Parathyroid adenoma: Difference between revisions
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== Treatment == | == Treatment == | ||
=== | ===Surgery=== | ||
[[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> | |||
=== Primary Prevention === | === Primary Prevention === | ||
Revision as of 20:39, 29 December 2015
For patient information, click Insert page name here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords:
Overview
Historical Perspective
Classification
Pathophysiology
- A parathyroid adenoma is a benign tumor of the parathyroid gland. It generally causes hyperparathyroidism; there are very few reports of parathyroid adenomas that were not associated with hyperparathyroidism.[1]
- 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 bones to release calcium into the blood and the kidneys 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 hypercalcemia.[2]
Genetics
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Causes by Organ System
Causes in Alphabetical Order
Differentiating type page name here from other Diseases
Epidemiology and Demographics
Age
Gender
Race
Developed Countries
Developing Countries
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
Hyperparathyroidism is confirmed by blood tests such as calcium and PTH levels.
History
A directed history should be obtained to ascertain
Symptoms
"Type symptom here" is pathognomonic of the "type disease name here".
"Type non specific symptoms" may be present.
Past Medical History
Family History
Social History
Occupational
Alcohol
The frequency and amount of alcohol consumption should be characterized.
Drug Use
Smoking
Allergies
Physical Examination
Appearance of the Patient
Vital Signs
Skin
Head
Eyes
Ear
Nose
Mouth
Throat
Heart
Lungs
Abdomen
Extremities
Neurologic
Genitals
Other
Laboratory Findings
Other Imaging Findings
- A specific test for parathyroid adenoma is sestamibi parathyroid scintigraphy, the sestamibi scan. This nuclear imaging technique reveals the presence and location of pathological parathyroid tissue.[4]
Imaging Findings
Patient #1
Patient #2
Other Diagnostic Studies
Treatment
Surgery
Surgery is the only cure for parathyroid adenomas.[5] 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.[6] By the 1980s, unilateral exploration became more common.[6] Parathyroidectomy can now be performed in a minimally invasive fashion, mainly because imaging techniques can pinpoint the location of the tissue.[6] Minimally invasive techniques include smaller open procedures, radio-guided and video-assisted procedures, and totally endoscopic surgery.[6]
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 ectopic, located not along the back of the thyroid but elsewhere in the body, sometimes in the mediastinum of the chest.[5] This can make them difficult to locate, so various imaging techniques are used, such as the sestamibi scan, single-photon emission computed tomography (SPECT), ultrasound, MRI,[5] and CT scans.[5][7]
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
References
- ↑ Sekine O, Hozumi Y, Takemoto N, Kiyozaki H, Yamada S, Konishi F (March 2004). "Parathyroid adenoma without hyperparathyroidism". Japanese Journal of Clinical Oncology. 34 (3): 155–8. doi:10.1093/jjco/hyh028. PMID 15078912.
- ↑ Felsenfeld AJ, Rodríguez M, Aguilera-Tejero E (November 2007). "Dynamics of parathyroid hormone secretion in health and secondary hyperparathyroidism". Clinical Journal of the American Society of Nephrology. 2 (6): 1283–305. doi:10.2215/CJN.01520407. PMID 17942777.
- ↑ Hsi ED, Zukerberg LR, Yang WI, Arnold A (May 1996). "Cyclin D1/PRAD1 expression in parathyroid adenomas: an immunohistochemical study". The Journal of Clinical Endocrinology and Metabolism. 81 (5): 1736–9. doi:10.1210/jcem.81.5.8626826. PMID 8626826.
- ↑ Goldstein RE, Billheimer D, Martin WH, Richards K (May 2003). "Sestamibi scanning and minimally invasive radioguided parathyroidectomy without intraoperative parathyroid hormone measurement". Annals of Surgery. 237 (5): 722–30, discussion 730–1. doi:10.1097/01.SLA.0000064362.58751.59. PMC 1514518. PMID 12724639.
- ↑ 5.0 5.1 5.2 5.3 Dsouza, Caren; Gopalakrishnan; Bhagavan, KR; Rakesh, K (2012). "Ectopic parathyroid adenoma". Thyroid Research and Practice. 9 (2): 68–70. doi:10.4103/0973-0354.96061.
- ↑ 6.0 6.1 6.2 6.3 Bellantone R, Raffaelli M, DE Crea C, Traini E, Lombardi CP (August 2011). "Minimally-invasive parathyroid surgery". Acta Otorhinolaryngologica Italica. 31 (4): 207–15. PMC 3203720. PMID 22065831.
- ↑ Zald PB, Hamilton BE, Larsen ML, Cohen JI (August 2008). "The role of computed tomography for localization of parathyroid adenomas". The Laryngoscope. 118 (8): 1405–10. doi:10.1097/MLG.0b013e318177098c. PMID 18528308.