Fact-sheet: Parathyroid adenoma
Updated on 09/17/2021 at 12:16 PM
View all RADEOS cases associated with this fact-sheet
Definition
Primary hyperparathyroidism is the most common cause of hypercalcemia, more frequent after age 50 and in women. Primary hyperparathyroidism is due to excessive and inappropriate secretion of parathyroid hormone (PTH) by:
- A single adenoma, most commonly, located in one parathyroid gland.
- Diffuse hyperplasia of all 4 glands or multiple adenomas in 10-15% of cases.
- Carcinoma in less than 1% of cases.
Clinical features
The disease is often asymptomatic, discovered incidentally on blood testing. Symptomatic forms are rarer (renal or bone involvement, hypertension, digestive pain, fatigue).
Laboratory findings
Biological diagnosis is established by elevated calcemia (hypercalcemia) with an inappropriately elevated PTH level.
Topographic diagnosis is aided by ultrasound and scintigraphy (the best method for parathyroid localization).
Ultrasound
Hypoechoic lesion, sometimes markedly hypoechoic.
•Oval shape, with a craniocaudal long axis
•Most often located adjacent to the posterior border of the thyroid lobe or attached to its lower pole
•Separated from the thyroid by a bright interface
•Often quite richly vascularized once it exceeds 1 cm
Nuclear medicine
MIBI parathyroid scintigraphy.
Management
Treatment is surgical, requires an experienced surgeon, and most often results in definitive cure. Failures do occur, however, due to adenomas that cannot be located (ectopic) or that are multiple.