Parathyroid Adenoma

Dr Jesse Hu
Dr Jesse Hu
Senior Consultant General Surgeon, Breast, Thyroid & Endocrine Surgery

What Is Parathyroid Adenoma?

Parathyroid adenoma is a benign tumour of the parathyroid glands, which are small endocrine glands located near the thyroid gland in the neck. These tumours are the most common cause of primary hyperparathyroidism, a condition characterised by the overproduction of parathyroid hormone (PTH).

Anatomy of the Parathyroid Glands

The parathyroid glands are typically four small glands, each about the size of a grain of rice, located on the posterior surface of the thyroid gland in the neck.

 

Despite their small size, they play a pivotal role in the body’s endocrine system by producing PTH. This hormone is essential for maintaining the balance of calcium and phosphorus in the bloodstream.

 

PTH functions by:

  • Increasing the release of calcium from bones into the bloodstream.
  • Enhancing the kidney’s ability to retain calcium and excrete phosphorus.
  • Stimulating the activation of vitamin D in the kidneys, which in turn increases the absorption of calcium from the intestine.

Causes and Risk Factors

The exact causes of parathyroid adenoma are not fully understood, but several factors may increase the risk of developing this condition.

Genetic Factors

Certain genetic mutations have been identified that can predispose individuals to develop parathyroid adenomas. For example, mutations in the MEN1 gene, which are associated with multiple endocrine neoplasia type 1, significantly increase the risk of parathyroid and other endocrine tumours.

Environmental Factors

Exposure to radiation, particularly previous therapeutic radiation to the head and neck, has been implicated as a potential risk factor.

Age and Gender

Parathyroid adenomas are most commonly diagnosed in people between the ages of 50 and 60, and the condition is more prevalent in women than in men. This demographic trend suggests that hormonal changes may influence the development of the condition.

Symptoms

Parathyroid adenoma primarily causes symptoms through the effects of excess PTH, which leads to hypercalcemia — abnormally high levels of calcium in the blood.

 

The symptoms can vary widely depending on the degree of hypercalcemia and how long the condition has been present. They include:

Fatigue and Weakness

Excess calcium in the blood can lead to fatigue and muscle weakness, making daily activities challenging.

Bone Pain and Fragility

High levels of PTH can cause calcium to be leached from the bones, leading to bone pain, increased fragility, and a higher risk of fractures.

Neuropsychiatric Symptoms

Hypercalcemia can affect the nervous system, leading to symptoms such as confusion, lethargy, depression, and in severe cases, cognitive impairments.

Kidney Problems

The kidneys work to filter excess calcium, which can lead to kidney stone formation and, in some cases, impaired kidney function or chronic kidney disease.

Abdominal Pain and Digestive Issues

High calcium levels can cause stomach upset, nausea, vomiting, and constipation.

Increased Thirst and Frequent Urination

The body’s attempt to eliminate excess calcium can lead to dehydration, prompting increased thirst and a higher frequency of urination.

Diagnostic Approaches

The diagnosis of parathyroid adenoma involves a combination of clinical assessment, laboratory testing, and imaging studies.

Medical History: A thorough medical history is taken to identify symptoms of hypercalcemia and any risk factors for parathyroid disease.

Physical Examination: While parathyroid adenomas are not typically palpable, the physical exam may focus on signs of hypercalcemia and its effects on the body.

Blood Tests: Blood tests are essential for measuring levels of calcium, PTH, and related substances such as vitamin D and phosphorus. Elevated calcium and PTH levels are indicative of parathyroid adenoma.

Ultrasound: A neck ultrasound can help locate an adenoma and assess its size.

Sestamibi Scan: A specialised nuclear medicine scan that uses a radioactive compound to visualise the parathyroid glands. This scan is particularly effective in pinpointing overactive glands.

CT Scan or MRI: These may be used if the adenoma is not easily located with other imaging modalities or to explore complications in surrounding tissues.

