Be careful with extremely small tumors located in this location but can cause kidney failure, disability-Life Health

The tumor is small but increases hormone secretion causing hypercalcemia affecting target organs, mainly kidneys and bones. The disease is often detected late, when there have been serious complications (kidney stones, kidney failure, broken bones…) affecting daily life, work, even disability.

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What is a parathyroid tumor?

A parathyroid adenoma is a tumor arising from one or more parathyroid glands, most of which are benign. Tumors are usually small, increase secretion of parathyroid hormone PTH (ParaThyroid Hormone), increase calcium and decrease blood phosphorus, causing damage to many organs, mainly kidneys, urinary tract, musculoskeletal system, nervous system, digestive system. … thereby reducing the health and quality of life of the patient.

In developed countries, statistics show that parathyroid tumors are the third most common among endocrine diseases, after diabetes and thyroid diseases. The disease occurs with a rate of 0.1 – 0.4% of the population, in all ages, most common at 50 – 60 years old, women are more common than men in a ratio of 3/1. In contrast, in our country, the disease is rare, perhaps because it has not been fully detected.

Parathyroid adenomas account for 85-90% of primary hyperparathyroidism. About 90% of cases are solitary, benign tumors, but hyperplasia or parathyroid cancer may also occur.

Reason

To date, the cause of benign parathyroid adenomas is unclear. Most are solitary tumors, arising from a mutated cell line. Some predisposing factors for parathyroid adenomas include a history of cervical irradiation, medications (eg, estrogens, thiazide diuretics, lithium), genetic factors (multiple endocrine neoplasia syndrome – MEN). .

Symptoms of parathyroid gland tumor

Parathyroid adenomas are characterized by long-term silent progression, in two stages.

* Early stage: The patient has no clinical symptoms. Only if blood tests show elevated PTH and calcium.

* Late stage (symptomatic stage, also called complicated stage): Clinical manifestations are diverse in many organ systems.

Physical symptoms

Symptoms are not specific: very common, not specific to any organ. Patients often present with fatigue, loss of appetite, excessive thirst, and weight loss. Excessive thirst is the result of insipidus in the kidneys causing frequent urination. Frequent urination along with loss of appetite causes dehydration.

Symptoms of urinary kidney: Frequent urination often accompanied by increased thirst, increasing at night, also known as insipidus in the kidney due to the kidneys’ inability to concentrate urine. In addition, there may be hematuria, painful urination due to moving stones causing inflammation.

Musculoskeletal symptoms: Chronic joint pain, caused by calcium deposition in cartilage. In some cases, pseudo-gout is present. Bone pain in longer bones (femur, lower leg …), dull pain, continuous. Muscle fatigue, muscle atrophy in the proximal extremities, decreased muscle strength, making it difficult for patients to move and walk.

Neuropsychiatric symptoms: Insomnia, memory loss, shaking hands.

Physical symptoms

In contrast to the overwhelming clinical symptoms, the physical examination is usually unremarkable. Examination of the neck is usually nothing special, only palpable when the tumor is large with the characteristics of a mass located around the thyroid gland, solid density, and mobility when swallowing.

Subclinical symptoms

Blood chemistry: Blood calcium and PTH tests are always increased. In addition, hypophosphataemia and increased alkaline phosphatase can be seen. When there is kidney failure, blood urea and creatinine tests increase.

Neck ultrasound: detect tumor in 50-95% of cases. However, it is easily confused with cervical lymph nodes and thyroid nodules. Ultrasound sensitivity is highly dependent on the physician’s experience.

Parathyroid scintigraphy: usually use radioactive drug Tc99m Sestamibi for imaging. This method is relatively specific for parathyroid tissue but has a low sensitivity of 55-70%.

Computed tomography, magnetic resonance of the neck: These two methods complement each other, helping to determine tumor location, tumor relationships, adjacent structures and surgical mapping. The sensitivity of these two methods is approximately the same, from 50 to 70%.

Measure bone density: Decreased bone density or osteoporosis was observed at all sites, especially the spine and femur.

Stomach supersonic: often see kidney stones, kidney calcification.

Aspiration cytology: is not usually used because it is difficult to distinguish from thyroid cells. In addition, it also causes bleeding, fibrosis, difficult for surgery.

Consequences of parathyroid tumors

High levels of calcium and PTH in the blood for a long time will cause damage to many different organs. Long-term kidney damage leads to nephritis, chronic pyelonephritis, kidney failure. The bones are gradually degraded, causing pathological fractures and loss of movement. High blood calcium levels can lead to disturbances of consciousness, even coma, cardiac conduction disturbances, cardiac arrest.

Treatment methods for parathyroid tumors

Periodic follow-up: applied to the case of asymptomatic tumor and unqualified for surgery. Patients need to have clinical examination, blood tests, osteoporosis measurement and renal ultrasound every 12 months.

Internally medical treatment: The purpose is to temporarily lower blood calcium, relieve symptoms while waiting for surgery. Treatment with intravenous infusion of Calcitonin, fluids, diuretics.

Surgery: It is the most optimal and thorough treatment to help rebalance PTH and blood calcium levels to resolve hyperparathyroidism.

With early surgery, the patient recovers completely. There are three basic surgical methods: minimally invasive surgery, exploratory surgery on one side of the neck and surgery on both sides of the neck. In addition, there are other methods such as: robotic surgery, surgery under the guidance of radioactive probes, laparoscopic surgery.

Surgery to remove parathyroid tumors is a routine surgery at the Department of Otolaryngology – Bach Mai Hospital, which has been implemented for many years, with good results, equivalent to countries with developed medical background. Many patients were examined, detected early and completely cured, leaving no complications and sequelae.

At Bach Mai Hospital, patients with parathyroid tumors were detected in many different specialties. Many patients have been detected early parathyroid adenoma by routine blood calcium test alone. The Department of Otolaryngology also conducts screening and screening for early detection of other tumors, especially cancers of the head, head, and neck.

Expert advice

According to the doctors of the Department of Otolaryngology, Bach Mai Hospital, in order to detect parathyroid tumors early, it is necessary to perform:

– Routine blood calcium measurement for all patients who come for regular health check-ups or medical examinations.

– Quantifying calcium, blood PTH for high-risk patients such as: kidney stones, kidney failure, osteoporosis, osteoarthritis pain.

Early detection and treatment of parathyroid tumors will prevent serious complications and contribute to improving people’s health.