Adenoma of the parathyroid gland

A benign hormonal neoplasm that occurs in the parathyroid gland is a parathyroid adenoma.

These glands are located behind the thyroid gland. The human body is equipped with a pair of upper and lower glands. Mostly, a parathyroid adenoma is presented as a hard nodule of a yellowish-brown hue with a clearly defined contour, with associated formations in the form of cysts. Most often, the object of damage by this disease is a pair of glands of the lower attachment. Much less often, you can find damage to two pairs of glands at once.

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Causes of parathyroid adenoma

Doctors tend to distinguish between two main causes of parathyroid adenoma:

• Degeneration of protein cells responsible for transporting the chemical element calcium to the parathyroid gland. The mutated cell divides uncontrollably and grows very quickly. This is the impetus for the development of a parathyroid gland adenoma. It is enough for one gene to mutate to trigger the tumor growth mechanism.
• A lack of calcium in the body can also provoke a change in the structure of the cell and its rapid division. The result is the same.

The cause or impetus for the emergence of these mutations can be trauma or a radiation dose received by a person in the neck and head area. The degeneration of adenoma into a malignant formation is unlikely, but possible, and accounts for about 2% of cases.

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Symptoms of parathyroid adenoma

A small adenoma, as a rule, practically does not manifest itself. Therefore, the clinical picture of the disease can not be seen immediately. And the symptoms can be somewhat unclear, blurred, slightly different in different patients. But it is still possible to identify the dominant manifestations:

• Increased sweating of the skin (activation of sweat glands).
• The release of droplets of moisture on the skin even in a calm, non-stressful state.
• Increased heart rate.
• Drowsiness.
• Decreased vitality, rapid fatigue.
• A little later, even visually, without ultrasound examination, one can observe an increase in the volume of the thyroid gland (goiter).

If these symptoms appear, you should consult a doctor, and if the diagnosis is confirmed, immediately begin treatment. If such symptoms have occurred before, it is worth monitoring how long they last (this is especially true for older people). If the symptoms are present all the time, you need to sound the alarm.

Diagnosis of parathyroid adenoma

If there are symptoms of a parathyroid gland adenoma, an urgent examination of the patient is necessary, and the doctor should not discount the fact that similar signs are observed in some other diseases and they need to be differentiated. For example, these deviations, secondary signs, may indicate diseases associated with the kidneys or skeletal system.

Diagnosis of parathyroid adenoma is carried out using:

• Visual examination of the patient.
• Analysis of his complaints.
• Collection of anamnesis.
• Ultrasound (ultrasound examination): detection of deviations in the size of the thyroid gland, location of the pathology.
• Laboratory clinical research: blood test for phosphorus and calcium content, determination of the amount of calcium lost through urine per day.
• Ultrasound of the abdominal cavity: it is necessary to exclude changes in the structure of the pancreas, nephritis and other diseases associated with the kidneys.
• Subtraction scintigraphy – differentiation of parathyroid adenoma, its location.
• X-ray. Exclusion of bone tissue pathology, cysts…
• Fibrogastroduodenoscopy. It is necessary to exclude ulcerative manifestations and gastritis.
• Biopsy. Taking tissue samples from the cervical lymph nodes.
• One of the main indicators in confirming the diagnosis of adenoma is the presence of remnants of a healthy gland next to the tumor.

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Treatment of parathyroid adenoma

Treatment of parathyroid adenoma is definitely only surgical, but before proceeding with surgery, it is necessary to conduct therapeutic therapy for hypercalcemia:

• Forced diuresis is a fairly commonly used detoxification method, which involves removing toxins from the body using urine using accelerated methods. Large volumes of excretion can be achieved by simultaneously taking a significant amount of fluid and medications that have a diuretic effect.

• Hypothiazide

Refers to thiazide diuretics. Dosage is individual.

For adults, a daily dosage of 25-50 mg is recommended in one dose. But upon individual consideration, for some patients the doctor may reduce the dosage to 12.5 mg or, conversely, raise it to 100 mg, but not more. The daily dose should not exceed this figure. The course of treatment is also determined by the attending physician.

For children, the dosage is set at 1-2 mg per kilogram of the baby's weight or 30-60 mg of the drug per 1 ^m2 of the child's body area. It is taken once a day. The total dose of the drug taken by children is 37.5-100 mg.

The side effects and contraindications of this drug are significant:

• severe manifestations of renal and hepatic failure;
• diabetes mellitus;
• manifestation of a deficiency of potassium, calcium and sodium in the patient's body;
• Addison's disease;
• individual intolerance to the components of the drug;
• It is not recommended to prescribe for children under three years of age;
• use with caution in elderly people;
• women in the first trimester of pregnancy (in the second and third trimesters, only if absolutely necessary);
• breastfeeding.

