Parathyroid adenoma

The hormonal benign neoplasm that has arisen in the region of the parathyroid gland is an adenoma of the parathyroid gland.

These glands are located behind the thyroid gland. The human body is provided with a pair of upper and lower glands. Overwhelmingly, the parathyroid adenoma is presented as a hard bundle of a yellowish-brown hue with a clearly outlined contour, with conjugate formations in the form of cysts. Most often, the object of infection of this disease is a pair of glands of the lower attachment. Significantly less often you can see the defeat of two pairs of glands.

[1], [2], [3], [4], [5], [6], [7]

Causes of parathyroid adenoma

Physicians are inclined to distinguish, two main causes of parathyroid adenoma:

• The degeneration of protein cells, which are responsible for the transport of a chemical element of calcium into the parathyroid gland. The mutated cell divides uncontrollably and grows very rapidly. This is the trigger for the appearance of parathyroid adenoma. It is enough to mutate one gene so that the tumor growth mechanism is started.
• Lack of calcium in the body is also capable of provoking a change in the structure of the cell and its rapid division. The result is the same.

The cause or trigger of these mutations may be trauma, or the radiation dose of radiation that a person received in the neck and head. The degeneration of adenoma into a malignant formation is unlikely, but it is possible that it is about 2% of cases.

[8], [9], [10], [11], [12], [13]

Symptoms of parathyroid adenoma

Adenoma of small size, as a rule, practically does not manifest itself. Therefore, the clinical picture of the disease can not be considered immediately. Yes, and the symptomatology is somewhat unclear, blurred, slightly different in different patients. But nevertheless it is possible to single out the dominant manifestations:

• Increased sweating of the skin (activation of glands secreting sweat).
• The release of droplets of moisture on the skin, even in a calm, not stressful, condition.
• Increasing heart rate.
• Drowsiness.
• Decrease in vital tone, fast fatigue.
• Somewhat later, even visually, without ultrasound, one can observe an increase in the volume of the thyroid (goiter).

When these symptoms occur, you should seek medical advice from a doctor, and in case of confirmation of the diagnosis, immediately begin treatment. If such manifestations have arisen before, it is worthwhile to see how long they last (especially for elderly people). If symptoms are present all the time - you need to sound an alarm.

Diagnosis of parathyroid adenoma

If the symptoms of parathyroid adenoma are present, an urgent examination of the patient is necessary, while the doctor should not be dismissed, that similar signs are observed in some diseases and need to be differentiated. For example, these abnormalities, secondary signs, may indicate diseases related to the kidney or bone system.

Diagnosis of parathyroid adenoma is carried out with the help of:

• Visual examination of the patient.
• An analysis of his complaints.
• Anamnesis collection.
• Ultrasound (ultrasound): the detection of abnormalities in the size of the thyroid gland, the location of pathology localization.
• Laboratory clinical research: a blood test for the content of phosphorus and calcium, determining the amount of calcium lost through the 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.
• Radiography. Exclusion of pathology of bone tissue, cyst ...
• Fibrogastroduodenoscopy. It is necessary to exclude ulcerative manifestations and gastritis.
• Biopsy. Sampling of the tissues of the cervical lymph nodes.
• One of the main indicators, in confirming the diagnosis of adenoma, is the presence of the remains of a healthy gland next to the tumor.

[14], [15], [16], [17], [18]

Treatment of parathyroid adenoma

Treatment of parathyroid adenoma is uniquely just an operative, but before proceeding to surgery, it is necessary to conduct therapeutic therapy of hypercalcemia:

• Forced diuresis is a method of detoxification that is often used, which is the excretion of toxins from the body of toxins by accelerated methods. Large volumes of excretion can be obtained through the simultaneous administration of a significant amount of liquid and drugs that have a diuretic effect.

• Hypothiazide

Refers to thiazide diuretics. Dosage is individual.

For adults, a daily dosage of 25 to 50 mg is recommended in one dose. But with individual consideration, for some patients the doctor can reduce the dosage and up to 12.5 mg or, conversely, raise up to 100 mg, but no more. The daily dose should not exceed this figure. The course of admission is also established by the attending physician.

Children dosage is set at the rate of 1 - 2 mg per kilogram of the weight of the baby or 30 - 60 mg of the drug per 1 m ² 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.

