Is your calcium level high? Could it be a parathyroid adenoma?

When you recently checked your blood test results, did your doctor tell you that your calcium level was a little high? You may not have noticed anything unusual or different in your body. You may have thought, "I'm fine, why is this calcium only high?" In fact, many people come to know about this condition by accident. So, in this article today, we are going to talk about the main and most common reasons for the increase in calcium levels in the blood in a very simple and understandable way.

First, let's see, what are these parathyroid glands?

When you hear this name, some people think that this is part of the thyroid gland itself. But that's not the case. These are a separate type of gland. They are located in our neck, around the thyroid gland, as if hugging it. Most people have four of these. Four oval-shaped glands, about the size of a small pea.

So what do these four little glands do to our bodies? These are our body's calcium regulators . They act like the ball that controls the water level in our water tank at home. When the calcium level in our blood drops, these glands release a chemical called Parathyroid Hormone (PTH) . This hormone tells our bones, "Okay, now give some calcium to the blood." It also tells our kidneys and intestines to reabsorb the calcium into the body instead of wasting it. When the calcium level in our blood returns to the right level, these glands stop releasing the hormone. Isn't it a wonderful mechanism?

Calcium is essential for every cell in our brain, heart, nervous system, bones, and digestive system to function properly. So keeping that calcium level just right is the biggest responsibility of these four small glands.

So what is this parathyroid adenoma?

Simply put, an adenoma is a small, non-cancerous (benign) tumor . This type of tumor can occur in one of the four parathyroid glands we talked about earlier (sometimes more than one).

Now imagine what happens when a tumor like this develops in one of those four glands. The gland with the tumor starts working uncontrollably, overactively. It's like a machine with a broken on/off switch that keeps turning on all the time. Then the gland produces too much parathyroid hormone (PTH). In medicine, we call this condition Primary Hyperparathyroidism .

When this hormone is produced in excess, it constantly takes calcium from the bones and puts it into the blood. It also increases the absorption of calcium from the kidneys and intestines. The end result is that the calcium level in the blood is constantly higher than necessary. We call this hypercalcemia .

What are the symptoms of high blood calcium (Hypercalcemia)?

Most of the time, there are no symptoms in the early stages. That's why we first said that many people find this by accident. But when calcium levels in the blood are high for a long time, various symptoms can appear. Let's see what they are.

If you have one or more of these symptoms, don't assume that it's definitely a parathyroid adenoma. These symptoms can also be caused by other conditions. Therefore, the most important thing is to see your doctor and talk about it.

Why do these tumors occur? Who is at higher risk?

In fact, in 90% of cases , no clear cause has been found for the development of these adenomas. It just happens. But in a small percentage, about 10%, this can be caused by a genetic cause that is passed down through generations.

In addition, several other factors have been found to increase the risk:

• Age: This condition most commonly occurs in people between the ages of 50 and 70.
• Gender: Women are about three times more likely to develop this condition than men.
• Exposure to radiation: If you have had radiation treatment to the neck and head area as a child or young adult, your risk may be slightly increased.
• Calcium deficiency: Not getting enough calcium from the diet for a long time is also considered a risk factor.

What happens if this condition is left untreated?

Although this is not cancer, if left untreated for a long time, various complications can occur due to the continued increase in calcium levels in the blood.

• Cardiac Arrhythmia: The heartbeat may become abnormal.
• Parathyroid Crisis: This is a rare but serious condition. The level of calcium in the blood becomes very high, leading to mental confusion and coma.
• In addition, there are long-term problems like kidney stones and bone fractures, which we discussed earlier.

Therefore, even if there are no symptoms, if the doctor detects this condition, it is very important to treat it appropriately.

How do doctors diagnose this? (Diagnosis)

The process of diagnosing this disease is very simple.

1. Blood tests: The first thing to do is to check the calcium level in the blood. If it is high, then the parathyroid hormone (PTH) level in the blood is checked. If both are high, the diagnosis is 99% certain. Whether there are symptoms or not, these two blood tests are the main ones to confirm the disease.

2. Other tests: Once the diagnosis is confirmed, the doctor may recommend a few more tests. These are done to check for other complications and to plan for surgery.

• Ultrasound scan of the neck: This is used to try to find the enlarged gland that is overactive.
• Sestamibi Scan: This is a special type of scan. A small amount of chemical is injected into the body, and the exact location of the tumor is determined by looking at how it binds to the active gland.
• Bone Densitometry (DEXA scan): Measures how weak the bones are.
• A 24-hour urine test: This measures how much calcium is excreted in the urine.

What are the treatments? What is the best solution?

The best, most effective, and permanent treatment for this condition is surgery to remove the abnormal gland or glands. This surgery is called a parathyroidectomy . After surgery, the disease is completely cured in more than 95% of cases.

If I have no symptoms, do I still need an operation?

This is a question that many people have. Yes, surgery is usually recommended even if there are no symptoms. Why is that? Because even if there are no symptoms, the increase in calcium in the blood causes damage to the body from the inside. Surgery is the best solution to prevent future kidney stones and osteoporosis.

How is the surgery performed?

This is usually not a large, complex operation.

• Under full anesthesia, a very small incision is made in the front of the neck.
• The surgeon examines all four glands, finds the enlarged, abnormal gland, and removes it.
• Sometimes there may be tumors in two glands. In that case, both are removed. If all four glands are enlarged (this is called hyperplasia), 3 1/2 of the glands are removed and the remaining half is left in the body. This is because the body needs a small amount of parathyroid tissue to control calcium.
• The PTH hormone level in the blood is checked during the operation. If the level decreases by about 50% after the abnormal gland is removed, it means that the surgery was successful.

Are there any risks to surgery?

As with any surgery, there are some minor risks. The main one is a temporary decrease in blood calcium levels (hypocalcemia) after surgery. This can cause numbness in the fingers and around the mouth, and a feeling of muscle twitching. But this is nothing to worry about. Your doctor will give you calcium and vitamin D tablets for a few weeks. If you take them correctly, this condition will be avoided.

What happens after surgery?

About a month after surgery, your symptoms (such as fatigue and body aches) will be almost completely gone. You will begin to feel a great sense of relief and rejuvenation.

The long-term benefits of surgery are:

• Bone density regains.
• Reduced risk of bone fractures.
• Eliminates the risk of kidney stones.

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