Author: justchunty

Muscle strains (pulled muscles) are common but painful injuries. You can often treat a pulled muscle at home. But not all strains are alike: A severe tear might need medical care or even surgery. Follow your healthcare provider’s advice to ensure a smooth recovery.

What Is a Muscle Strain?

A muscle strain, or pulled muscle, is a tear in your muscle fibers. It’s one of the most common soft tissue injuries. You can strain a muscle by pulling it too hard or using it too much, which weakens the fibers.

Muscle strains can be minor to major. A mild strain might only break tiny fibers within the fabric of your muscle, while a severe one can tear through it. Strains are painful, but most can heal with time and rest.

Your muscles are made of thousands of small fibers woven together. When you strain a muscle, the strands of fiber are stretched beyond their limit and tear apart. If you’ve ever tried to use an old bungee cord to hold something in place, you’ve seen this happen. New bungee cords have plenty of give and stretch. But if you use one for too long or suddenly jerk on it too hard, the fibers will start to pull apart.

Types of muscle strains

Common types of muscle strains include:

• Abdominal muscle strain
• Back strain
• Groin muscle strain
• Hip flexor strain
• Calf muscle strain
• Hamstring strain

Healthcare providers also classify muscle strains as either acute or chronic.

• Acute muscle strains. These happen suddenly and cause immediate symptoms. You might pull a muscle with a sudden, forceful movement, or by twisting it.
• Chronic muscle strains. These develop gradually, and so do the symptoms. You can gradually tear a muscle by overusing it without giving it enough time to repair.

Muscle tears symptoms

Symptoms of a pulled or torn muscle include:

• Muscle pain
• Muscle spasms
• Bruising
• Swelling
• Muscle weakness
• Limited range of motion
• Feeling a “pop” during the injury
• Seeing a gap or dent in the shape of the muscle

What does a torn muscle feel like?

A torn muscle feels sore when you try to use it. You can usually locate the pain in one spot. You may be able to connect it to a recent event or activity. If it’s a chronic muscle strain, you may develop pain gradually over a few days. If it’s an acute muscle strain, you’ll feel pain immediately, and it may even feel like tearing. You may also feel your muscle weaken, and you may feel that you can’t use it at all.

Causes of muscle strains

Muscle strains happen when you tear the fibers of your muscle. This can happen suddenly or gradually.

Common causes of muscle strains include:

• Acute injuries. Muscle strains are often sports injuries, caused by sudden sprinting, twisting or jumping. But accidental muscle strains are also common in everyday life.
• Repetitive strain injuries. Repeating the same movement over and over, whether at work or a recreational activity, can strain your muscles over time.
• Overtraining. Training or laboring too hard or too long without letting your muscles rest weakens them. If they don’t have a chance to rebuild, they might break instead.
• Undertraining. Low flexibility and strength can cause muscles to strain with ordinary use. Not stretching or warming up before exercise can overstress your muscles before they’re ready.

Risk factors of muscle strains

Some muscles are more likely to tear than others. These are muscles that:

• Cross more than one joint. Muscles that cross joints often act to restrain other muscles when you move that joint. If the joint moves with too much force, these muscles feel the impact first.
• Contract eccentrically. Eccentric muscles stretch and lengthen when bearing a load. They absorb the impact of the load with controlled movements, like lowering a weight or walking downhill.
• Have type II muscle fibers. Muscles with higher concentrations of type II muscle fibers (fast-twitch fibers) are designed for short bursts of power and speed, so they use more force.

Other risk factors that can contribute to muscle strains include:

• Muscle stiffness. When muscles are tight and inflexible, the fibers break more easily.
• Muscle imbalances. Favoring some muscles over others can make the others too weak.
• Previous injuries. Muscles that have been torn before are more likely to tear again.

How is a muscle strain diagnosed?

If you’ve pulled a muscle, you’ll probably have a pretty good idea of how it happened. A healthcare provider will start by asking you about when the pain started and what you were doing at the time. Then, they’ll examine the spot, which may have visible bruising and swelling if it’s been at least 24 hours since the injury. They’ll gently feel it for tenderness and test the muscle for strength and range of motion.

A physical exam is often enough to diagnose a pulled muscle. But in some cases, your provider might want to take an MRI to rule out other conditions, or to determine the extent of the tear and grade it.

Muscle strain grades

Healthcare providers also grade muscle strains by how severe they are.

• Grade I. If you have a mild muscle strain, you’ve stretched and pulled your muscle enough to cause minor damage, but it isn’t torn through. This is the most common type.
• Grade II. A moderate muscle strain has torn through some or even most of the muscle. This will affect your muscle strength and range of motion. It can take time to heal.
• Grade III. If you have a severe muscle strain, your muscle has torn all the way through. A complete muscle tear (muscle rupture) might need surgery to repair it.

