Primary parathyroid hyperplasia: Difference between revisions
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== Overview == | == Overview == | ||
==Classification== | ==Classification== | ||
* Primary parathyroid hyperplasia | * Primary parathyroid hyperplasia | ||
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* Parathyroid hyperplasia is the diffuse enlargement of the parathyroid glands and is a cause of primary hyperparathyroidism<ref> Parathyroid hyperplasia. Radiopedia (2016). http://radiopaedia.org/articles/parathyroid-hyperplasia Accessed on January 7, 2016</ref> | * Parathyroid hyperplasia is the diffuse enlargement of the parathyroid glands and is a cause of primary hyperparathyroidism<ref> Parathyroid hyperplasia. Radiopedia (2016). http://radiopaedia.org/articles/parathyroid-hyperplasia Accessed on January 7, 2016</ref> | ||
* In ~50% of cases there is asymmetric enlargement of the parathyroid glands. | * In ~50% of cases there is asymmetric enlargement of the parathyroid glands. | ||
=== Associated Conditions=== | === Associated Conditions=== | ||
* Multiple endocrine neoplasia I (MEN I) | * Multiple endocrine neoplasia I (MEN I) | ||
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* +/-Water-clear cells ("water-clear cell hyperplasia"). | * +/-Water-clear cells ("water-clear cell hyperplasia"). | ||
[[Image:Parathyroid hyperplasia.png|thumb|center|500px|Hyperplasia of parathyroid gland HE-staining, 20× magnification.<ref name=radio> Image courtesy of wikipedia. [http://www.biomedcentral.com Biomedcentral] (original file [http://bmcendocrdisord.biomedcentral.com/articles/10.1186/1472-6823-12-29 ‘’here’’].[http://biomedcentral.com/licence Creative Commons BY-SA-NC]</ref>]] | [[Image:Parathyroid hyperplasia.png|thumb|center|500px|Hyperplasia of parathyroid gland HE-staining, 20× magnification.<ref name=radio> Image courtesy of wikipedia. [http://www.biomedcentral.com Biomedcentral] (original file [http://bmcendocrdisord.biomedcentral.com/articles/10.1186/1472-6823-12-29 ‘’here’’].[http://biomedcentral.com/licence Creative Commons BY-SA-NC]</ref>]] | ||
==Causes== | ==Causes== | ||
* Primary parathyroid hyperplasia | * Primary parathyroid hyperplasia | ||
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* Secondary parathyroid hyperplasia | * Secondary parathyroid hyperplasia | ||
:* Renal failure | :* Renal failure | ||
==Differentiating type page name here from other Diseases== | ==Differentiating type page name here from other Diseases== | ||
* Parathyroid adenoma | * Parathyroid adenoma | ||
* Parathyroid carcinoma | * Parathyroid carcinoma | ||
== Epidemiology and Demographics == | == Epidemiology and Demographics == | ||
===Age=== | ===Age=== | ||
Females are more commonly affected with parathyroid hyperplasia than males. The females to male ratio is approximately 3:1. | Females are more commonly affected with parathyroid hyperplasia than males. The females to male ratio is approximately 3:1. | ||
== Risk Factors == | == Risk Factors == | ||
* Multiple endocrine neoplasia I | * Multiple endocrine neoplasia I | ||
* Multiple endocrine neoplasia II A | * Multiple endocrine neoplasia II A | ||
* Isolated familial hyperparathyroidism | * Isolated familial hyperparathyroidism | ||
== Natural History, Complications and Prognosis== | == Natural History, Complications and Prognosis== | ||
* Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as excellent. | * Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as excellent. | ||
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===Diagnostic Criteria=== | ===Diagnostic Criteria=== | ||
If available, the diagnostic criteria are provided here. | If available, the diagnostic criteria are provided here. | ||
===History=== | ===History=== | ||
A directed history should be obtained to ascertain | A directed history should be obtained to ascertain | ||
=== Symptoms === | === Symptoms === | ||
* Constipation | * Constipation | ||
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* Lethargy | * Lethargy | ||
* Muscle pain | * Muscle pain | ||
====Alcohol==== | ====Alcohol==== | ||
The frequency and amount of alcohol consumption should be characterized. | The frequency and amount of alcohol consumption should be characterized. | ||
=== Laboratory Findings === | === Laboratory Findings === | ||
* Calcium | * Calcium | ||
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* Vitamin D levels | * Vitamin D levels | ||
* A 24-hour urine test | * A 24-hour urine test | ||
==== Chest X Ray ==== | ==== Chest X Ray ==== | ||
* Bone x-rays | * Bone x-rays | ||
==== Other Imaging Findings ==== | ==== Other Imaging Findings ==== | ||
* Bone density test (DXA) | * Bone density test (DXA) | ||
* Nuclear medicine (Tc-99m MIBI) is the current modality of choice. | * Nuclear medicine (Tc-99m MIBI) is the current modality of choice. | ||
=== Other Diagnostic Studies === | === Other Diagnostic Studies === | ||
== Treatment == | == Treatment == | ||
=== Surgery=== | === Surgery=== | ||
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hypoparathyroidism | hypoparathyroidism | ||
Recurrent nerve palsy leads to a hoarse voice that usually recovers but may require procedures such as vocal cord medialisation. If the external branch of the superior laryngeal nerve is damaged, the patient may lose the ability to sing, shout or project their voice. Failure to locate abnormal parathyroid tissue may be due to the adenoma being in an ectopic site such as the mediastinum. Further localisation studies and surgery will be required. If more than one parathyroid gland is involved, subtotal parathyroidectomy may lead to hypoparathyroidism, which may require short-term administration of oral calcium and 1,25-dihydroxyvitamin D for several weeks. | Recurrent nerve palsy leads to a hoarse voice that usually recovers but may require procedures such as vocal cord medialisation. If the external branch of the superior laryngeal nerve is damaged, the patient may lose the ability to sing, shout or project their voice. Failure to locate abnormal parathyroid tissue may be due to the adenoma being in an ectopic site such as the mediastinum. Further localisation studies and surgery will be required. If more than one parathyroid gland is involved, subtotal parathyroidectomy may lead to hypoparathyroidism, which may require short-term administration of oral calcium and 1,25-dihydroxyvitamin D for several weeks. | ||
=== Secondary Prevention === | === Secondary Prevention === | ||
* Genetic screening for patients with family history of MEN syndrome. | * Genetic screening for patients with family history of MEN syndrome. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Revision as of 17:28, 7 January 2016
For patient information, click Insert page name here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Hyperplasia of the parathyroid gland
Overview
Classification
- Primary parathyroid hyperplasia
- Secondary parathyroid hyperplasia
Pathophysiology
- Parathyroid hyperplasia is the diffuse enlargement of the parathyroid glands and is a cause of primary hyperparathyroidism[1]
- In ~50% of cases there is asymmetric enlargement of the parathyroid glands.