Side effects and contraindications of this drug are essential:

• severe manifestations of renal and hepatic insufficiency;
• diabetes;
• the lack of potassium, calcium and sodium in the patient's body;
• Addison's disease;
• individual intolerance of the constituents of the drug;
• it is not recommended to attribute to children less than three years;
• with caution when applying to older people;
• women in the first trimester of pregnancy (in the second and third trimester, only if essential);
• lactation.

• Furosemide

Refers to stronger "loop diuretics"

When appointing this medicine, the treating doctor considers the dosage individually for each patient, taking into account the age of the patient, the clinical indices, and the goal that he is trying to achieve.

The starting daily dosage for an adult varies from 20 to 80 mg, which, if necessary, can increase to 600 mg.

The starting single dose of this medication is calculated from the ratio of 1-2 mg per kilogram of the weight of the baby. If necessary, the dosage increases, but should not exceed 6 mg per kilogram of body weight.

For adults, the drug is injected into a vein or muscle. The daily starting dosage should not be more than 40 mg and only in rare cases it is brought to a figure of 80 mg, but it is not taken once but divided into two doses.

When furosemide is pregnant, you can take a very limited time. If the patient suffers from such diseases as stenosis of the urethra, hyperuricemia, urolithiasis of the exit routes, renal failure and others, this medication should not be taken.

• Infusion of phosphates

80 - 85% of the phosphates that are contained in the body are in bone tissue, and its lack (hypophosphatemia) has a significant effect on the bone state, but at the same time it affects the endocrine processes.

• Sodium Phosphate

The drug is prescribed inside. Enter slowly, at a rate of 2.5 mg per kilogram of the patient's weight. Contraindications may be a hypersensitivity to the components of the remedy.

• During the whole treatment it is necessary to control the activity of the heart.
• A constant monitoring of the calcium content in plasma is also necessary.
• Surgery is performed.

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

• Parathyroid hormone

Take this medicine in dosages that depend on the age of the patient and his gender, a woman in a similar situation receives a dosage slightly lower.

• At the age of 22 years, the dosage of the drug is from 12 pg / ml to 95 pg / ml.
• If the patient falls into the category of 23 to 70 years - the dose varies from 9.5 to 75 pg / ml.
• The patient aged 71 years - the resulting dosage - 4.7 to 117 pg / ml.
• After surgery, the patient is prescribed a diet that limits the intake of foods rich in calcium, while meals and foods that contain large amounts of phosphorus are welcome.
• After operation, diuretics are attributed. Only not from thiazide diuretics, as they, on the contrary, promote the accumulation, and not the withdrawal of calcium from the body. For example,

• Hygrotan

Refers to the oxodolines.

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

The considered drug should not be taken to people who are hypersensitive to the substances that make up the drug; severe renal and hepatic insufficiency, lack of potassium in the body, diabetes, gout and others.

• Indapamide

The drug is consumed orally, in the morning, 1,25 to 1,5 mg daily. If after a month of treatment the result is not very visible, you must select another treatment protocol. Increasing the dosage will lead to nothing, only the diuretic effect will increase.

Contraindication to the use of indapamide can serve as hepatic and renal failure, gout, impaired blood circulation in the brain, individual intolerance of the constituents of the drug.

• Also, such a patient is shown vitamin D3 in tablets and in the form of sun baths.
• Physiotherapy.
• Massages.
• When there is a hypercalcemic crisis, the patient is subject to urgent hospitalization. In this case, three to four liters of isotonic sodium chloride solution are administered intravenously within 24 hours. 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 applied for the prompt removal of calcium from the patient's body.

Operation with parathyroid adenoma

This surgical intervention can be attributed to complex operations. Due to its specificity, it should be performed by an endocrinologist-surgeon in a specialized, rather than general, surgical department.

Preparatory stage

The patient needs to know that there is no fundamental difference, at what time of year the operation is performed for parathyroid adenoma, no. Postponement of the surgical intervention can only be exacerbation of chronic or the emergence of infectious diseases. The operation is postponed to the time of treatment. Before the surgical intervention, the patient undergoes a complete examination with the delivery of all the necessary clinical tests.

Direct operation

Operation with adenoma of the parathyroid gland under general anesthesia, which is introduced by an anesthesiologist. He also controls the patient's condition during the operation (pulse, pressure ...). The duration of resection of 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. There are cases when the operation lasts up to four to six hours. Often this occurs with pathology of the lymph nodes of the neck. Also, the duration depends on the kind of operation that is done to a specific patient.

