Parathyrenoma

Parathyrenoma is a hormone-producing tumor, usually benign, which is characterized by an increase in the level of calcium in the blood and corresponding clinical signs. This diagnosis is very difficult to establish, because the location of the tumor is often ectopic, which requires additional complex diagnostic methods.

Causes parathyrenomas

Parathyrenoma is a tumor of cells that are similar to the cells of the parathyroid glands. Therefore, such a tumor has the same functions and is characterized by increased production of parathyroid hormone. Under normal conditions, the parathyroid glands are located on the back surface of the thyroid glands and have a common capsule with them. There are four of them, and their shape is no larger than a bean. But with parathyrenoma, their size increases and their number can be significantly greater. Also, then cells with an ectopic location appear, that is, we are talking about parathyrenoma with an ectopic source of hormone production.

The exact cause of parathyrenoma, like all tumors, is very difficult to determine. The etiological factor that induces excessive division of parathyroid gland cells can be external and internal factors. Among the internal causes, the following can be distinguished:

• gene and chromosomal mutations of cells at a certain development cycle, which lead to disruption of cell division;
• the influence of biologically active substances and growth factors on the processes of cellular differentiation;
• congenital ectopia of the parathyroid glands;

Among the environmental factors that can cause the development of parathyrenoma, the following can be distinguished:

• ionizing radiation or the effect of radio waves of a certain frequency on the human body can cause disruption of the regulation of cell division;
• postoperative trauma to the parathyroid tissue in the case of thyroidectomy can cause ectopic metastasis of cells with subsequent activation of the function of these cells;
• the influence of viruses, bacteria, fungi and other living organisms is often associated with the theory of oncogenesis, in this case these factors also cannot be excluded from the causal ones;
• hormonal imbalances with increased levels of certain hormones that are associated with the level of calcium in the blood;
• disorders of the skeletal system under the influence of exogenous factors.

These causes can act at any time in a person's life, so it is impossible to predict the development of parathyrenoma.

Pathogenesis

The pathogenesis of parathyrenoma formation is inducing excessive cell division, which stimulates their function and corresponding clinical signs. Thus, when a certain etiological factor begins to act, the cells of the parathyroid gland begin to divide intensively and uncontrollably - this is accompanied by an increase in the normal size of the gland. At the same time, their functional activity also increases and a huge amount of parathyroid hormone is synthesized. When the tumor mass increases in volume, there is a need for its spread. This is how ectopic foci of parathyroid cells appear, which are called extraendocrine parathyrenoma. These foci can spread to the chest cavity, abdominal cavity, intestines. In this case, parathyrenoma does not cause any local changes, since it is not malignant and does not disrupt the normal topic of other organs. But its function increases proportionally to the mass of cellular structures. And, thus, the amount of parathyroid hormone increases.

The pathogenesis of clinical symptoms in parathyrenoma depends on the level of this hormone. Under normal conditions, parathyroid hormone increases the amount of calcium in human blood, being an antagonist of calcitonin. In this case, parathyroid hormone acts on osteoclasts of bone tissue and this is accompanied by an increase in their function with the release of free calcium from the bones and its entry into the blood. Parathyroid hormone also acts on the intestine by increasing the absorption of calcium and the synthesis of proteins, which are transport forms of the calcium molecule.

Thus, the amount of calcium in the blood increases significantly, and the function of calcitonin is insufficient to regulate the normal level of calcium, especially in the presence of ectopic foci of parathyrenoma. This contributes to the manifestation of a specific clinical picture.

Symptoms parathyrenomas

Hypercalcemia as a leading symptom of endocrine tumors of the pancreas is a rare phenomenon. Ectopic secretion of parathyroid hormone in these neoplasms has not been definitively proven, since it is difficult to decide whether the manifestations of hyperparathyroidism are the result of a pancreatic tumor or are part of multiple endocrine neoplasia type I, which is often observed in islet cell neoplasms in general.

It should be taken into account that hypercalcemia may be the result of a metastatic process in the bone.

The clinical course of parathyrenoma is not malignant, since this tumor does not reveal any local manifestations. Symptoms are caused mainly by the level of calcium in the blood, which affects many human organs. Calcium is a microelement that ensures cardiac activity, the work of muscle and nerve fibers, as well as the structure of bone tissue. Calcium also participates in the normal conduction of impulses and contraction of muscle fiber. It is the main initiator of muscle contraction at the moment when it enters the cell through calcium channels. With parathyrenoma, the amount of calcium in the blood increases and, accordingly, its passage through the channels increases.

