Parathyroid Adenoma
Parathyroid glands are generally located on the sides of the thyroid gland, between 3 and 6 glands, often the size of a lentil. It secretes a hormone that regulates calcium metabolism called parathormone. We call hyperparathyroidism when the level of this hormone is high. It is often detected while investigating the causes of high calcium levels in routine calcium tests. We call this condition, which is not due to any cause, primary hyperparathyroidism. The most common cause of primary hyperparathyroidism is parathyroid adenomas.
Parathyroid adenoma is characterized by an increase in parathormone and calcium levels as a result of abnormal cell proliferation-growth of any parathyroid gland. It leads to weakening of the bones and disorders due to calcium deposits in different parts of the body, especially in the bones, as it increases the mixing of calcium in the bones into the blood and causes this calcium elevation. Since high calcium also affects the functions of tissues such as the heart and kidneys, it can lead to conditions such as the formation of kidney stones and rhythm disorders in the heart, although it is not life-threatening in the foreground. It can also be accompanied by symptoms such as dizziness, headache, weakness, malaise and even depression.
Although the diagnosis of the disease is considered with hormone and calcium tests, it is possible to make a clear diagnosis with imaging methods. Because the gland is very small, it requires the use of dynamic methods in imaging methods. The first examination is performed during thyroid ultrasound, and even if there is a suspicion, parathyroid scintigraphy is performed for confirmation to investigate the gland secreting excess hormones. If these tests are not successful, tests such as 3D tomography and magnetic resonance imaging (MRI) are used. The main reason for all these imaging tests is that the surgery must be performed with a precise localization. In cases of doubt, parathormone levels are checked by sampling the neck with a needle (PTH washout test). Parathyroid surgeries that are not localized are either performed with a very wide neck exploration or, if performed with narrow borders, often result in incomplete gland removal and may result in second-third surgeries.
Although we benefit from tomography and MRI examinations today, in some cases it may be difficult to get successful results despite these examinations. For this reason, we also perform neck exploration surgery in cases of difficulty. However, in general, in most patients, we successfully conclude this surgery by locating the parathyroid adenoma before surgery.