Part of the diagnostic process involves ruling out other conditions that can mimic the symptoms of hypercalcemia, such as malignancies or other endocrine disorders. This ensures that treatment is appropriately targeted to parathyroid adenoma.

Treatment Options

The treatment approach depends on the severity of symptoms, the size of the adenoma, and the overall health of the patient.

Surgical Treatment

Parathyroidectomy: This surgical procedure involves the removal of the adenomatous gland. In cases where multiple glands are involved, more extensive surgery may be required. The success rate for surgery in curing hyperparathyroidism is very high, and complications are rare.

Medical Management

Medications: For patients who are not suitable candidates for surgery, medications that control the levels of calcium and PTH may be used. These include calcimimetics, which mimic calcium in the bloodstream and decrease PTH production.

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Potential Complications

Parathyroid adenoma, if not managed properly, can lead to several significant health issues due to prolonged hypercalcemia.

Osteoporosis and Bone Fractures

Chronic high levels of PTH can lead to the mobilisation of calcium from the bone, weakening the bone structure and increasing the risk of fractures. Osteoporosis, characterised by reduced bone mass and deterioration of bone tissue, is a common complication of untreated hyperparathyroidism.

Chronic Kidney Disease

Over time, the strain on the kidneys from filtering high levels of calcium can lead to a reduction in kidney function, potentially resulting in chronic kidney disease.

Kidney Stones

Excess calcium can accumulate in the kidneys, forming kidney stones that can cause pain, infection, and obstructive uropathy.

Mood Disorders

Elevated calcium levels can affect brain function, leading to mood swings, depression, and irritability.

Cognitive Impairment

Long-standing hypercalcemia can cause memory loss, confusion, and in severe cases, cognitive decline.

Hypertension

High calcium levels can increase the risk of developing high blood pressure, which in turn may lead to other cardiovascular diseases.

Cardiac Arrhythmias

Abnormal calcium levels can disrupt the electrical impulses that regulate heart rhythms, potentially causing arrhythmias.

Dr Jesse Hu

Dr Jesse Hu

Senior Consultant General Surgeon, Breast, Thyroid & Endocrine Surgery

Dr Jesse specialises in managing both benign and malignant breast and thyroid conditions, which also includes breast pain, breast lumps, breastfeeding problems, neck lumps, amongst others.

Her dual expertise in cancer removal and plastic surgery techniques expands the design of individualized treatments, leading to holistic patient outcomes.

Dr Jesse was part of the teaching faculties of both NUS Yong Loo Lin School of Medicine and Lee Kong Chian School of Medicine, where she teaches and mentors the next generation of medical students and trainee doctors.

  • Surgical training at NUS School of Medicine
  • FRCS (Fellow of the Royal College of Surgeons) Edinburgh, UK in 2014
  • Completed 2 Health Manpower Development Program (HMDP) fellowships at Oxford University Hospital, UK in 2016

Dr Jesse is recognized as an authority in breast cancer and thyroid surgery and a sought-after conference speaker.

Read Full Bio

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    Parathyroid Adenoma

    Frequently Asked
    Questions

    Can parathyroid adenoma turn into cancer?

    Parathyroid adenomas are benign and do not turn into thyroid cancer. However, in very rare cases, a malignant tumour can develop in the parathyroid gland, known as parathyroid carcinoma.

    What is the typical recovery time after surgery for parathyroid adenoma?

    Recovery time varies, but most patients can resume normal activities within a week after a parathyroidectomy, with complete recovery taking a few weeks.

    Can parathyroid adenoma recur after treatment?

    Recurrence of parathyroid adenoma is possible but relatively rare. Regular follow-up appointments are necessary to monitor calcium levels and detect any changes early.

    How does parathyroid adenoma affect pregnancy?

    Hyperparathyroidism can complicate pregnancy, affecting both the mother and fetus. It’s important to manage the condition under the guidance of a thyroid specialist.