Increased calcium content inside the cell causes a huge influx of water, which in turn contributes to intracellular hyperhydration. Edema of muscle fibers causes compression of nerve ganglia and nerve endings, which is a factor in the development of the clinical picture caused by parathyrenoma. This is accompanied by a violation of the innervation of muscles and their contraction, which at the initial stages manifests itself as numbness and paresthesia of the distal muscles of the upper and lower extremities. Therefore, the first signs of parathyrenoma can manifest themselves in such nonspecific symptoms as numbness of the hands, paresthesia, increased muscle fatigue.

Further, when the calcium level in the blood increases to such a level that the amount in the cell and outside the cell is equalized, then more serious clinical signs of the disease appear. The muscle cell is unable to relax, since the calcium channels do not work, then tetany of the cell occurs and the muscle spasm lasts longer than usual, which causes manifestations in the form of cramps. Thus, cramps are another clinical symptom of parathyrenoma. Cramps can be localized in the distal muscles with the clinic of spasm of part of the arm or leg like "obstetrician's hand" or "equine foot". Also, with a pronounced clinical picture, there may be cramps of the respiratory muscles, which is fatal. Long and recurring cramps are a serious symptom, as they can lead to tetany, spasm of the glottis, and this is also dangerous due to complications. It is this clinical picture that can suggest a possible increased level of calcium in the blood, which will subsequently allow one to suspect parathyrenoma.

Osteoporosis, which develops against the background of an increased amount of parathyroid hormone, can also be considered a symptom of parathyrenoma. In this case, symptoms appear in the form of frequent fractures, bone axis disorders and their curvature. Complaints of pain in the legs, joints, and a feeling of leg fatigue appear. This important clinical symptom is often the main one that makes patients seek medical attention.

With a long progressive course of the disease, calcium salts form conglomerates that can be deposited as kidney stones, causing renal colic. But this is far from a specific symptom and is not the main one in the parathyrenoma clinic.

The non-specific clinical picture of such a benign tumor allows it to not give any serious signs for a long time, so it is important not to forget about the possible symptoms of parathyrenoma and to monitor the blood electrolyte levels in a timely manner.

Complications and consequences

The most serious complication of parathyrenoma can be considered the development of muscle tetany against the background of long-term hypercalcemia. In this case, the diaphragm, glottis and other respiratory muscles can contract, which can lead to death. Therefore, it is necessary to strictly monitor the level of calcium in the blood with the possible rapid introduction of the necessary drugs.

Diagnostics parathyrenomas

The diagnosis of parathyrenoma is difficult to establish and confirm, especially if it has an ectopic localization. In this case, the parathyroid glands may be normal in size and function, while the main role in the development of symptoms is played by ectopic foci of parathyrenoma. Then the diagnosis can only be established clinically without precise confirmation.

Often, patients with parathyrenoma come with complaints of pain in the legs, a feeling of aching in the bones, as well as twitching or frequent cramps in the muscles. Then it is necessary to study the anamnesis data accurately and find out possible provoking factors. It is important to find out when the symptoms first began and how they progressed. It is necessary to clarify the condition of the thyroid gland, find out whether any surgical interventions were performed on the thyroid gland. This is an important diagnostic sign, since trauma or removal of the parathyroid glands is possible, which subsequently provoked their ectopia and increased function.

No specific symptoms can be identified during examination. It is very important to conduct additional diagnostic methods if there is a suspicion of any formation of this nature.

The tests that need to be done first and that will help determine the severity of the disease are the determination of the blood electrolyte levels. This is also necessary for differential diagnostics of various pathologies with similar symptoms. Therefore, a biochemical blood test is performed to determine the level of calcium, magnesium and potassium in the blood. The normal level of calcium in the blood is 2.25 - 2.75 mmol / l. If this indicator is significantly higher than normal, then another test must be done - determination of the level of parathyroid hormone in the blood and calcitonin. The level of these hormones will allow us to talk about a possible parathyrenoma if the level of parathyroid hormone is significantly increased, as is calcium.

Instrumental diagnostics of parathyrenoma is carried out as the final stage of diagnostics to clarify the size of the tumor and its localization. The most informative method is computed tomography or magnetic resonance imaging. These methods of examination allow us to see the condition of the parathyroid glands, their size and structure due to numerous cross-sections using X-rays. Thus, it is possible to see a tumor of the parathyroid glands, determine its size and confirm the diagnosis. If such methods of examination are not possible, an ultrasound examination of the thyroid gland and parathyroid glands can be used. On ultrasound, it is also possible to see foci of the parathyroid glands in the form of a tumor, which have increased echogenicity against the background of the normal structure of other glands.

Confirmation of the diagnosis of a benign process is necessary using a fine-needle biopsy. This should also be done for the purpose of differential diagnosis, since a parathyrenoma node may resemble a tumor metastasis. Therefore, a parathyrenoma biopsy is performed under ultrasound control and after a cytological examination, a diagnosis can be accurately established and malignant growth can be excluded.