What’s the best treatment for a pulled muscle?

Most people can recover from a pulled muscle at home. Only a severe, grade III tear might need surgery. Surgery for a complete muscle tear means stitching the two ends of the muscle back together.

Home treatment for a muscle strain includes:

• The RICE method. Rest, ice, compression and elevation can help relieve pain and inflammation during the first few days of your recovery. After the first few days, you can start moving it again.
• Crutches. If your injury is in your lower body, you might need to use crutches to keep weight off the muscle when you walk. Your healthcare provider can guide you on how long to use them.
• Pain relievers. Anti-inflammatory medications, like NSAIDs, can help during the first few days of your recovery. After this, your healthcare provider might recommend switching medications.
• Physical therapy. It’s important to reintroduce gentle movement after the first few days of recovery. A physical therapist can guide you in specific exercises to rehabilitate your muscle.
• Platelet-rich plasma injections. This newer treatment uses platelets from your own blood to stimulate tissue repair. It’s still unproven, but some studies suggest it can speed up healing.

When should I see a healthcare provider for a muscle strain?

Check in with a healthcare provider if your muscle strain:

• Seems severe. If you heard or felt a “pop” when your muscle tore, if you can’t move your muscle at all, or if pain, bruising and swelling are severe, see a provider right away.
• Isn’t improving. If symptoms persist or get worse after a few days, your injury might not be as minor as you thought. It’s time to have a provider examine it.
• Triggers new symptoms. If you develop nerve-related symptoms like numbness, tingling, sudden weakness or difficulty controlling certain muscles, you may have nerve damage.

You might want to ask:

• Which muscle did I strain?
• What grade is my muscle strain (how bad is it?)
• What activities should I avoid during recovery?
• How long should I rest, and when should I start moving again?

How long does a pulled muscle take to heal?

If you only have a minor (grade I) muscle strain, it should heal within a few weeks. Moderate (grade II) muscle strains may take several weeks to months to heal completely. A severe (grade III) muscle strain can take four to six months to heal after surgery. You may need to immobilize your muscle with a cast for up to six weeks before starting your rehabilitation program. Athletes will need to sit out the season.

Most people recover completely from a muscle strain, even a severe one. But how you treat your muscle during recovery can affect how well it heals. In some cases, the muscle might retain some scar tissue, which is stiffer and more brittle than healthy muscle tissue. This makes it easier to tear the muscle again. You might have to be more mindful of how you use your muscle in the future.

What can I do to prevent muscle strains?

Some simple guidelines to help prevent muscle strains are:

• Condition your muscles with a daily fitness program.
• Stretch and warm up your muscles before using them.
• Check your technique when lifting weights or performing physical tasks.
• Pay attention to your posture and workplace ergonomics.

A note from QBan Health Care Services

Pulling a muscle is painful. For some, the frustration of having to sit out of your favorite sports and activities while you recover can be just as difficult. But your muscle needs time to heal, and it needs your patient attention during the rehabilitation process. Giving yourself that time is the best way to ensure you’ll be able to return safely to doing what you love to do, at the intensity level you’re used to.

A soft tissue injury can be painful and debilitating, whether it’s from a traumatic event or chronic overuse. Sprains, strains and contusions are a few examples. Repetitive strain can cause inflammation in your soft tissues, which can damage them if it lasts too long. These injuries take time to heal.

What is a soft tissue injury?

A soft tissue injury happens in the soft parts of your musculoskeletal system, like your muscles, tendons and ligaments. These are the tissues that support your skeleton and help it move. You can injure these tissues during physical activity or in an accident. Sudden, excessive force can also cause a traumatic injury, or chronic overuse may cause a repetitive strain injury. Most soft tissue injuries heal with time and rest.

What are the different types of soft tissue injuries?

Acute (immediate) soft tissue injuries include:

• Strains. A strain is when you overstretch or tear a muscle. You can strain a muscle by pulling it too hard or for too long. Sudden movements with a lot of force or repetitive movements with normal force cause muscle strains. Groin strains and hip flexor strains are common sports injuries. You can also strain or tear a tendon, the tissue that attaches a muscle to a bone.
• Sprains. A sprain is a tear in a ligament that holds a joint together. Ligaments connect and stabilize the muscles and bones in a joint. When something forces a joint too far out of its normal range of motion, it can stretch and tear the ligament, weakening your joint. For example, you might sprain your ankle by twisting it or sprain your wrist by falling onto your hand.
• Contusions. A contusion is a bruise, which is what you see when broken blood vessels cause discoloration under your skin. A forceful blow may break blood vessels deep within your soft tissues, including your muscles. A muscle contusion may not be visible, but it’s painful and takes time to heal. If it doesn’t heal completely, it can sometimes lead to long-term complications.

