What is Surgery – Parathyroid Gland Disease
Primary hyperparathyroidism with hypercalcemia and osteomalacia is caused by benign tumours of the parathyroid gland (parathyroid adenomas) or parathyroid hyperplasia with excessive parathyroid hormone (PTH) release.
Malignancy is a rare occurrence (parathyroid adenocarcinomas).
The specific reason for the formation of these benign tumours is unknown. Previous radiation to the head, neck, and chest has been linked to a higher risk of parathyroid adenomas. Endocrine tumour syndromes (such as MENI and MENIIa) can cause parathyroid adenomas.
Uncommon. Approximately 1 in 1000; most common in people between the ages of 50 and 70.
Hypercalcaemia is frequently asymptomatic and detected with basic blood tests. Hypercalcaemia can cause the following symptoms: Fatigue, myalgia, ,arthralgia bone ache,nephrolithiasis depression, anxiety, and a loss of consciousness as well as pancreatitis
Other than the consequences of hypercalcaemia, there is usually nothing to uncover on inspection.
U&E (to determine fluid balance and electrolytes), bone profile (Ca2+, phosphate), and plasma PTH Urine: Urinary calcium levels have increased. Simple radiographs: Osteopenia is also known as osteoporosis. Lesions in the bones that are cystic.
CXR: To rule out sarcoidosis. The location of the adenoma may be determined by technetium-99 scintigraphy.
DEXA bone scan: Required to determine the degree of osteopenia or osteoporosis. US neck: Parathyroid adenomas can have a characteristic look.
IV rehydration is used to treat hypercalcemia (normal saline). To increase renal calcium excretion, continue to maintain fluids using loop diuretics (e.g. furosemide) after rehydrated. Other electrolytes should be kept an eye on.
Consider intravenous pamidronate (which increases bone resorption), calcitonin, or steroids (which are only useful in other types of hypercalcemia). Neck exploration and total parathyroidectomy (removal of all aberrant glands) are the procedures used. Directed parathyroidectomy may be an option if the adenoma site is clearly recognised (needs more than one modality); alternatively, parathyroidectomy guided by intraoperative monitoring of PTH levels can be conducted because PTH levels diminish within minutes after the adenoma is removed.
Surgical risks include: Hypoparathyroidism caused by 'hungry bone syndrome' after surgery may necessitate short-term calcium and vitamin D supplements. The likelihood of recurrent laryngeal nerve damage is high, especially if the neck is extensively explored. Vocal cord paralysis can be detected using a laryngoscopy, and an early intervention to repair a severed nerve can help to reverse some of the damage. A neck haematoma can obstruct the airway by compressing the trachea; large haematomas may necessitate surgery to remove the haematoma. Hypercalcaemia complications include nephrolithiasis, osteoporosis, and cognitive impairment.
PROGNOSIS It's ideal if the adenoma is completely eradicated. Many patients don't require any extra supplements.
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