Differential diagnosis

Differential diagnostics of parathyrenoma should be carried out at the stage of symptoms, when complaints of cramps and paresthesia in the muscles can be caused by a simple lack of trace elements - magnesium, calcium. Then it is important to conduct a blood test, which can reveal a normal level of magnesium against the background of a significant increase in calcium. When conducting an ultrasound or CT, MRI, it is necessary to distinguish parathyrenoma as a benign tumor and metastasis to the parathyroid glands or thyroid gland. In this case, parathyrenoma has a clear outline, uniform structure and smooth boundaries, since it does not spread to surrounding tissues and does not have malignant growth. Metastasis does not have a clear structure and boundaries, and the primary tumor is determined.

Such diagnostic measures are necessary to establish a timely diagnosis, since with the progression of the tumor mass, the clinical symptoms intensify and complications may arise.

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Treatment parathyrenomas

Treatment of parathyrenoma is a very difficult task, because any tumor, even if it is benign, does not respond to conservative treatment. But in the case of parathyrenoma, treatment can only be symptomatic, associated with pathogenetic features. If the tumor mass does not increase in size dynamically, then conservative therapy is indicated for some time, which will normalize the calcium level and reduce the severity of the clinic.

First of all, you need to start with dietary recommendations. You need to limit the amount of calcium that comes with food:

• exclude cottage cheese from your diet;
• exclude milk, butter, you can only have kefir once a week;
• You should also exclude hard cheese and sour foods – sorrel, lemons.

These dietary recommendations apply only to the acute period, when the level of parathyroid hormone and calcium is elevated. Then the diet is expanded according to the amount of microelements in the blood.

A very important point in the treatment of parathyrenoma is the correction of hypercalcemia. For this purpose, infusion therapy with saline solution is carried out at the initial stages, followed by forced diuresis. This accelerates the excretion of calcium without the formation of stones, and also normalizes the water-electrolyte balance inside the cell and outside. Furosemide is often used for this purpose as a loop diuretic, which effectively and quickly stimulates the kidneys.

1. Furosemide is a diuretic that acts by reducing the reabsorption of sodium and chlorine in the nephron tubules, which promotes rapid excretion of metabolic products, including calcium salts. The method of using the drug is to administer it at the end of infusion therapy intravenously by drip, which allows achieving the so-called forced diuresis. The dosage of the drug is from 20 to 60 milligrams per day, administered once or twice. Side effects are possible in the form of allergic skin reactions with severe itching, dizziness, decreased blood pressure, drowsiness, sleep disturbances and increased blood sugar levels. Precautions - if there is a history of renal colic, the drug is recommended to be used with extreme caution.
2. Drugs that inhibit the action of parathyroid hormone in parathyrenoma should also be aimed at restoring bone resorption, since in this case the work of osteoclasts decreases and calcium, which comes from the bones, decreases in the blood. Therefore, the use of drugs that prevent bone resorption is considered effective in the treatment of parathyrenoma - such drugs include bisphosphonates.

Pamidronate is a drug from a group of drugs that inhibit bone resorption. The active substance of the drug is pamidronic acid. The method of administration of the drug depends on the initial level of calcium in the patient's blood, but on average the dosage is from 15 to 90 milligrams. The drug is administered intravenously by drip, slowly, over two hours. The interval between administrations is four weeks. Side effects are possible in the form of frequent headaches, initial pain in the bones, muscles, abdominal pain, vomiting, dizziness are also possible.

1. Tevabon is an effective treatment for parathyrenoma due to the pathogenetic action of the drug due to its combined composition. The active ingredients of the drug are alendronic acid and alphacalcidiol. Alendronic acid is a bisphosphonate, so it prevents bone resorption, and calcidiol is a form of vitamin D and ensures the normalization of calcium-phosphorus metabolism due to various mechanisms. One of these mechanisms is a decrease in calcium absorption in the intestine, as well as a decrease in the amount of parathyrenoma, which is especially important for parathyrenoma. The method of administration of the drug has its own characteristics - the drug is available in the form of tablets containing alendronic acid and in the form of capsules containing alphacalcidiol. The dosage of the drug is as follows: tablets should be taken one time per week, and alphacalcidiol capsules one capsule daily. Side effects are possible in the form of dizziness, hypotension, muscle pain, cramps, and dyspeptic phenomena.

Surgical treatment of parathyrenoma has its advantages, since only this method can completely eliminate the cause and cure the disease. To do this, it is necessary to accurately determine the location of the tumor, its size and the topic of the surrounding tissues, which will determine the scope of surgical intervention. The operation is usually performed under general anesthesia and under ultrasound control if the tumor is small and there is a possibility of minimally invasive surgery. Otherwise, the surgery is open. The scope of the operation is the complete removal of the tumor and the parathyroid gland from which it formed and the preservation of unchanged glands for normal functioning in the future.

