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| {{SI}} | | {{Parathyroid adenoma}} |
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| '''For patient information, click [[Insert page name here (patient information)|Insert page name here]]'''
| | ==[[Parathyroid adenoma overview|Overview]]== |
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| | ==[[Parathyroid adenoma historical perspective|Historical Perspective]]== |
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| | ==[[Parathyroid adenoma classification|Classification]]== |
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| == Overview == | | ==[[Parathyroid adenoma pathophysiology|Pathophysiology]]== |
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| ==Historical Perspective== | | ==[[Parathyroid adenoma causes|Causes]]== |
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| ==Classification== | | ==[[Parathyroid adenoma differential diagnosis|Differentiating Vulvar cancer from other Diseases]]== |
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| == Pathophysiology== | | ==[[Parathyroid adenoma epidemiology and demographics|Epidemiology and Demographics]]== |
| * A parathyroid adenoma is a [[adenoma|benign tumor]] of the [[parathyroid gland]]. It generally causes [[hyperparathyroidism]]; there are very few reports of parathyroid adenomas that were not associated with hyperparathyroidism.<ref name=sekine>{{cite journal |author=Sekine O, Hozumi Y, Takemoto N, Kiyozaki H, Yamada S, Konishi F |title=Parathyroid adenoma without hyperparathyroidism |journal=Japanese Journal of Clinical Oncology |volume=34 |issue=3 |pages=155–8 |date=March 2004 |pmid=15078912 |doi=10.1093/jjco/hyh028}}</ref>
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| * A human being usually has four parathyroid glands located on the back surface of the [[thyroid]] in the neck. The parathyroids secrete [[parathyroid hormone]] (PTH), which increases the concentration of [[calcium]] in the blood by inducing the [[bone]]s to release calcium into the blood and the [[kidney]]s to reabsorb it from the urine into the blood. When a parathyroid adenoma causes hyperparathyroidism, more parathyroid hormone is secreted, causing the calcium concentration of the blood to rise, resulting in [[Hypercalcaemia|hypercalcemia]].<ref name=fel>{{cite journal |author=Felsenfeld AJ, Rodríguez M, Aguilera-Tejero E |title=Dynamics of parathyroid hormone secretion in health and secondary hyperparathyroidism |journal=Clinical Journal of the American Society of Nephrology |volume=2 |issue=6 |pages=1283–305 |date=November 2007 |pmid=17942777 |doi=10.2215/CJN.01520407}}</ref>
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| === Genetics === | | ==[[Parathyroid adenoma risk factors|Risk Factors]]== |
| * Parathyroid adenoma can be associated with overexpression of the [[cyclin D1]] gene.<ref>{{cite journal |author=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}}</ref>
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| ===Micrographs of Parathyroid Adenoma=== | | ==[[Parathyroid adenoma screening|Screening]]== |
| <gallery>
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| Image:Parathyroid adenoma intermed mag.jpg
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| Image:Parathyroid adenoma high mag.jpg
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| Image:Parathyroid adenoma histopathology (1).jpg
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| Image:Parathyroid adenoma histopathology (2).jpg
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| Image:Parathyroid adenoma histopathology (3).jpg
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| </gallery>
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| ==Causes== | | ==[[Parathyroid adenoma natural history, complications and prognosis|Natural history, complications and prognosis]]== |
| ===Life Threatening Causes===
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| Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
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| ===Common Causes=== | | ==Diagnosis== |
| | | [[Parathyroid adenoma history and symptoms|History and Symptoms]] | [[Parathyroid adenoma physical examination|Physical Examination]] [[Parathyroid adenoma CT|CT]] | [[Parathyroid adenoma MRI|MRI]] | [[Parathyroid adenoma other imaging findings|Other Imaging Findings]] | [[Parathyroid adenoma other diagnostic studies|Other Diagnostic Studies]] |
| ===Causes by Organ System===
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| ===Causes in Alphabetical Order===
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| ==Differentiating type page name here from other Diseases==
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| == Epidemiology and Demographics ==
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| ===Age===
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| ===Gender===
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| ===Race===
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| ===Developed Countries===
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| ===Developing Countries===
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| == Risk Factors ==
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| * he following risk factors may increase a person’s chance of developing a parathyroid adenoma:
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| :* An inherited syndrome
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| :* Multiple endocrine neoplasia type 1 (MEN 1)
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| :* Multiple endocrine neoplasia type 1 (MEN 1)
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| * A rare genetic condition that is associated with tumours in more than one endocrine gland and an increased risk of developing endocrine system cancers.