• Furosemide

Belongs to the more powerful "loop diuretics"

When prescribing this drug, the attending physician considers the dosage individually for each patient, taking into account the patient's age, clinical indicators, and the goal he is trying to achieve.

The starting daily dosage for an adult varies between 20 and 80 mg, which, if necessary, can be increased to 600 mg.

The starting single dose of this medicine for children is calculated from the ratio of 1-2 mg per kilogram of the baby's weight. If necessary, the dosage is increased, but should not exceed 6 mg per kilogram of weight.

For adult patients, the drug is administered intravenously or intramuscularly. The daily starting dosage should not exceed 40 mg and only in rare cases is it increased to 80 mg, but is not taken once, but divided into two doses.

During pregnancy, furosemide can be taken for a very limited time. If the patient suffers from diseases such as stenosis of the urethra, hyperuricemia, urolithiasis of the excretory tract, renal failure, etc., then this drug is not recommended.

• Phosphate infusion

80-85% of phosphates contained in the body are found in bone tissue, and its deficiency (hypophosphatemia) significantly affects the condition of the bones, but at the same time affects endocrine processes.

• Sodium phosphate

The drug is prescribed orally. It is administered slowly, at a rate of 2.5 mg per kilogram of the patient's weight. Hypersensitivity to the components of the drug may be a contraindication.

• Throughout the treatment, it is necessary to keep the heart activity under control.
• Constant monitoring of plasma calcium levels is also necessary.
• Surgical intervention is performed.

After a successful operation, the calcium level in the blood normalizes within two days, but there is a risk of hypocalcemia (extremely low calcium level in the body). In this case, the patient begins to receive parathyroid hormone.

• Parathyroid hormone

This medicine is taken in dosages that depend on the patient's age and gender; a woman in a similar situation receives a slightly lower dosage.

• For children under 22 years of age, the dosage of the drug is from 12 pg/ml to 95 pg/ml.
• If the patient falls into the 23 to 70 years old category, the dose varies from 9.5 to 75 pg/ml.
• Patient over 71 years of age – received dosage - 4.7 to 117 pg/ml.
• After surgery, the patient is prescribed a diet that limits the consumption of calcium-rich foods, while dishes and products that contain a large amount of phosphorus are welcomed.
• After the operation, diuretics are prescribed. Just not thiazide diuretics, since they, on the contrary, promote the accumulation, rather than the removal of calcium from the body. For example,

• Hygrotan

Belongs to oxodolines.

The starting daily dosage of the drug is 100-120 mg, the drug is taken every other day, in severe cases - daily. When raising the dosage above 120 mg - no significant improvement in urination is observed. If necessary, after a few days of taking the drug, the doctor reduces the dosage according to the scheme 100 - 50 - 25 mg per day, moving to a maintenance amount.

The drug in question should not be taken by people suffering from hypersensitivity to the substances included in the drug; severe renal and hepatic insufficiency, potassium deficiency in the body, diabetes, gout, and others.

• Indapamide

The medicine is taken orally, in the morning, 1.25 - 1.5 mg daily. If after a month of treatment the result is not very visible, it is necessary to choose another treatment protocol. Increasing the dosage will not lead to anything, only the diuretic effect will increase.

Contraindications to the use of indapamide may include liver and kidney failure, gout, impaired blood circulation in the brain, and individual intolerance to the components of the drug.

• Such a patient is also prescribed vitamin D3 both in tablets and in the form of sunbathing.
• Therapeutic gymnastics.
• Massages.
• If a hypercalcemic crisis occurs, the patient is subject to urgent hospitalization. In this case, three to four liters of isotonic sodium chloride solution are administered intravenously during the day. This drug stimulates the production of renal secretion. If there is no renal failure, then complex treatment based on furosemide, sodium chloride, potassium chloride, 5% glucose is used. All these efforts are made to quickly remove calcium from the patient's body.

Surgery for parathyroid adenoma

This surgical intervention can be classified as a complex operation. Due to its specificity, it should be performed by an endocrinologist surgeon in a specialized, not general, surgical department.

Preparatory stage

The patient needs to know that there is no fundamental difference in what time of year the operation for parathyroid adenoma is performed. The only thing that can delay the surgical intervention is the exacerbation of chronic diseases or the occurrence of infectious diseases. The operation is postponed for the duration of the treatment. Before the surgical intervention itself, the patient undergoes a full examination with all the necessary clinical tests.

