, such as the sestamibi scan, single-photon emission computed tomography (SPECT), ultrasound, MRI, and CT scans.{{cite journal |vauthors=Zald PB, Hamilton BE, Larsen ML, Cohen JI |title=The role of computed tomography for localization of parathyroid adenomas |journal=The Laryngoscope |volume=118 |issue=8 |pages=1405–10 |date=August 2008 |pmid=18528308 |doi=10.1097/MLG.0b013e318177098c|s2cid=46264400 }} sometimes parathyroid adenomas can be ablated by ethanol injection, laser or radiofrequency guided by ultrasound.

Image:Parathyroid adenoma intermed mag.jpg

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• Endocrine system
• Parathyroid disease

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{{Medical resources

| DiseasesDB = 9626

| ICD10 = {{ICD10|D|35|1|d|10}}

| ICD9 = {{ICD9|227.1}}

| ICDO =

| OMIM =

| MedlinePlus = 001188

| eMedicineSubj = radio

| eMedicineTopic = 525

| MeshID = D010282

| SNOMED CT = 128474007

}}

{{Endocrine gland neoplasia}}

Category:Endocrine neoplasia

Category:Benign neoplasms