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| :* Familial isolated hyperparathyroidism (FIHP)
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| :* Hyperparathyroidism–jaw tumour (HPT-JT) syndrome
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| :* Radiation therapy to the head or neck
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| == Screening ==
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| == Natural History, Complications and Prognosis==
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| == Diagnosis ==
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| ===Diagnostic Criteria===
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| Hyperparathyroidism is confirmed by blood tests such as calcium and PTH levels.
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| ===History===
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| A directed history should be obtained to ascertain
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| === Symptoms ===
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| * Fatigue
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| * Confusion
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| * Nausea
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| * Constipation
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| * Kidney stones
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| * Muscle aches
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| * Bone fracture
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| ===Past Medical History===
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| ===Family History===
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| ===Social History===
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| ====Occupational====
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| ====Alcohol====
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| The frequency and amount of alcohol consumption should be characterized.
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| ====Drug Use====
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| ====Smoking====
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| ===Allergies===
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| === Physical Examination ===
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| ==== Appearance of the Patient ====
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| ====Vital Signs====
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| ====Skin====
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| ====Head====
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| ==== Eyes ====
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| ==== Ear ====
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| ====Nose====
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| ====Mouth====
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| ====Throat ====
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| ==== Heart ====
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| ==== Lungs ====
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| ==== Abdomen ====
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| ==== Extremities ====
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| ==== Neurologic ====
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| ====Genitals====
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| ==== Other ====
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| === Laboratory Findings ===
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| ==== Other Imaging Findings ====
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| * A specific test for parathyroid adenoma is [[sestamibi parathyroid scintigraphy]], the sestamibi scan. This [[Nuclear medicine|nuclear imaging technique]] reveals the presence and location of pathological parathyroid tissue.<ref>{{cite journal |author=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}}</ref>
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| ===Imaging Findings===
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| '''Patient #1'''
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| <gallery>
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| Image:
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| Parathyroid-adenoma-001.jpg
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| Parathyroid-adenoma-002.jpg
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| </gallery>
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| '''Patient #2'''
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| <gallery>
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| Image:
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| Parathyroid-adenoma-101.jpg
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| Parathyroid-adenoma-102.jpg | |
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| Parathyroid-adenoma-103.jpg
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| </gallery>
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| === Other Diagnostic Studies ===
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| == Treatment ==
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| ===Surgery===
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| [[Surgery]] is the only cure for parathyroid adenomas.<ref name=ds/> 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.<ref name=bell>{{cite journal |author=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}}</ref> By the 1980s, unilateral exploration became more common.<ref name=bell/> Parathyroidectomy can now be performed in a [[Invasiveness of surgical procedures|minimally invasive]] fashion, mainly because imaging techniques can pinpoint the location of the tissue.<ref name=bell/> Minimally invasive techniques include smaller open procedures, radio-guided and video-assisted procedures, and totally [[Endoscopy|endoscopic]] surgery.<ref name=bell/>
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| 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 [[Ectopia (medicine)|ectopic]], located not along the back of the thyroid but elsewhere in the body, sometimes in the [[mediastinum]] of the chest.<ref name=ds>{{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}}</ref> This can make them difficult to locate, so various imaging techniques are used, such as the sestamibi scan, [[single-photon emission computed tomography]] (SPECT), [[Medical ultrasonography|ultrasound]], [[Magnetic resonance imaging|MRI]],<ref name=ds/> and [[X-ray computed tomography|CT]] scans.<ref name=ds/><ref>{{cite journal |author=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}}</ref>
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| === Primary Prevention ===
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| === Secondary Prevention ===
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| === Cost-Effectiveness of Therapy ===
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| === Future or Investigational Therapies ===
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| ==References==
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| {{Reflist|2}}
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| [[Category:Disease]]
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| [[Category:Help]]
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| ==Related Chapters==
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| *[[Hyperparathyroidism]]
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