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Parathyroid Tumors

By

James L. Lewis III

, MD, Brookwood Baptist Health and Saint Vincent’s Ascension Health, Birmingham

Last full review/revision Mar 2021| Content last modified Mar 2021
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Most parathyroid tumors are benign.

Parathyroid adenoma

Most parathyroid adenomas do not cause symptoms and are identified when blood tests done for another reason reveal elevated calcium levels. Symptoms of hyperparathyroidism may occur and are usually due to hypercalcemia or kidney stones.

Diagnosis of hyperparathyroidism is based on the presence of an elevated PTH level in patients with hypercalcemia. In patients with elevated levels of PTH, further studies are needed, including measurement of calcium and phosphorus levels and imaging to evaluate bone density and determine the presence of kidney stones.

Treatment is usually surgical removal of the affected parathyroid gland. Parathyroid surgery should done by a surgeon experienced in operating on the parathyroid glands.

Localization of parathyroid tissue before surgery on the parathyroid(s) is sometimes done, especially when minimally invasive surgery is planned. High-resolution CT with or without CT-guided biopsy and immunoassay of thyroid venous drainage, MRI, high-resolution ultrasonography, digital subtraction angiography, and thallium-201–technetium-99 scanning all have been used and are highly accurate, Technetium-99 sestamibi, a radionuclide agent for parathyroid imaging, is more sensitive and specific than older agents and may be useful for identifying solitary adenomas.

Occasionally, the calcimimetic, cinacalcet, is given to decrease secretion of PTH.

Parathyroid cancer

Parathyroid cancers are rare.

Risk factors for parathyroid cancer include

Parathyroid carcinomas are usually slow growing. If the initial surgery is able to remove the entire gland without rupture of the capsule, long-term survival without recurrence is common. Recurrent cancer is usually slow growing and spreads locally in the neck. Occasionally, parathyroid cancers are more aggressive with distant metastases.

Parathyroid carcinomas cause hyperparathyroidism similar to adenomas except that the hyperparathyroidism and hypercalcemia due to parathyroid carcinoma is more severe. Calcium levels of 14 to15 mg/dL (3.5 to 3.7 mmol/L) should raise concern for carcinoma.

Diagnosis includes blood tests to detect elevated levels of PTH and imaging tests to locate tumors.

Parathyroid cancers are usually removed surgically. Sometimes radiation therapy and/or chemotherapy are also needed.

Discovery of a number of mutations in established cancer genes in parathyroid carcinoma cells raises hope of new treatments using targeted therapeutic agents developed for other types of cancers. Unsuspected germline mutations have also been discovered in a minority of patients with parathyroid cancer. Genetic screening of family members in select cases has been recommended.

Key Points

  • Parathyroid tumors secrete parathyroid hormone (PTH) causing hyperparathyroidism and hypercalcemia.

  • Parathyroid adenomas are most often isolated solitary adenomas but sometimes occur with other endocrine tumors as part of a multiple endocrine neoplasia syndrome.

  • Parathyroid cancers cause hyperparathyroidism and hypercalcemia that is often more severe than with adenomas.

  • Surgical resection is often curative for both parathyroid adenoma and carcinoma.

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