Repetitive strain injuries that may affect your soft tissues include:

• Tendonitis. Tendonitis is inflammation and swelling in a tendon. It has several causes, but the most common cause is repetitive strain. This is when overuse causes tiny, microscopic tears in the tendon fibers. When your tendon becomes inflamed, it needs time and rest to repair itself. Chronic (long-lasting) tendonitis can lead to destructive changes in your tendon (tendinopathy).
• Bursitis. Bursitis is inflammation and swelling in your bursae. These are soft tissues that cushion the space between your bones and other tissues and provide shock absorption when they move. Too much stress on your bursae from too much force or friction can cause painful swelling. It’s common in your elbows and knees. It’s also common to have bursitis along with tendonitis.

How serious can soft tissue damage (injury) be?

Acute soft tissue injuries can be mild to severe. A healthcare provider may grade your injury as first-degree, second-degree or third-degree. If you have a first-degree strain or sprain, the tissue is “pulled” but not torn. A second-degree injury is a partial tear. A third-degree injury is a complete tear through the tissue. Most soft tissue injuries heal with time, but a third-degree injury might need surgical repair.

Similarly, muscle contusions heal on their own with time, but a very severe one can cause extra complications due to severe swelling. These complications may require special treatment and a longer recovery. Repetitive strain injuries heal when you stop the activity that’s irritating the tissue. But if you go back to those activities too soon, they can become chronic injuries that cause lasting damage.

What are the symptoms of a soft tissue injury?

The most common symptom of soft tissue injuries is pain, usually accompanied by swelling. Swelling is a sign of inflammation, which is your body’s way of responding to an injury. Your body is sending extra blood and resources to the area to begin the healing process. But swelling can add to your discomfort.

Other possible symptoms include:

• Stiffness and lost range of motion
• Difficulty moving or putting weight on the body part
• Visible bruising, if blood vessels are broken
• Numbness or tingling, if a nerve is damaged

What causes soft tissue damage?

The two major causes of soft tissue injury or damage are repetitive strain (from overuse) and trauma (from a sudden force). A forceful impact from a direct blow, fall or collision may cause a contusion. A sudden, jerking movement or many strong pulls may strain a muscle or tendon or sprain a ligament.

Soft tissue injuries are different from bone injuries, but sometimes, they can occur together. For example, a broken bone, or one that’s been dislocated, may penetrate or pull the surrounding tissues. The bone injury might be more obvious, but you might also have damaged soft tissues with it.

What are the possible complications of soft tissue injuries?

Immediate (acute) complications that can occur with soft tissue injuries include:

• Blood vessel damage. Most bruises or contusions are from mildly damaged, leaking blood vessels. But a severe injury may cause more serious blood vessel damage. This could lead to serious internal bleeding (hemorrhage) or loss of blood supply to your tissues (ischemia).
• Nerve damage. Trauma that causes soft tissue damage can also cause mild nerve damage, called neuropraxia. This can temporarily interfere with sensory and motor signals between your brain and body part. Swelling from tendonitis or bursitis can affect your nerves by compressing them.
• Compartment syndrome. Compartment syndrome is severe swelling within a muscle compartment — a collection of muscles wrapped in fascia. It’s intensely painful and can cut off the blood supply to the muscles. You might need emergency surgery to relieve the pressure.

Long-term complications that can occur with improper healing include:

• Contracture. You may need to immobilize your injured body part while it’s healing. But too much immobilization can make soft tissues tighten and contract, sometimes, permanently. Your healthcare provider will prescribe specific physical therapy exercises to prevent this.
• Joint instability. A sprain that doesn’t heal completely can leave your joint unstable and more likely to sprain again. Some severe sprains may need surgery to fix this. Other soft tissue injuries that don’t heal can affect your joints by shifting weight and stress to tissues that support a joint.
• Chronic inflammation. Repetitive strain injuries that don’t heal completely can lead to chronic tendonitis or bursitis. This can cause chronic pain and eventually, long-term soft tissue damage. Your tissues may weaken and stiffen, becoming less functional. Weakening can lead to rupture.
• Heterotopic ossification. Severe soft tissue injuries can cause a sort of scarring in which bone tissue develops within your soft tissue. Myositis ossificans, bone tissue in your muscle, can occur after a muscle contusion. Enthesophytes, bone spurs in your entheses, can follow tendonitis.

How are soft tissue injuries diagnosed?

A healthcare provider will physically examine your injury and ask you questions about how it happened or what type of stress might have caused it. Sometimes, they’ll want to take images to see the injury in more detail or to check for additional injuries or complications. An MRI can show soft tissue damage.

