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A parathyroid adenoma is a benign tumor of the parathyroid gland. This tumor is hormonally active and is accompanied by excessive secretion of parathyroid hormone and the phenomenon of hyperparathyroidism. With a tumor of the parathyroid gland, the development of hypercalcemia is observed, which, in turn, is manifested by bone, renal, cardiovascular and gastrointestinal clinical syndromes. These include: pancreatitis, hypertension, ulcers, osteoporosis, nephrolithiasis.
To diagnose this disease, it is necessary to undergo a series of laboratory tests: to determine the level of parathyroid hormone, calcium, phosphorus, alkaline phosphatase and calcium secretion. In addition, it is necessary to conduct an x-ray examination, radioisotope scanning, ultrasound, magnetic resonance imaging and computed tomography. Thyroid adenoma can be cured only by surgery.
Indications for the operation
If a person has been diagnosed with parathyroid adenoma, then surgery is recommended for him. The parathyroid glands are paired glandular formations located on the posterior surface of the thyroid gland. They are extremely necessary and vital, because thanks to these organs, parathyroid hormone is produced. If a patient has an adenoma, then hyperparathyroidism gradually begins to develop, and the hormonal balance is disturbed. Most often, this problem occurs in people aged forty to sixty years. At the same time, women suffer from these diseases several times more often than men.
Removal of the parathyroid gland can be prescribed for the following diseases: hyperparathyroidism and cancer of the gland.
When this disease is detected, the tumor itself is removed.
Types of adenoma
Parathyroid adenoma can be divided into several types.
A watery cell adenoma is a formation that looks like a capsule with a nucleus. A chief dark cell adenoma is a tumor that consists of dark cells and has a nucleus inside. The most rare and hormonally inactive type of tumor is an adenoma of acidophilic cells. Epithelioma of the parathyroid glands is a solitary formation that can affect the lower pair of glands. Young women are prone to this disease. Epithelioma may be accompanied by hemorrhage and cysts. Adenolipoma is a rare type of neoplasm, it can reach quite large sizes and be hormonally inactive. It is very important not to confuse this species with lipomatosis, as false organ hypertrophy can form.
Causes of the disease
Modern medicine suggests that this disease can be caused by two types of mutations: in the mechanism of mitotic or final control.
Both the first and the second type of mutation affect one of the genes that encodes a protein involved in the transport of calcium through parathyroid cells. As a result, the mutant cells become more active and begin to divide. In addition, the development of thyroid adenoma contributes to head trauma, as well as radiation.
Most often, an adenoma is a nodule that looks like a tumor, which has a yellowish-brown color, soft texture and clear contours.
Symptoms of adenoma
Clinical manifestations of parathyroid adenoma may be different, as they depend on a particular organ. Most often, this disease remains asymptomatic for a long period and is detected incidentally during a routine medical examination during an ultrasound examination of the thyroid gland. In this case, a nodular formation can be detected by palpation of the neck. It is dense or elastic, mobile and absolutely painless. If the thyroid adenoma increases in size, then there may be a noticeable deformity of the neck and shortness of breath may appear. The long course of the disease may be accompanied by calcification and ossification. Hemorrhage into the adenoma tissue and infection of the hematoma is also possible.
As for the general symptoms, with thyroid adenoma, a person has a decrease in body weight for no particular reason, increased sweating, tremors, fatigue, poor tolerance to warm and hot weather. In addition, the patient becomes more irritable, anxious and whiny. He develops insomnia, arrhythmia, hypertension. Often there are problems with the gastrointestinal tract, men may experience problems with potency, women – menstrual irregularities.
Diagnosis of the disease
If a patient has been diagnosed with primary hyperarathyroidism, which was developed against the background of an adenoma, then he will have to visit several specialists:
- a neurologist;
- cardiologist;
- endocrinologist;
- gastroenterologist;
- the nephrologist.
In general, the examination includes a doctor’s examination, tests, ultrasound, scintigraphy. This method allows you to establish the presence of a neoplasm and its location. An x-ray may also be ordered. It is necessary to exclude possible diseases of the skeletal system. In addition, a procedure such as fibrogastroduodenoscopy may be needed. With this method, you can exclude all kinds of diseases of the stomach and duodenum. Diagnosis of parathyroid adenoma often requires a research method such as tissue biopsy of the cervical lymph nodes. To exclude other possible diseases, the doctor may prescribe other methods of examination, based on the patient’s complaints.
Therapies
The main treatment for a parathyroid tumor is to remove it. Completely get rid of this disease is possible only with the help of surgical intervention. It should be noted that the prognosis of life with this disease is favorable.
Before starting the operation, it is necessary to carry out thorough preparation. First of all, we are talking about drug therapy, which helps to reduce the intake of calcium, as well as its removal from the body. In addition, it is necessary to adhere to the correct therapeutic diet, which limits the use of those foods that contain calcium. This is due to the fact that adenoma of the gland is always accompanied by an increased content of calcium in the blood.
Preoperative therapy can be carried out in stationary conditions. In addition, diuretics may be prescribed to the patient. After preoperative preparation, an operation is prescribed to remove the parathyroid adenoma. The doctor together with the patient must choose the date of the operation. In addition, it is important to talk with a surgeon who can answer all your questions and explain all the nuances of surgery.
An equally important step before surgery is to perform an ultrasound examination of the neck. When preparing before surgery, a patient with any pathologies or chronic diseases may be prescribed saline sodium chloride, droppers with dysphosphonates. Also, if a patient in the body has an increase in the concentration of calcium in the blood plasma, then intravenous infusions (glucose, corticosteroid, sodium bicarbonate) can be prescribed to him.
It should be noted that surgical treatment is possible at any time of the year. The main task is to pass all the mandatory tests and a complete examination before the operation. This is a necessary condition, because in this way it is possible to exclude the presence of exacerbations of chronic diseases. The operation itself can last 3-6 hours, all this time the patient is under general anesthesia. The person is in a medical sleep and does not feel any pain. The anesthesiologist must monitor the patient’s condition during surgery and for some time after it.
Surgical treatment of thyroid adenoma can be carried out by several methods. The first method is subtotal resection. The essence of this method is to remove the main part of the gland. The second is total parathyroidectomy. In this case, all parathyroid glands are removed and healthy areas are transplanted into the forearm area. The third method is selective parathyroidectomy. This option involves the removal of only the affected gland. The doctor makes a minimal incision and removes the neoplasm without affecting other parathyroid glands.
Quite often, patients who are about to undergo surgery to remove a tumor on the thyroid or parathyroid gland are interested in whether it can be performed under local anesthesia. In this case, it is important to understand that the duration of the operation can depend on many factors and can be either 40 minutes or 4 hours. At present, the quality of anesthesia performance occupies a leading position in terms of safety for the patient, so it is best to listen to the doctor’s advice and not be afraid of anything.
Complications after surgery are very rare. If a person went to a trusted clinic to a highly qualified doctor, then the outcome of the operation will be successful. Still, it is important to know what unpleasant consequences can occur in some cases. First of all, it can be an infection and bleeding if the doctor did not follow all the rules during the operation. In addition, scars may remain at the incision site. After surgery, hoarseness and difficulty in speech may occur. It is important to understand that these cases are extremely rare, but if a person has found at least one of the above symptoms, you should immediately contact your doctor.