Parathyroid Adenoma

Condition Overview

A Parathyroid adenoma is a benign tumor of the parathyroid gland that causes excessive production of parathyroid hormone (PTH), leading to primary hyperparathyroidism. The usual cause of this tumor developing is a mutation in the calcium sensing receptor. This condition results in elevated calcium levels in the blood (hypercalcemia) and can cause a range of symptoms and complications, including kidney stones, osteoporosis, fatigue, muscle weakness, depression, and abdominal pain.

Parathyroid adenomas are the most common cause of primary hyperparathyroidism. They typically affect one of the four parathyroid glands located in the neck, adjacent to the thyroid gland. While the exact cause of parathyroid adenomas is not always clear, they may be associated with genetic mutations and certain familial syndromes, such as Multiple Endocrine Neoplasia type 1 (MEN1).

Diagnosis involves measuring calcium, Vitamin D, and PTH levels, which are elevated in cases of primary hyperparathyroidism. Imaging studies such as ultrasound, sestamibi scan, CT scan, or (rarely) MRI are used to localize the adenoma. Fine-needle aspiration may be performed in some cases to confirm the diagnosis. Surgery is usually curative, which can limit future complications and also help patients to feel better in most cases.

Treatment Options

1. Parathyroidectomy
   • Description: This surgical procedure involves the removal of the affected parathyroid gland(s). It is the most common and effective treatment for a parathyroid adenoma, resolving hyperparathyroidism and normalizing calcium levels. Usually, minimally invasive parathyroidectomy (MIP) can be considered for well localized parathyroid adenomas.
   • Indications: Confirmed parathyroid adenoma with hypercalcemia, symptomatic patients, complications such as kidney stones or osteoporosis, too much calcium in the urine, or patient wants to be cured.
2. Radiofrequency Ablation (RFA)
   • Description: RFA is a minimally invasive procedure that uses heat generated by radiofrequency energy to destroy the adenoma tissue. It can be an alternative to surgery for patients who are not suitable candidates for surgery or prefer a less invasive approach.
   • Indications: Patients unfit for surgery
3. "Scarless" Parathyroidectomy
   • Description: Also known endoscopic parathyroidectomy, this technique involves the removal of the adenoma through small incisions inside the lower lip, minimizing visible scarring and reducing recovery time.
   • Indications: Well localized parathyroid adenomas, patients who are very motivated to avoid a cervical incision
   • Minimally Invasive Parathyroidectomy (MIP)
   • Description: similar to a general parathyroidectomy, but more focused. Instead of attempting to treat all parathyroid glands, this approach can be utilized when only a single parathyroid gland is felt to be problematic. It usually uses a smaller incision and relies on labs during surgery (intraoperative PTH monitoring, or IOPTH). This can be safer than traditional parathyroidectomy because there is a lower risk of permanent hypoparathyroidism and potentially lower risk of nerve injury, but there is also a slightly higher risk of recurrence. Minimally invasive parathyroidectomy can be done with or without a scar ("Scarless" parathyroidectomy).
   • Indications: well localized parathyroid adenomas, patients who would like to lower surgical risks

Management of parathyroid adenoma involves a multidisciplinary approach, including endocrinologists, surgeons, and radiologists. Early diagnosis and appropriate treatment are essential to prevent complications associated with hypercalcemia and improve the patient's quality of life. Regular monitoring and follow-up are important to ensure successful outcomes and detect any potential recurrence. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for your parathyroid adenoma.