Parathyroid( synonymous name - parathyroid) glands are paired glandular formations, the site of which is the posterior surface of the thyroid gland. In the body of an overwhelming number of patients, there are two pairs of such glands.
In very rare cases of parathyroid glands - located in the tissues of the thyroid gland, in the posterior esopharyngeal( retro-esophageal) space, in the mediastinum and near the vascular bundle - there may be more than five.
The main purpose of parathyroid glands is the production of parathyroid hormone( parathyroid hormone), which plays an important role in the calcium-phosphorus metabolism.
Parathyroid adenoma introduces its own corrections in this process. This disease rarely affects young( up to 20 years) patients. His favorite age category is from forty to sixty years. Women suffer from it two to three times more often than men.
Concept of the disease
Parathyroid adenoma is a benign tumor that is of a single or multiple nature and has the ability to produce parathyroid hormone in an amount that affects the biochemical characteristics of the blood.
The calcium content in the blood serum of a sick person is significantly increased.
According to medical statistics, in almost 90% of cases primary hyperparathyroidism is a consequence of parathyroidism.
Most parathyroidism( usually the lower parathyroid glands are involved in the tumor process), enclosed in a well-defined capsule, has a smooth surface, lobate structure and a soft, elastic consistency.
The incision of the tumor tissue reveals a matte surface colored in red-brown tones, areas of necrosis with hemorrhages and small-cystic cavities filled with liquid.
A microscopic examination of parathyroidum reveals the presence of alveoli separated by septa from connective tissue and a branched system of blood vessels.
There are four types of cells involved in the formation of alveoli:
- major;
- is syncial;
- light;
- oxyphilic.
Depending on what type of cells prevail in the tissues of benign neoplasms, parathyroidadenomas can be:
- alveolar;
- oxyphilic;
- is clear-celled;
- the main cell.
Given the high probability of pathological mitosis( direct division of cells that occurs with some deviations from the normal process) and the widespread phenomenon of cellular polymorphism( characterized by the presence of cells of different sizes and shapes in the tumor tissues), experts concluded that morphological characters alone were insufficient to make a verdictabout whether the tumor is benign or malignant.
In the International Classification of Diseases of the 10th version( ICD 10), the parathyroidadenomas are grouped together with the nodes and cysts of the thyroid gland, which is assigned code D34.
Causes of
pathology Modern endocrinologists believe that the parathyroid adenoma occurs due to:
- Mutation mutation of , leading to a change in one of the genes involved in the encoding of proteins that transport calcium to the tissues of the parathyroid glands. A cell with a mutated gene acquires the capacity for increased secretion of parathyroid hormone. It is she who gives rise to a huge number of clone cells, uncontrolled division of which causes the appearance of an adenoma, also endowed with the ability to produce this hormone.
- Insufficient amount of calcium in the body of a sick person. This factor gives rise to a disorderly division of parathyroid gland cells.
Another factor that can trigger the onset of a gene mutation or a lack of calcium ions can be trauma to the parathyroid gland and surrounding tissues, as well as radioactive irradiation of the head and neck.
Malignant cases of parathyroidadenoma are quite rare( they are noted only in 1-2 patients out of hundreds of cases).
Symptoms of parathyroid adenoma
Diagnosis of the disease significantly complicates the blurring of the clinical course and the complete absence of specific symptoms.
However, from the eyes of an experienced specialist who closely observes the patient, the first signs that indicate the malfunction of the parathyroid glands can not be hidden.
Patient should be alerted if:
- has profuse sweating;
- increased skin moisture, observed even at low ambient temperatures and in a person at rest;
- increased drowsiness and fatigue;
- reduced tone of all systems;
- heart palpitations;
- hypertrophic enlargement of the thyroid.
Hyperparathyroidism, which developed as a result of parathyroid gland adenoma, is accompanied by:
- with general weakness;
- frequent nausea and urge to vomit;
- with regular constipation;
- sustained decrease in appetite;
- painful sensations in the joints, which are transitory;
- significant memory degradation;
- with constant psychoemotional disruptions;
- predisposition to depressive states;
- convulsions;
- with all sorts of mental disabilities.
A person suffering from hyperparathyroidism may suddenly fall into a coma.
Bone form of hyperparathyroidism leads to disruption of the musculoskeletal system and the appearance of:
- of osteoporosis;
- sudden fractures of the ribs and tubular bones of the limbs;
- loosening of the teeth.
In the gastrointestinal form of hyperparathyroidism, the development of:
- is often a worsening duodenal ulcer or stomach;
- pancreatitis, accompanied by severe pain, attacks of vomiting and abundant release of fats along with the feces( steatoriey).
Adenoma of the parathyroid gland is fraught with the development of hypercalcemia, which can lead to:
- chondrocalcinosis( joint damage);
- calcification of the auricles;
- adrenal keratitis( deposition of calcification in the eye corneal tissue);
- excessive dryness and itchy skin;
- acute myocardial infarction;
- acute renal failure( a precursor of this condition is acute tubular necrosis).
If the level of calcium in the patient's blood exceeds the value of 3.7 mmol / l, this can lead to the development of a hypercalcemic crisis - a severe condition, accompanied by:
- with severe pain in the epigastric region;
- with attacks of indomitable vomiting;
- decreased urinary excretion( oliguria) until the complete cessation of its entry into the bladder( anuria);
- confusion;
- cardiovascular failure;
- with the most dangerous gastrointestinal bleeding;
- with vascular thrombosis.