The operation itself

The operation for parathyroid adenoma is performed under general anesthesia, which is administered by an anesthesiologist. He also monitors the patient's condition during the operation (pulse, pressure, etc.). The duration of the resection of the parathyroid adenoma largely depends on the amount of work that the surgeon will have to do, but on average it takes from an hour to a hundred minutes. Although there are cases when the operation lasts up to four to six hours. This often happens with pathology of the lymph nodes of the neck. The duration also depends on the type of operation that is performed on a particular patient.

All radical interventions for parathyroid adenoma can be divided into several groups:

• Complete resection of the thyroid gland. Or as doctors call it, thyroidectomy.
• Resection of one lobe of the gland – hemithyroidectomy.
• During resection, the surgeon leaves a small amount (several grams) of the thyroid gland – Subtotal removal.
• When resecting only one isthmus of the thyroid gland - removal of the isthmus.

The operating surgeon himself determines which group a specific pathology belongs to, based on the extent of the tumor spread and damage to associated organs.

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Removal of parathyroid adenoma

Removal of a parathyroid gland adenoma is radical, but often the only way to rid the patient of this problem. Single tumors are removed without fail. However, during the surgical intervention, the endocrinologist surgeon must carefully examine all the glands so as not to miss the emergence of a new parathyroid gland adenoma, but in a different location. Asymmetric hyperplasia or the presence of several adenomas is also possible.

If all glands are affected by adenoma, the surgeon resects three of them completely and partially the fourth (subtotal parathyroidectomy). The doctor saves about 100 milligrams of the organ, which, well supplied with blood, is able to maintain the normal parathyroid hormone level. After such an operation, relapses are minimal, only 5% of all cases.

There are also various methods of accessing the location of the parathyroid adenoma:

• Classic direct access to the surgical site, practiced everywhere.
• Resection with mini-access to the tumor location. This method is more gentle on the patient's body.
• Video-assisted resection. This method causes minimal trauma to the patient's body. It uses innovative access technology with the help of modern equipment. The videoendoscopic device penetrates the surgical site through a small incision. And the resection itself is performed using a special medical instrument and optical systems. At the same time, the postoperative rehabilitation period is significantly reduced. Pain syndrome is minimized, an excellent cosmetic aspect is obtained, which is very important, especially for women.

The neck is a rather specific place in the human body, blood arteries that feed the brain, nerve endings, muscles that support the cranium pass through it. Therefore, during surgery, the surgeon is careful not to intersect short muscles, such as the sternothyroid, sternohyoid…

The operating surgeon also ensures that the vocal nerves and the vocal apparatus as a whole are not damaged by visual control. During the operation, a modern material made of organic polymers is used to fix the suture, which has hypoallergenic properties and dissolves over time. The external suture is made cosmetic, so it is not so noticeable to strangers, allowing former patients to feel more comfortable in everyday life.

Prevention of parathyroid adenoma

Prevention of parathyroid adenoma mainly comes down to streamlining the patient’s lifestyle and revising their culinary preferences.

• It is necessary to minimize the intake of phosphorus and increase the amount of calcium. In this light, dairy products are especially preferable.
• You have to eat a lot of fruits and vegetables, raw, stewed or baked. The body must receive a full range of vitamins and microelements.
• The body also needs vitamin D3, which can be replenished either with tablets or by "swimming" in the sun. The main thing is not to overdo it with the dosage, receiving ultraviolet rays.

Food priorities:

• Algae with high iodine content.
• Fatty fish. The positive qualities of fish oil are used.
• Reduce consumption of butter, cheeses and full-fat milk. Milk is very healthy, but with a small percentage of fat.
• Ergocalciferol. Some types of wild mushrooms, especially chanterelles, can serve as its source. Mushrooms grown in artificial conditions do not give the necessary effect.

Life expectancy for parathyroid adenoma

After the operation, the prognosis for life with parathyroid adenoma is usually positive. The rehabilitation period takes a short period of time, during which the calcium content in the blood and the work of the cardiovascular system are monitored. In most cases, the calcium level in the plasma is normalized by the end of the second day. And only some patients have to deal with transient hypocalcemia (no more than 5% of cases), which will have to be treated with complex methods (medication, nutrition...). After a few months, the symptoms of bone disease also go away. The general well-being of the patient is normalized.

If you observe symptoms that deviate from the norm and are afraid to go to the clinic, in vain. Today, parathyroid adenoma is treated quite simply. At the same time, the trauma to the body is reduced to a minimum. The main thing is not to miss the moment when the disease goes too far and it is necessary to resect not a small area, but the entire organ. Therefore, be more attentive to yourself and your health. After all, it is no secret that a healthy body is a full-fledged social life in society and a quiet, calm old age.