Physiotherapy can be used in the postoperative period to better restore damaged tissue. Vitamins should be selected in the future without calcium, and calcium should be taken in a separate form when needed and under control of blood electrolyte levels.

Traditional treatment of parathyrenoma

Traditional treatment of parathyrenoma can be used as a comprehensive measure and is mainly aimed at reducing the amount of calcium in the blood by binding it and forming insoluble elements. The main traditional remedies are as follows:

1. Comfrey is a plant that helps normalize the function of bone tissue cells and restore the normal structure of bone beams, which reduces the severity of osteoporosis and bone pain. For a medicinal infusion, take three tablespoons of the herb, pour boiling water over it and simmer for another five minutes, cover the infusion and leave for three hours. Take it warm five times a day, two tablespoons at a time. The course of treatment is at least three months.
2. Using massage oil from the medicinal products helps to normalize blood circulation in bone tissue and the symptoms are reduced. To do this, take three tablespoons of olive oil, add a tablespoon of aloe juice, a teaspoon of honey and one ampoule of vitamin E. Mix all this and massage the limbs every evening.
3. Rubbing with cold water in the morning helps to normalize calcium levels by regulating hormonal balance and influencing the thyroid gland. Therefore, it is recommended to do such rubbing every morning followed by light gymnastics.

Herbal treatment also has its advantages:

1. Licorice root has a very high affinity for bone tissue and the muscular system, so it is excellent for limb cramps. To prepare the medicine, take licorice root, pour alcohol over it and leave it for at least three days. Take this solution one teaspoon in the morning and evening for two weeks.
2. Walnut is widely used to treat bone pathology, so the medicine can also be used as a symptomatic remedy. For a medicinal infusion, take three tablespoons of walnut shells, pour boiling water over them and simmer for another ten minutes, cover and let steep. Take warm, one teaspoon in the morning and evening. The course of treatment is one month.
3. Valerian root and nettle leaves have a good effect on phosphorus-calcium metabolism, so they are recommended for this disease. To do this, take nettle leaves and valerian root, pour water over them and leave for ten minutes. This solution should be drunk in a glass twice a day.

Homeopathic remedies can also be used in the complex treatment of parathyroidoma:

1. Ferrum iodatum is a single-component homeopathic preparation, the main active ingredient of which is the inorganic substance iron. The preparation is recommended for the treatment of osteoporotic phenomena as a drug of the substitution mechanism of action. The preparation is released in the form of standard homeopathic granules and its dosage is ten granules three times a day. Method of application - under the tongue after meals after half an hour. Precautions - do not use if you are allergic to conifers. Side effects can be in the form of menstrual irregularities, which disappear after dose adjustment.
2. Fucus vesiculezus is a homeopathic single-component remedy used to correct hormonal levels and electrolyte metabolism in thyroid and parathyroid gland pathologies. The drug is available in the form of drops and granules. Method of administration and dosage: seven granules three times a day or ten drops per glass of warm water. Side effects are rare, dyspeptic disorders are possible.
3. Adonis vernalis is a homeopathic remedy of natural origin. The drug is available in the pharmacological form of a homeopathic solution in ampoules and is dosed in a third of an ampoule once a week with possible oral use. Side effects are rare, but there may be stool disorders, dyspeptic symptoms and allergic reactions. Precautions - the drug cannot be used in acute inflammatory processes of any localization.
4. Spongia is a drug that is well suited for patients in the postoperative period for the treatment of thyroid hormone deficiency, as well as induced parathyrenoma. The drug is available in the form of drops and the dosage is five drops once a day.

These are the main folk remedies and homeopathic preparations that are used most often.

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Prevention

Prevention of parathyroidoma formation can only be non-specific and consists of general measures of proper nutrition, a healthy lifestyle and avoidance of potential mutagens.

Forecast

The “gold standard” of parathyrenoma treatment can be considered surgical intervention, but if it is not possible to carry this out, then the consequence may be tumor metastasis and the formation of ectopic foci of these cells, and then there will no longer be an opportunity to carry out a complete revision and elimination of the tumor.

The prognosis for life with parathyrenoma is favorable, since it is a benign tumor and with symptomatic treatment measures, the general condition of patients is satisfactory, and they can live a long time. If surgery is performed to remove the parathyrenoma, then the prognosis for complete recovery is also favorable.

Parathyrenoma is a benign hormone-producing tumor of the parathyroid gland, which is characterized by an increase in the level of parathyroid hormone and calcium in the blood. The main clinical symptoms develop with significant changes and are not specific, so it is important to correctly and promptly diagnose the pathology.