From the Guidelines
Surgical excision of the adenoid tumor surrounding the parathyroid gland is the recommended management approach, with careful preoperative evaluation and planning to preserve parathyroid function whenever possible. The management of an adenoid tumor surrounding the parathyroid gland typically involves surgical intervention, as it can cause compression symptoms, may secrete excess hormones leading to hyperparathyroidism, and has potential for malignant transformation in some cases 1.
Preoperative Evaluation
Prior to surgery, patients should undergo comprehensive imaging studies including ultrasound and/or dual-phase 99mTc-sestamibi scintigraphy with SPECT/CT (if available), referred to as a “parathyroid scan” 1. Laboratory tests including serum calcium, phosphorus, and parathyroid hormone levels are essential to establish baseline parathyroid function.
Surgical Approach
The surgical procedure of choice is usually a focused parathyroidectomy or neck exploration performed by an experienced endocrine surgeon. During surgery, intraoperative monitoring of parathyroid hormone levels may be used to confirm complete tumor removal. The surgical approach may include resection of a solitary enlarged gland or total four-gland parathyroidectomy with autotransplantation of parathyroid tissue to the neck or forearm 1.
Postoperative Care
Post-operatively, patients require close monitoring of calcium levels, as hypocalcemia is a potential complication. Calcium supplementation and calcitriol may be needed temporarily. Long-term follow-up with periodic calcium and PTH level monitoring is necessary to ensure continued normal parathyroid function.
Key Considerations
- The parathyroid glands may also be removed and autotransplanted during prophylactic thyroidectomy in individuals harboring a RET genotype associated with a high risk for PHPT 1.
- For patients with “moderate” risk alleles who have both a lower risk for metastatic disease and a low risk for PHPT, central neck dissection should be avoided during thyroidectomy, to preserve the parathyroid glands 1.
- Given the inherent surgical challenges associated with thyroidectomy, the importance of an experienced surgeon cannot be overstated 1.
From the Research
Management Approach for Adenoid Tumor Surrounding Parathyroid Gland
The management of an adenoid tumor surrounding the parathyroid gland involves several approaches, including:
- Surgical excision: This is often the preferred treatment for parathyroid adenomas, especially if they are causing symptoms or are large in size 2.
- Medical therapy: Cinacalcet, a calcimimetic, has been shown to reduce the size of parathyroid adenomas in patients with primary hyperparathyroidism 3.
- Imaging studies: Preoperative localization of the parathyroid gland using scintigraphy, such as 99mTc sestamibi SPECT and SPECT/CT, can aid in the identification and localization of hyperfunctioning glands 4.
- Combination therapy: In some cases, a combination of surgery, medical therapy, and radiation therapy may be used to manage parathyroid carcinoma, a rare and aggressive form of parathyroid tumor 5.
Considerations for Treatment
When treating an adenoid tumor surrounding the parathyroid gland, several factors should be considered, including:
- Tumor size and location: Larger tumors or those that are invasive may require more aggressive treatment.
- Patient symptoms: Patients with symptoms such as hypercalcemia, bone pain, or renal disease may require more urgent treatment.
- Histopathological diagnosis: The diagnosis of parathyroid carcinoma or adenoma should be confirmed through histopathological examination.
- Patient age and overall health: Older patients or those with underlying medical conditions may require more conservative treatment approaches.
Potential Complications
Potential complications of untreated or inadequately treated adenoid tumors surrounding the parathyroid gland include:
- Hypercalcemia: Elevated calcium levels can lead to symptoms such as nausea, vomiting, and bone pain.
- Bone disease: Untreated hyperparathyroidism can lead to osteopenia or osteoporosis.
- Renal disease: Hypercalcemia can also lead to renal impairment or kidney stones.
- Hungry bone syndrome: This is a potential complication of parathyroidectomy, especially in patients with giant adenomas 6.