Parathyroid Adenomas

1) What are parathyroid adenomas?

"You can hear Dr Anil Kamath speaking on various aspects of Parathyroid Adenomas:"

2) What problems do parathyroid adenomas cause?

Whenever there is an adenoma in the parathyroid gland it causes excess secretion of the hormones. This condition is known as primary hyperparathyroidism. This causes elevated levels of calcium in the blood leading to various problems.

3) What are the symptoms of parathyroid adenomas?

Parathyroid adenomas can be asymptomatic sometimes detected only during routine health checks. A few others present with symptoms of excess calcium in the blood which can manifest as

• Psychological disturbances
• Deposition of excess calcium in the kidneys leading to stone formation
• Weakness of the bones leading sometimes to fractures and swellings in the bone known as pseudotumors
• Excess calcium can lead to inflammation in the pancreas known as acute pancreatitis

4) What happens if parathyroid adenomas are not treated?

In certain situations the raised calcium and the manifestations can lead onto :

• Dangerous and life threatening situations
• Pancreatitis can be a dangerous condition
• Cardiac rhythm abnormalities can occur leading to death
• Very high calcium levels can necessitate ICU admission

5) How are parathyroid adenomas diagnosed?

The initial suspicion is raised based on high levels of calcium. Normal calcium levels are between 8.5 to 10.5 mg/dl. When the calcium levels are higher than this the possibility of Parathyroid adenoma should be kept in mind. Many other conditions too can cause raised calcium levels.

The next step is to check serum parathormone levels which is usually elevated An important test to locate parathyroid adenoma is a sestamibi scan which is usually done by the nuclear medicine department.

Sometimes a special CT scan of the neck is required.

6) How are parathyroid adenomas treated?

The main and only treatment of parathyroid adenoma is surgery. The gland which is harboring the adenoma must be removed by a small incision on the neck. The procedure is known as parathyroidectomy.

The main challenges in the surgery can be

• Difficulty in locating the abnormal gland
• In few cases there can be more than one glands with parathyroid adenoma

If the gland is well localized by preoperative techniques and ultrasound at the time of surgery can be done through a very small incision known as minimally invasive parathyroidectomy.

Following successful surgery the calcium levels and the parathormone levels start coming down within a few hours

7) What are the possible complications after parathyroid surgery?

In experienced hands this is a very safe surgery carrying minimal risks.

There is a small risk of temporary weakness of the nerve supplying the vocal cords. This should usually recover within few days

There is risk of not finding the parathyroid adenoma and the levels of calcium not coming down adequately