Parathyroid Adenoma

The parathyroid glands are four small but extremely important endocrine glands, usually located on the posterior surface of the thyroid. Their primary role is the production and regulation of Parathyroid Hormone (PTH), which is essential for maintaining calcium and phosphorus balance in the body.

Through PTH, the parathyroid glands control key functions such as:

• Calcium absorption from the intestine
• Calcium release from the bones
• Regulation of kidney function related to calcium

The proper functioning of these glands is critical for normal muscle, nerve, and heart function. When one of the glands becomes overactive, as occurs in an adenoma, PTH production increases excessively, leading to significant disturbances in the body.

Unfortunately, this condition usually does not cause obvious or pronounced symptoms. Patients may experience vague discomfort, which they often attribute to other causes, while associated problems may incorrectly go unlinked to the presence of the adenoma.

Commonly reported symptoms include:

• Easy fatigue and muscle weakness
• Musculoskeletal pain
• Kidney stones or ureteral stones
• Osteopenia and osteoporosis, increasing fracture risk
• Gastrointestinal symptoms, such as constipation, nausea, unexplained vomiting, and peptic ulcers
• High blood pressure and cardiac arrhythmias
• Neuropsychiatric symptoms, including confusion, fatigue, depression, behavioral changes, and memory disturbances
• Frequent urination (polyuria) and increased thirst

In the vast majority of cases, a parathyroid adenoma occurs as a sporadic, isolated event of unknown cause.

Less commonly, it may be part of a genetic syndrome, such as Multiple Endocrine Neoplasia (MEN), or related to glandular hyperplasia, and in rare instances, it may be associated with a malignant tumor.

The diagnosis of a parathyroid adenoma essentially involves two phases:

• Firstly, diagnosing the disorder caused by the adenoma, namely primary hyperparathyroidism.
  The family physician, internist, or endocrinologist, based on clinical suspicion, confirms the diagnosis by identifying elevated or borderline Parathyroid Hormone (PTH) levels in the blood, high or borderline calcium levels, normal or low phosphorus levels
• Secondly, locating the adenoma anatomically to determine the exact position of the parathyroid gland responsible for the disorder.

Locating a parathyroid adenoma is not always straightforward, as each imaging method has its own strengths and limitations regarding sensitivity and specificity. Often, a combination of two or more tests is required to improve diagnostic accuracy. The most commonly used tests to locate a parathyroid adenoma include:

• Neck ultrasound
• Parathyroid scintigraphy with technetium-99m (Sestamibi)
• Four-dimensional CT (4D-CT)
• PET/CT or MRI
• Single-photon emission computed tomography (SPECT)

In practice, most cases rely primarily on the first two methods.

It is noteworthy that sometimes one of these imaging tests (ultrasound or scintigraphy) may fail to visualize the lesion, or the two tests may disagree on the exact location of the adenoma. In some cases, ultrasound alone is sufficient to clearly identify the lesion.

At this point, it should be emphasized that parathyroid adenoma surgeries often rely not only on preoperative imaging, which may sometimes be inconclusive, but primarily on the surgeon’s experience and expertise in endocrine surgery. It is of great importance not only to evaluate preoperative data, but above all, to rely on the surgeon’s specialized training, skill, and experience to identify intraoperatively one or more adenomas and remove them with complete success.

Yes, though less common, the parathyroid glands can develop multiple adenomas in approximately 5–15% of cases.

Accurate preoperative diagnosis is crucial, combined with specialized surgical management. Successful treatment relies not only on the surgeon’s extensive experience but is also enhanced by advanced surgical techniques, such as intraoperative PTH measurement and frozen section (rapid) biopsy, among others.

No, a parathyroid adenoma is not cancer.

To clarify, although a parathyroid adenoma is a benign tumor and not a carcinoma, its significant harmful effects, caused by excessive parathyroid hormone production, can adversely impact multiple organ systems, making it medically important despite not being classified as malignant.

The definitive treatment for a parathyroid adenoma is surgical removal of the affected parathyroid gland (parathyroidectomy).

This highly specialized procedure should be performed by an experienced endocrine surgeon. At our Center of Excellence for Thyroid and Parathyroid Surgery, we have the privilege of treating these complex cases from across Greece. By applying a practically bloodless minimally invasive technique without a scalpel, combined with intraoperative PTH measurement, we provide a definitive cure for hundreds of patients, without sutures, without pain, and with a rapid return to daily life.

Parathyroidectomy is a highly delicate procedure that requires complete specialization and extensive experience from the surgeon.

A key aspect of this surgery is the surgeon’s ability to intraoperatively identify the parathyroid adenoma and remove it safely. The risk of complications, such as hematoma or postoperative hoarseness, is rare when the operation is performed in a specialized Endocrine Surgery Center.

Parathyroidectomy is a safe procedure that, in experienced hands, leads to the successful removal of the adenoma, providing a definitive cure and full restoration of normal parathyroid function.

Recovery after parathyroidectomy is rapid, especially when minimally invasive techniques are used. Most patients return to their daily activities within 24 hours, without pain or discomfort.

Immediate benefits include:

• Rapid drop in parathyroid hormone (PTH) levels during surgery

• Gradual normalization of calcium levels within hours to a day

• Improvement of symptoms such as fatigue, muscle weakness, neuropsychiatric disturbances, or kidney stones

The body’s smooth transition to normal calcium regulation after adenoma removal is supported by temporary supplementation with calcium and vitamin D, preventing postoperative hypocalcemia.

Full recovery is usually immediate, and quality of life improves significantly within a short period.

For more information about parathyroid adenomas, their causes, and treatment options, contact Dr. Evangelos Karvounis, a leading Endocrine Surgeon specializing in Thyroid and Parathyroid surgery, and Director at the Center of Excellence, Euroclinic Athens. With extensive experience in the UK and the use of innovative, minimally invasive techniques, he provides safe, bloodless surgeries with rapid recovery and a patient-centered approach. Book your appointment today and entrust your health to an expert.