Diagnosis of the disease
To establish the correct diagnosis for primary hyperparathyroidism triggered by an adenoma of the parathyroid gland, a complex of studies is required that requires the participation of a whole team of specialists, which must include an endocrinologist, nephrologist, gastroenterologist, cardiologist, neurologist.
Photo MRI of the image - parathyroid gland adenoma
Algorithm of the diagnostic study includes:
- Drawing up a medical history( history), performed during the patient's interview.
- Physical examination of the patient with obligatory palpation of the neck area.
- Analysis of the outpatient card of the patient, aimed at studying the transferred diseases with the purpose of revealing the probable forms of parathyroidadenoma.
- Ultrasound examination of the thyroid and parathyroid glands.
- Collection and analysis of daily urine( performed to determine the amount of calcium removed from the patient's body).
- General and biochemical blood test performed to identify biochemical markers of parathyroid adenoma( special attention is paid to the content of phosphorus and calcium, in which the parathyroid gland takes part).
- Ultrasound of the abdominal cavity organs( performed in order to exclude gastrointestinal tract pathologies, urolithiasis and nephrocalcinosis).
- The procedure of binuclide scintigraphy, consisting of intravenous administration of two radioisotopes and imaging( scintigrams), which allows to differentiate adenoma from other thyroid diseases.
- Radiography of the bones of the skull, upper and lower extremities( to assess the degree of involvement of the bone system in the tumor process).
- Fibrogastroduodenoscopy procedure necessary to eliminate possible ulcerative and erosive disorders.
- Execution of ECG, echocardiograms and daily monitoring of blood pressure and ECG( performed in the presence of anxiety cardiovascular symptoms).
- Perform a fine needle biopsy followed by a histological examination of the biopsy specimen( this study is necessary to confirm the diagnosis and determine the form of parathyroidadenoma).
Treatment options for parathyroid adenoma
Treatment of parathyroid adenoma can yield an effective result only if surgical operation is performed, but during preoperative preparation the patient undergoes an obligatory course of conservative treatment aimed at eliminating the effects of hypercalcemia.
- Patient prescribed a diet that includes the use of foods with a low level of calcium.
- Intravenous( through a dropper) it is poured diphosphonates or saline solution of sodium chloride.
- Drip infusion of diuretics aims to force diuresis.
- In the presence of hypercalcemic crisis, the patient's condition is improved by intravenous infusion of cardiac corticosteroids, glucose solution, sodium hydrogen carbonate.
Operation
The patient's condition( pressure indicators, pulse characteristics) during an operation conducted under general anesthesia is supervised by an anesthesiologist.
The duration of the operation, depending on the amount of work performed, is from sixty minutes to several hours.
The most complex and, therefore, the longest are the operations aimed at eliminating the pathology of the cervical lymph nodes.
Surgical removal of parathyroidenoma is carried out by:
- thyroidectomy( complete thyroidectomy);
- hemithyroidectomy( removal of one lobe of the affected gland);
- subtotal resection, after which from the thyroid gland remains only a small part of it, weighing several grams;
- removal of the affected isthmus of the thyroid.
When performing the operation, the surgeon should evaluate the condition of all endocrine glands, excluding the possibility of recurrence of parathyroidism in the future.
If the tumor struck both pairs of glands, perform a subtotal parathyroidectomy, involving the removal of three lesions at once and partial removal of the fourth. Even a small piece of it, the mass of which does not exceed one hundred milligrams, is able to maintain a normal level of parathyroid hormone.
Consequences of removal of
The removal of parathyroid adenoma is one of the most complex surgical interventions associated with risk:
- bleeding( varying degrees of intensity);
- infection;
- scar formation;
- appearance of hoarseness;
- difficulties occurring during speech and breathing.
Another factor that reduces the risk of complications is careful preoperative preparation of patients, using modern therapeutic methods and carrying out a whole complex of comprehensive diagnostic studies.
Patients who have had an operation to remove parathyroid glands will need to take medications containing calcium: this will prevent the onset of hypocalcemia.
Reviews
Alexandra:
Anyone who thinks about whether to remove adenoma of the parathyroid gland, I want to advise you to do it immediately. At one time, I also pulled with the operation, fearing its consequences and resigning to all manifestations of the disease. I felt a dramatic change in my condition the day after the surgery: waking up after the operation was equivalent to a second birth.
The pains that tormented me for many years, disappeared, and most importantly - my upper respiratory tract cleared of clumps of mucus, so I stopped panting during sleep. Already 48 hours after the operation I ran, as in my youth( now I'm 62 years old).
Do you want to regain health and a good mood? Decide on the operation to remove the adenoma, and forget about all the problems associated with it.
Margarita:
A month ago, I had an operation to remove the parathyroid adenoma. The operation was free, I presented only the general health insurance policy: the state of health did not allow me to wait for the quota. All the necessary information about the center. NI Pirogov, in which I was operated, I got no problem on the site of this medical institution.
Contrary to my fears, everything went well. In the hospital I was kept only two days. About operation reminds me now only a tiny scar, like a scratch. The most striking thing was that the improvement of the condition occurred the day after the surgical intervention.
Life expectancy
Timely operation with parathyroid adenoma is the guarantor of a positive prognosis of a patient's life.
Throughout the rehabilitation period, which is quite short-term, the attending physician controls the functioning of the heart muscle and the level of calcium in the patient's body.
As a rule, the normalization of this indicator in the blood plasma occurs by the end of the second day after surgery. The untimely appeal for medical assistance is fraught with malignant adenomas and a deterioration in the prognosis of life.
The risk of postoperative relapse occurs in one case out of twenty.
Video about parathyroid adenoma: