Tumors of the parathyroid glands. Parathyroid gland: what symptoms of the disease can occur in women with various pathologies

Due to the fact that the parathyroid gland is inflamed or damaged, the symptoms of the disease in women and men can manifest themselves completely differently. The clinical picture also depends on the specifics of organ dysfunction.

Localization location approx. thyroid gland- surface of the thyroid gland. The main mission of the organ is to maintain optimal levels of calcium in human blood. Correction occurs through parathyroid hormones.

An imbalance of Ca becomes the cause of the development of a whole galaxy unpleasant symptoms. This trace element carries out the following missions:

Muscle contraction;
Fast and correct transmission of impulses along the nerve tissue;
Functioning of the heart muscle, according to physiological norms.

Any deviation from the norm significantly affects a person’s well-being. Treatment of the parathyroid gland will depend on the specific pathology, individual characteristics body, presence accompanying pathologies and a number of other important nuances.

Pathologies

The range of pathologies is extremely wide. It is enough to open any modern medical directory, and make sure of it. To date official medicine use the following classification pathological conditions characteristic of the parathyroid glands:

Hyperparathyroidism (increased production of parathyroid hormones);
Hypoparathyroidism (deficiency of parathyroid hormones in the body);
Pseudohypoparathyroidism (syndrome hypersensitivity body to parathyroid hormone);
Hypocalciuremic hypercalcemia ( increased concentration SA in the blood, associated with an extremely high ability of the kidneys to absorb the microelement);
Hypocalcemia ( chronic deficiency calcium due to vitamin D deficiency);
Hyperplasia of the parathyroid glands (pathological proliferation of the glandular structures of the organ);
Acute hypocalcemia (calcium deficiency accompanied by serious illness);
Oncological conditions (parathyroid cancer);
Latent hypocalcemia (calcium deficiency, which manifests itself as minor deviations from the norm).

Hyperparathyroidism

There are primary and secondary forms of this disease. Primary hyperparathyroidism is formed against the background of a change in the functional potential of the gland itself. Dysfunction can be provoked by:

Hyperplasia of glandular tissue;
Benign neoplasms;
Parathyroid cyst;
Adenoma;
Malignant phenomena (cancer).

They are rare. They occur equally often in people of both sexes aged 20 to 80 years, are localized more often in the lower glands, especially in the right, usually behind the thyroid gland, but occasionally they can be located in the substance of the thyroid gland itself, which gives it the appearance of a goiter (“ para-struma").

Rice. 2. parathyroid gland, consisting of the main clear cells.

It is sometimes very difficult to distinguish histologically hyperplasia of the parathyroid glands from a tumor. Usually hyperplasia develops in all about thyroid glands, while true tumors more often arise in one of the glands. Among the tumors of the parathyroid glands, benign ones predominate - adenomas (Fig. 2), consisting of the main or oxyphilic cells of the gland. The size of adenomas usually does not exceed 3-5 cm, but adenomas and more have been observed large sizes. Adenomas of the parathyroid glands have a capsule and consist of alveoli separated by thin connective tissue septa. Alveoli usually consist of chief cells, among which there are dark and light ones. different ratios or exclusively cells of one type. In some cases, groups of oxyphilic ones were also found among the main cells.

Fibroids, lymphomas, lipomas, angiomas and cysts arising from the parathyroid glands have been described. Cancers of the parathyroid glands are very rare. Histologically, cancer is characterized by more pronounced structural and cellular atypia. Cancerous tumors of the parathyroid glands do not always grow into surrounding tissues and metastasize relatively rarely. Epithelial tumors are hormonally active and are accompanied by hyperparathyroidism (the latter is also observed with hyperplasia).

Clinical picture (symptoms and signs). Local symptoms of the tumor manifest themselves in the formation of a node and its very slow enlargement, most often in the area of the right lower parathyroid gland, corresponding to the right lobe of the thyroid gland. This tumor growth in its initial period can occur without any complaints from the patient. However, as the tumor grows, the patient can palpate it in himself. All the more significant are cases when the tumor puts pressure on the trachea or recurrent nerve, causing shortness of breath, hoarseness or paresis vocal cord on the losing side.

Symptoms common to adenomas and cancers are caused by hyperfunction of the parathyroid glands, expressed in disorders of varying strength and form. calcium metabolism. These disorders are manifested by varying degrees of decalcification of the skeleton and the development of calcareous metastases in the organs.

The diagnosis is difficult. In the presence of local symptoms Often the true nature of the patient’s tumor is revealed only during surgery. Changes in calcium metabolism detected in the patient (hypercalcemia, skeletal x-ray data) can give rise to a diagnosis of a tumor of the parathyroid glands, even in the absence of clinically detectable local symptoms of a tumor in the neck.

Surgical treatment - removal of adenoma (struma), as well as malignant tumors. Success surgical removal the latter is directly dependent on timely (early) tumor removal.

Removal of the parathyroid glands - parathyroidectomy - is indicated for tumors of the parathyroid glands, hyperparathyroidism, which is accompanied by symptoms of Recklinghausen's disease, various lesions bones, kidney stones; surgery is often effective for ankylosing polyarthritis. The effect is most pronounced in cases where the removed parathyroid glands are clearly changed. The difficulty of the operation lies in the fact that only noticeably enlarged parathyroid glands are easily detected; Moreover, only through histological examination of the specimen can it be established that it is the parathyroid gland that has been removed, and not a piece of fat, a lymph node, etc.

Anesthesia is usually local. An incision is made along the anterior edge of the sternocleidomastoid muscle, or collar; the latter is more convenient, as it provides access to the parathyroid glands on both sides. Having exposed the lobe of the thyroid gland on one side, it is pulled anteriorly and medially, and the posterior surface of the capsule is examined. You should start by finding the superior parathyroid gland, which is the most permanent. If the parathyroid glands are not found in place, areas of their possible atypical location are examined - in the thyroid gland itself, at the bifurcation carotid artery, at the thymus gland, etc. If the search for altered parathyroid glands on one side of the neck is unsuccessful, they move to the other. Each suspicious formation is subject to removal and immediate histological examination. It should be taken into account that parathyroid adenomas can be multiple. Great care is necessary to avoid injury to the recurrent nerve, as well as to the intact parathyroid glands. After completing the operation, the wound is sutured, leaving a narrow tampon and drainage in the lower corner for two days. A complication of the operation is parathyroid tetany, which can develop immediately or several days after the intervention due to injury to the remaining parathyroid glands or due to an existing decrease in their activity caused by previous hyperfunction of the altered parathyroid glands. Tetany is prevented by the use of vitamins A and D, infusions calcium chloride(10 ml of 10% solution once a day). In case of tetany, injections of parathyreocrine and the use of AT-10 are also indicated.

Other operations that reduce the function of the parathyroid glands - resection of the posterior outer part of the thyroid gland together with the capsule and adjacent tissue in which the parathyroid glands should lie, ligation of the inferior thyroid arteries - are less appropriate.

Causes of the disease

The exact reasons for this rare disease have not yet been fully established, there are suggestions that they may play a role in the malignant process genetic mutations, other pathologies in the body (for example, renal failure), as well as the degeneration of an adenoma or cyst into a malignant tumor.

The following people are at risk:

having a lack of iodine and calcium in the body;
patients with dystrophy;
having a history of anorexia;
with heavy metal intoxication;
after radiation therapy;
age group over 50 years.

Clinical picture

Malignant formation is characterized by rather slow growth, and signs of the disease appear gradually. Cancer tumor, growing into the tissue, begins to put pressure on the trachea and esophagus. Sometimes the tumor can be accompanied by hyperparathyroidism, and then there are renal changes and pathological processes in bone tissue.

If you suspect parathyroid cancer, the following symptoms can be observed:

muscle weakness and high level fatigue;
cough and hoarseness of voice;
feeling of pressure in the chest;
bone pain;
pain in the peritoneum;
osteoporosis;
sharp weight loss with normal nutrition;
stones in the urinary organs.

As can be seen from listed symptoms, they are based on signs of hyperparathyroidism, which is why they are so diverse. Because of this, the malignant process may remain undiagnosed for a long time, as doctors look for the causes of symptoms in other diseases.

As for metastases, in almost half of patients with oncology of these glands they penetrate the lymph nodes and lungs; rarely metastases can be found in the kidneys, liver or bone tissue. Sometimes recurrent nerve paresis may occur. Carcinomas are most often hormonally active, but it happens that the disease occurs without hormonal imbalance.

Diagnosis of the disease

At laboratory research high levels of certain hormones can be found in the blood and in the urine increased secretion phosphorus and calcium. Main diagnostic method in detection malignant process in the parathyroid glands is hardware method– Ultrasound, CT, MRI, scintigraphy. As for selective angiography, this test can not only detect and visualize a tumor, but also take a blood test to determine the level of the hormone in it. In order to determine the morphology of the formation, a fine-needle biopsy is necessary.

To determine dimensions pathological process and its prevalence to other human organs, echocardiography, ultrasound of the kidneys and peritoneum, x-ray are performed chest, examination of the esophagus. It is important to differentiate the malignant process from benign tumors (adenomas), hyperplasia; parathyroid cysts are characterized by similar symptoms. In addition to the endocrinologist and oncologist, the patient is recommended to be examined and consult with other specialists.

Treatment of the disease

On this moment the only thing effective treatment Oncology of the parathyroid glands is surgical intervention. How large-scale the operation will be depends on the diagnostic results, on the size of the formation itself, on the degree of involvement of nearby tissues and organs in the process, as well as on the metastasis of the formation.

Talk about full recovery It is possible only when the tumor is detected at the stage at which it has not yet left the gland. In this case, the iron is completely removed. In the case when the tumor has already grown into the cervical lymph nodes, it is necessary to remove them in order to prevent the spread of the malignant process to other organs and systems.

Currently malignant tumors parathyroid glands are removed using an endoscope, however, this method has one significant drawback compared to traditional intervention - they may remain in the lesion. atypical cells, which will naturally provoke a relapse.

If the oncological process has already spread to other organs - the thyroid gland, esophagus or trachea, then it becomes impossible to remove all the atypical cells, so the patient is prescribed chemotherapy or radiation therapy.

After the operation, patients are prescribed calcium and vitamin D supplements; if the thyroid gland is removed, lifelong hormone replacement therapy is required.

What is the life expectancy

It is clear that it is very difficult to make any predictions about life expectancy, but in general they are favorable. At timely application see a doctor and provided that the treatment was chosen correctly, about half of patients can live another 20 years, ten-year survival rate is about 80%, and five-year survival rate is 90%.

Of course, a big role in favorable prognosis the stage of the oncological process plays a role, therefore, when the slightest symptoms You should immediately contact a specialist, because in the case of oncology, even a month of delay can cause a worsening prognosis.

Other neoplasms of the parathyroid gland

Adenomas.

These are benign tumors that can cause parathyroid cancer. They develop from secretory cells and are manifested by the following symptoms:

kidney functionality decreases;
constant thirst appears;
emergence urolithiasis;
development of renal acidosis;
renal failure.

In addition, symptoms of pathologies may appear gastrointestinal tract, heart and nervous system.

If an adenoma becomes a malignant process, it may change appearance neck - upon palpation, tubercles are felt, as well as the focus of the oncological process - a lump, the mobility of which is limited.

Cyst.

Parathyroid cysts can be hormonal or non-hormonal. Regardless of the reason that led to cystic formation, a cyst is a round cavity containing liquid contents inside. Symptoms of this disease may be the following:

weight loss;
bone pain;
muscle weakness;
stones in the kidneys and urinary organs;
mental disorders;
dental problems;
migraine.

Both adenoma and cystic formation can cause a malignant process in the parathyroid gland. Since the symptoms of these ailments manifest themselves in late stages diseases, it is recommended to undergo annual preventive examination from an endocrinologist even in the absence of pathological signs.

As for the prevention of diseases of the parathyroid gland, it consists in proper nutrition– the diet must contain foods that provide the body with a sufficient amount of calcium.

Tumors of the parathyroid glands are pathological neoplasms, localized on the thyroid glands, can be both benign and malignant. The bulk of parathyroid tumors have hormonal activity, which provokes symptoms of hyperparathyroidism and hypercalcemia. This type tumors are quite rare; the category of people suffering from this disease are people from 20 to 80 years old. As a rule, the neoplasm affects the posterior lower section parathyroid gland, often with right side, but in some cases tumors are found in the body of the parathyroid gland, which is why it may look like a goiter (“para-struma”).

Causes of parathyroid tumors

At the moment, the origin of neoplasms of the parathyroid glands is unknown, as is, in principle, the majority of neoplasms developing in the human body. Hyperparathyroidism, caused by abnormal growth or neoplasms of the parathyroid gland, may have a familial or sporadic association with an autosomal dominant pattern of inheritance. Very often, tumors of the parathyroid glands are part of the syndrome of multiple endocrine neoplasia.

Symptoms of parathyroid tumors

Adenomas are characterized by localization in the lower lobe of one of the glands. An increase in the size of the glands is an indication for differential diagnosis, the purpose of which is to determine the cause, since very often such an increase as hyperplasia is not associated with neoplasms. Hormonally inactive tumors are extremely rare (about 5%). The clinical picture of parathyroid tumors is primarily represented by hyperparathyroidism. Malignant tumors, in particular carcinomas, have big sizes, compared to benign (adenomas). However, no more than 5% of neoplasms can be diagnosed by palpation. 30% of identified tumors of the parathyroid glands at the time of diagnosis have metastases to the near-regional lymph nodes, in some cases they are fused to the trachea, esophagus, thyroid gland, which is an obstacle to tumor removal.

TO general manifestations this disease applies renal syndrome, which is characterized by thirst, polyuria, concentration dysfunction of the kidneys, the development of renal tubular acidosis, urolithiasis, renal failure, diffuse nephrocalcinosis.

Hypercalcemia, provoked by tumors with hormonal activity of the parathyroid glands, causes calcification of the valves and vessels of the heart, arrhythmias and arterial hypertension.

The presence of lesions in the gastrointestinal tract is manifested by panreatitis, peptic ulcer duodenum and stomach, vomiting, anorexia, diarrhea, constipation, gastroesophageal reflux.

With ophthalmic lesions, calcium deposits occur in upper layers cornea, as well as the development of cataracts and keratitis. Signs of damage to the central nervous system may also occur - headache, fatigue, weakness, psychosis, depression.

Diagnosis of parathyroid tumors

Diagnosis of neoplasms of the parathyroid glands includes a set of measures, which consists of collecting anamnesis and patient complaints, identifying the presence hereditary factors, examination and palpation examination, a number of laboratory and topographic studies, as well as differential diagnosis.

Laboratory studies for this pathology make it possible to detect an increase in the level of parathyroid hormone, hypophosphatemia, hypercalcemia, as well as increased excretion of phosphorus and calcium in the urine.

Topical diagnosis of tumors of the parathyroid glands involves ultrasound examination, subtraction scintiography of the parathyroid glands and computed tomography neck. With the help of selective angiography, it is possible not only to see the neoplasm of the parathyroid glands, but also to remove venous blood for the purpose of analyzing the level of parathyroid hormone. For morphological verification of a neoplasm of the parathyroid glands, a fine-needle aspiration biopsy is performed.

To assess damage to other organs and systems, comprehensive examination body. These activities include ultrasonography kidneys, abdominal organs, echocardiography, fibrogastroduodenoscopy, radiographic examination organs of the chest and esophagus, densitometry. Consultations with specialized specialists (neurologist, gastroenterologist, ophthalmologist, nephrologist, otolaryngologist) are also carried out. The main goal of differential diagnosis is to distinguish tumors of the parathyroid glands from other pathologies that have similar symptoms (hyperplasia and various shapes parathyroid neoplasia).

Treatment of parathyroid tumors

The main treatment method for parathyroid tumors, both benign and malignant, is surgery. During surgical procedures, a tumor (adenoma or carcinoma) is removed. Positive result This type of treatment depends on the timeliness of its implementation. In some cases, radical surgery is indicated, the purpose of which is complete removal parathyroid gland (parathyroidectomy).

This type of operation is indicated for extensive neoplasms of the parathyroid gland, as well as hyperparathyroidism, which is complicated by signs of Recklinghausen’s disease, kidney stones and various lesions of the skeletal system.

Typically, in the process surgical treatment used local anesthesia. A collar incision is made or along the anterior edge of the sternocleidomastial muscle. All suspicious neoplasms are subject to immediate removal and further histological examination. Main danger with this operation, this is traumatization of the recurrent nerve, which can lead to its paresis, disturbance of the patient’s voice, and in some cases can cause swelling of the larynx. After the removal of tumors is completed, the wound is sutured and drainage is installed for two days.

As a complication in postoperative period Parathyroid tetany may develop; in order to prevent it, the patient is prescribed vitamins A and D, as well as infusions of calcium chloride.

The parathyroid glands (glandulae parathyreoideae) are represented, as a rule, by two pairs of small yellow-brown bodies, closely adjacent to the posterolateral surface of the thyroid gland, with which they share a common innervation and blood supply. Benign tumors parathyroid glands (adenomas) and malignant tumors (cancer) are rare and almost always have hormonal activity, which is an important diagnostic sign. Let's consider the structure, as well as possible diseases parathyroid glands.

The structure of the parathyroid glands

Upper parathyroid glands permanently located at the upper pole of the thyroid gland. Lower in 20% of cases - in anterior mediastinum retrosternally or ectopic into the stichoid gland, thymus gland. The dimensions of the parathyroid glands are 5x4x2 mm, the maximum weight is 50 mg.

In the parathyroid glands, there are main and acidophilic parathyroid cells, as well as transitional cell forms between them. The bulk of the parenchyma of the glands consists of the main parathyroid cells.

The parathyroid glands (their chief and acidophilic cells) produce parathyroid hormone, which, together with calcitonin (synthesized by the C-cells of the thyroid gland) and vitamin D, plays a major role in the regulation of calcium-phosphorus metabolism. Under the influence of parathyroid hormone, calcium is mobilized from the bones and lacunar bone resorption occurs with the restoration of calcium levels in the extracellular fluid. A long-term excess of parathyroid hormone (hyperparathyroidism) leads not only to demineralization of bone tissue, but also to the destruction of its protein framework (matrix), and peculiar diseases of the parathyroid glands are noted - hypercalcemia and hypercalciuria.

Diseases of the parathyroid glands: causes and consequences

The effect of parathyroid hormone on the kidneys is to inhibit the reabsorption of phosphates in proximal parts renal tubules, which leads to phosphaturia and hypophosphatemia, as well as to increased calcium reabsorption in the distal tubules, i.e., a decrease in urinary calcium excretion.

In addition, with the participation of vitamin D, parathyroid hormone increases the reabsorption of calcium in the intestine.

Parathyroid hormone deficiency (hypoparathyroidism) leads to hypocalcemia, hyperphosphatemia and decreased levels of calcium and phosphorus in the urine. Hypersecretion of the hormone in diseases of the parathyroid glands causes severe disorders mineral metabolism, and then damage to the bones and kidneys.

It should be remembered that, in addition to parathyroid hormone, calcitonin and vitamin D, other hormones also influence calcium metabolism in the body - glucocorticoids, growth hormone, thyroid hormones, glucagon, sex hormones.

Tumors of the parathyroid glands: types and symptoms

Symptoms of the disease are typical for primary hyperparathyroidism, the leading one being severe hypercalcemia. Hormonally inactive forms of parathyroid disease are diagnosed extremely rarely (less than 5%). The size of carcinoma is usually larger than the size of adenoma. Palpable formations on the neck are detected in only 5% of cases. In almost 30% of patients, metastases are detected in the regional lymph nodes of the neck; often they are closely connected to the thyroid gland, trachea, and esophagus, which makes tumor removal difficult. Sometimes paresis of the recurrent laryngeal nerve develops. Distant metastasis occurs mainly in the lungs, less often in the liver and bones. Topical diagnosis of the tumor is similar to that for parathyroid adenomas. Intraoperative ultrasound allows one to evaluate the relationship of the tumor with surrounding tumors.

Diseases of the parathyroid glands: adenoma

Adenomas often develop from the main parathyroid cells and are localized in one of the lower glands. If several parathyroid glands are enlarged, a differential diagnosis with hyperplasia. IN clinical picture diseases, the phenomena of hyperparathyroidism come to the fore. IN topical diagnostics great importance given ultrasound with fine-needle biopsy, combined radioisotope research from 20| T1 and """Tc, CT and MRI. In difficult diagnostic cases, selective arteriography and selective venous blood sampling are performed to study the level of parathyroid hormone. Surgical treatment is removal of the adenoma.

Diseases of the parathyroid glands: cancer

Malignant tumors of the parathyroid glands are detected when primary hyperparathyroidism in 0.5-4.6% of observations. The disease occurs with equal frequency in men and women, usually between the ages of 50 and 60 years. A familial form of cancer has been described, as well as parathyroid cancer in MEN-1 syndrome.

Treatment of parathyroid tumors

Treatment of tumors of the parathyroid glands is surgical - removal of the tumor from the adjacent lobe of the thyroid gland. With an increase in regional lymph nodes lymphadenectomy is performed. During surgery, rupture of the tumor capsule should be avoided in order to prevent implantation relapse. Local relapses of parathyroid disease are observed frequently - up to 50%.

A morphological diagnosis is difficult to establish even for an experienced pathologist.