Giant parathyroid adenoma: The rare condition

46-year-old Bharathi B talks about her struggle for the right diagnosis, as well as her surgery and recovery

Bengaluru 26 November 2024- Persistent joint pain made walking seem almost impossible for Bharathi B, a 46-year-old woman from Kolar. Initially, it was suspected that she had osteoporosis or other bone-related conditions and she kept popping painkillers between 2022 and 2024. In July 2024, when she was brought to Bangalore for further tests, it came as a shocker that the root cause of her joint pain and mobility issues was parathyroid adenoma, a noncancerous tumor located in the neck.

Parathyroid glands are usually about the size of a pea. Bharathi shared that she continued living with the tumor which had grown 6 cm long and was almost 10 times its original size, for a long time. “Initially, I ignored the pain, thinking it was caused by overworking. But, in 2024, when it became unbearable and affected my gait, I underwent tests and scans. I also visited Bangalore-based specialists on the recommendation of the local doctors,” Bharathi recalled.

The uncertain phase

Tests done in a private hospital in Bangalore showed bony lesions. It also revealed that there were no spinal issues. Bharathi was referred to oncologists in Sparsh Hospital, Bangalore, where she met Dr Suraj Hindiskere, consultant orthopedic oncosurgeon, and Dr Narayana Subramaniam, senior consultant and director, head and neck surgery and oncology and director of clinical innovation. “It was hard to digest that they suspected cancer,” said Bharathi, who had to live with the fear of possibly having cancer for about a month.

Bharathi’s biopsy and PET scan had inconclusive results. Blood tests showed increased blood calcium levels and extremely high levels of parathyroid hormone, which is produced by the parathyroid glands in the neck. However, it was later revealed that the tumor was non-cancerous.

What are parathyroid glands?

Parathyroid glands are small endocrine glands in the neck, located behind the thyroid gland. Most people have four parathyroid glands. “Parathyroid hormones control calcium metabolism. When there is a tumor in these glands, it results in overactivity of parathyroid hormone, leading to high levels of calcium in the blood,” added Dr Subramaniam.

Parathyroid adenoma and its misleading symptoms

Dr Subramaniam explained that the symptoms of parathyroid adenoma are often indirect. They include kidney stones, abdominal pain, difficulty in urinating and bone fractures without external impacts. “Given the symptoms are non-specific, we need more awareness about these disorders. In some cases, affected people may be misdiagnosed with bone disorders like osteoporosis, bone cancers or cancers that have spread secondarily to the bone,” said Dr Subramaniam.

He further explained that the metabolism of parathyroid adenoma is slightly different from cancer; hence, it is not revealed in a PET scan. “In Bharathi’s case, the calcium and parathyroid hormone levels were high. So we did a specialized scan called sestamibi scan, a nuclear test specific to parathyroid glands. This revealed a large 6 cm adenoma (hormonally active tumor). It was found in the neck and extended into the chest,” he explained.

Surgery and recovery

In July 2024, Bharathi was operated on, and a 6-cm tumor was removed. In her case, it was situated in front of the windpipe adjacent to the recurrent laryngeal nerve (which controls vocal cord movement and voice quality) and the brachiocephalic veins (large veins draining the neck and upper limb). However, her voice was not affected due to the tumor.

Bharathi was told that, if left untreated, the high calcium levels in the blood could result in damage and failure of multiple organs, multiple fractures, and renal dysfunction. “Unfortunately, in such conditions, diagnosis is delayed, and people come to us with complications,” said Dr Subramaniam. However, Bharathi didn’t face these issues. Further, the parathyroid hormone levels in her blood came back to the normal range post-surgery. However, parathyroid adenomas can recur. “All of us have four parathyroid glands and in Bharathi’s case, we have removed one of them. There are remote chances of the other three glands turning into an adenoma, but it is less than 5% and rarely seen.”

Bharathi’s recovery brought smiles to the family and the medical team that treated her. “Earlier, I used to limp, and my mobility was affected. Now I’m slowly regaining my strength. I was able to start walking around freely in the last two months,” she said, adding that she is no longer on any medications.