Associated Conditions
- Multiple endocrine neoplasia I (MEN I)
- Multiple endocrine neoplasia II A (MEN IIA)
- Isolated familial hyperparathyroidism
Gross Pathology
- Classically all parathyroid glands are involved; however, some may be spared making it difficult to differentiate this from parathyroid adenoma.
Microscopic Pathology
- Classically have abundant adipose tissue[2]
- +/-Water-clear cells ("water-clear cell hyperplasia").
Causes
- Primary parathyroid hyperplasia
- Sporadic (80%): associated with exposure to radiation and lithium
- Familial (20%): associated with MEN 1 and MEN 2a
- Secondary parathyroid hyperplasia
- Renal failure
Differentiating type page name here from other Diseases
- Parathyroid adenoma
- Parathyroid carcinoma
Epidemiology and Demographics
Age
Females are more commonly affected with parathyroid hyperplasia than males. The females to male ratio is approximately 3:1.
Risk Factors
- Multiple endocrine neoplasia I
- Multiple endocrine neoplasia II A
- Isolated familial hyperparathyroidism
Natural History, Complications and Prognosis
- Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as excellent.
Complications
- Kidney stones
- Osteitis fibrosa cystica
Diagnosis
Diagnostic Criteria
If available, the diagnostic criteria are provided here.
History
A directed history should be obtained to ascertain
Symptoms
- Constipation
- Bone fractures or bone pain
- Nausea
- Lethargy
- Muscle pain
Alcohol
The frequency and amount of alcohol consumption should be characterized.
Laboratory Findings
- Calcium
- Phosphorus
- Magnesium
- PTH
- Vitamin D levels
- A 24-hour urine test
Chest X Ray
- Bone x-rays
Other Imaging Findings
- Bone density test (DXA)
- Nuclear medicine (Tc-99m MIBI) is the current modality of choice.
Other Diagnostic Studies
Treatment
Surgery
- Surgery is the mainstay of treatment for parathyroid hyperplasia. Three and a half part of the glands are removed during surgery.[4]
Parathyroidectomy
Patients with primary hyperparathyroidism and concordant localisation to a single site can undergo minimally invasive parathyroidectomy. Patients with primary hyperparathyroidism where localisation has not been successful are more likely to have multiple gland disease and should undergo open parathyroidectomy and four-gland exploration. Patients with secondary and tertiary hyperparathyroidism require either subtotal parathyroidectomy or total parathyroidectomy with or without forearm autotransplantation. Successful detection and removal of the involved parathyroid tissue will occur in 98% of patients. In the small percentage of patients in whom the gland is not detected at the time of primary surgery, it is likely to lie in an ectopic position, e.g. pericardium or middle mediastinum and additional, localisation studies such as CT scanning and selective venous sampling will be required prior to a second operation.
Complications of parathyroidectomy
The complications of parathyroidectomy include all the general complications of any operation, such as bleeding, wound infection, and reaction to the anaesthetic agent. In addition, there are specific complications, including: damage to the recurrent laryngeal nerves and to the external branch of the superior laryngeal nerves failure to locate abnormal parathyroid tissue hypoparathyroidism Recurrent nerve palsy leads to a hoarse voice that usually recovers but may require procedures such as vocal cord medialisation. If the external branch of the superior laryngeal nerve is damaged, the patient may lose the ability to sing, shout or project their voice. Failure to locate abnormal parathyroid tissue may be due to the adenoma being in an ectopic site such as the mediastinum. Further localisation studies and surgery will be required. If more than one parathyroid gland is involved, subtotal parathyroidectomy may lead to hypoparathyroidism, which may require short-term administration of oral calcium and 1,25-dihydroxyvitamin D for several weeks.
Secondary Prevention
- Genetic screening for patients with family history of MEN syndrome.
References
- ↑ Parathyroid hyperplasia. Radiopedia (2016). http://radiopaedia.org/articles/parathyroid-hyperplasia Accessed on January 7, 2016
- ↑ Parathyroid hyperplasia. Librepathology (2016). http://librepathology.org/wiki/index.php?title=Parathyroid_hyperplasia&redirect=no Accessed on January 7, 2016
- ↑ Image courtesy of wikipedia. Biomedcentral (original file ‘’here’’.Creative Commons BY-SA-NC
- ↑ Parathyroid. Surgwiki (2016). http://www.surgwiki.com/w/index.php?title=Parathyroid&oldid=5933 Accessed on January 7, 2016