All radical interventions for parathyroid adenoma can be represented in several groups:

• Complete resection of the thyroid gland. Or as her name is a physician thyroidectomy.
• Resection of one lobe of the gland is hemithyroidectomy.
• When resected, the surgeon leaves a small amount (several grams) of the thyroid gland - Subtotal removal.
• When resection of only one isthmus with the thyroid gland - removal of the isthmus.

The operating surgeon himself determines to which group the particular pathology belongs, proceeding from the volumes of tumor spread and the defeat of the accompanying organs.

[19]

Removal of parathyroid adenoma

Removal of parathyroid adenoma is radical, but, often, the only way to relieve the patient of this problem. Single tumors are removed without fail. But, in the process of surgical intervention, the endocrinologist-surgeon must carefully examine all the glands in order not to miss the onset of a new adenoma of the parathyroid gland, but of another localization. Another possible asymmetric hyperplasia or the presence of several adenomas.

In case of detection of adenoma lesion of all glands, the surgeon resects three of them completely and partially the fourth (subtotal parathyroidectomy). The doctor saves about 100 milligrams of the body, which, perfectly supplied with blood, is able to maintain a norm of parathyroid hormone. After carrying out such operation relapses are minimal, only 5% of all cases.

There are also various methods of access to the site of localization of the parathyroid adenoma:

• Classic direct access to the site of operation, practiced everywhere.
• Resection with a mini-access to the location of the tumor. This method is more gentle to the patient's body.
• Resection with video assist. This technique minimally injures the patient's body. When it is carried out, innovative access technology is used with the help of modern technology. Video endoscopy device penetrates to the site of operation through a slight incision. And the resection itself is performed using a special medical instrument and optical systems. At the same time, the terms of postoperative rehabilitation significantly decrease. Minimized pain syndrome, it turns out a great cosmetic aspect, which is very important, especially for women.

The neck is quite a specific place in the human body, through it there are blood arteries feeding the brain, nerve endings, muscles that support the skull. Therefore, during surgery, the surgeon makes sure that you do not cross especially short muscles, such as sterno-thyroid, sternoclavicular ...

The operating surgeon also ensures that the voice nerves and the voice apparatus as a whole are not visually impaired. During the operation, a modern, organic polymer material is used to fix the suture, which has hypo-allergenic properties and eventually dissolves itself. The outer seam is made cosmetic, so it is not so striking to outsiders, allowing former patients to feel more comfortable in everyday life.

Prevention of parathyroid adenoma

Prevention of parathyroid adenoma, mainly, reduces to the ordering of the patient's lifestyle and the revision of his culinary preferences.

• It is necessary to minimize the intake of phosphorus in the body and increase the amount of calcium. In this light, dairy products are particularly preferred.
• Eat plenty of fruits and vegetables in raw and stewed or baked form. The body should receive a full set of vitamins and trace elements.
• You need the body and vitamin D3, which can be replenished with either tablets or "bathing" in sunbathing. The main thing is not to overdo it with dosage, getting ultraviolet rays.

Nutritional priorities:

• Algae with a high content of iodine.
• Fatty varieties of fish. The positive qualities of fish oil are used.
• Reduce the consumption of butter, cheeses and fatty milk. Milk is very useful, but with a small percentage of fat.
• Ergocalciferol. Its source can serve as some species of forest mushrooms, especially chanterelles. Fungi grown under artificial conditions do not give the desired effect.

Prognosis of life with parathyroid adenoma

After the surgery, the prognosis of life with parathyroid adenoma is usually positive. The rehabilitation period takes a short time, during which the calcium content in the blood and the cardiovascular system are monitored. In most cases, the level of calcium in the plasma is normalized by the end of the second day. And only some patients have to face transitional hypocalcemia (no more than 5% of cases), which will have to be treated with complex methods (medication, nutrition ...). After a few months, symptoms of bone disease also disappear. 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 polyclinic, it is in vain. To date, the parathyroid adenoma is treated quite simply. In this case, the injured organism is minimized. The main thing is not to miss the moment when the disease goes too far and will have to resect is not a small area, but the whole body. Therefore, be more attentive to yourself and your health. After all, it's no secret that a healthy organism is a full-fledged social life in society and a quiet, quiet old age.