What is the best treatment for a soft tissue injury?

Most soft tissue injuries heal at home with conservative care. Rarely, you might need surgery for a severe injury. Head to the ER if you think you have a severe injury, or if you have alarm symptoms like increasing pain, numbness or faintness. You should still see a healthcare provider for minor injuries.

Conservative care for soft tissue injuries consists of pain relief and standard protocols like RICE or its recent update, PRICE (protection, rest, ice, compression and elevation). Recently, healthcare providers have introduced a new protocol to guide your recovery after the first few days: PEACE and LOVE.

PRICE

RICE is a well-known acronym for treating acute musculoskeletal injuries. PRICE is a recent update.

It stands for:

• Protection. To protect the injury during healing, you might need to wear a cast, brace or splint.
• Rest. Rest is the most important part of healing for any musculoskeletal injury.
• Ice. Ice helps reduce pain and inflammation. Apply an ice pack for 20 minutes at a time.
• Compression. An elastic bandage around your soft tissues can reduce swelling and bleeding.
• Elevation. While resting your injury, keep it elevated to reduce blood flow and swelling.

PEACE and LOVE

The longer acronym, PEACE and LOVE, offers additional advice for the later stages of your recovery.

It stands for:

• Protection. To protect the injury during healing, you might need to wear a cast, brace or splint.
• Elevation. While resting your injury, keep it elevated to reduce blood flow and swelling.
• Avoid anti-inflammatories. Providers now recommend pain relievers that don’t suppress inflammation, like acetaminophen or arnica, after the first few days of recovery.
• Compression. An elastic bandage around your soft tissues can reduce swelling and bleeding.
• Education. This is to remind healthcare providers to educate you about your role in your own recovery. Specifically, they should encourage you to play an active rather than passive role.

and

• Load. Loading means gradually returning some mechanical load (weight or stress) to your injured part. Your provider might refer you to a physical therapist to guide this process.
• Optimism. Research has found that a positive approach to recovery can affect your prognosis. Believe in your own capacity to heal, and don’t neglect your mental health during recovery.
• Vascularization. This means increasing blood flow to your injured tissues. While you might use ice and compression to reduce blood flow earlier on, later on, blood flow can help with healing.
• Exercise. Physical therapy can help restore strength and flexibility to your weakened tissues. This can help prevent reinjury as you return to your activities, especially for unstable joints.

How long does it take for a soft tissue injury to heal?

Recovery from a soft tissue injury can take weeks to months, depending on how severe it is. Your healthcare provider is the best person to tell you what to expect. Following your provider’s advice during your recovery will help ensure it goes smoothly. If you return to activities too soon, you could reinjure your tissues. But if you wait too long to start moving again, your recovery might take longer.

What can I do to prevent soft tissue injuries?

Most injuries are accidents, which are hard to prevent entirely. But some people are more at risk of soft tissue injuries than others. If you’re among them, you can reduce your risk with a little preparation.

Risk factors for soft tissue injuries include:

• Practicing sports and physical training
• Tasks that require repetitive movements
• Poorly designed equipment or workstations
• Becoming suddenly active after not being active

To reduce your risk of soft tissue injury, remember to:

• Stretch your muscles before using them and after sitting still for many hours.
• Check your technique before beginning training or repetitive tasks.
• Make sure your tools and work area are clean, safe and ergonomic.
• Listen to your body and its limits and ease up when it tells you to.

A note from QBan Health Care Services

Soft tissue injuries can be just as serious as bone injuries, and they can take just as long — or longer — to heal. This can be hard to understand and explain to others, especially when you and they want you to return to your activities as soon as possible. But don’t shortchange your recovery. It takes time and slow, deliberate rehabilitation to repair these tissues, but it’s worth doing it right. Your body will thank you.

Sports injuries are common muscle, bone or soft tissue injuries that occur during physical activities. They include sprains, strains and fractures — injuries that usually heal within weeks or months — as well as longer-lasting conditions like tendinitis. Overtraining, falls and running into things are common causes. Many sports injuries can heal at home, but it’s important to have a plan for rehabilitation.

What are sports injuries?

Sports injuries are the types of injuries that commonly happen when you’re playing a sport or doing something athletic. Exercise is important to your overall health, and it can help build strong bones and muscles (musculoskeletal system). But physical activity also raises the risk of injury to your bones, muscles and other soft tissues. Accidents, overtraining and contact sports can lead to sports injuries.

Injuries in sports can happen suddenly, or they can develop slowly over time. Acute injuries happen with sudden, excessive force. Repetitive strain injuries happen when you repeatedly overuse a body part. Any injury can become chronic (long-lasting) if it doesn’t heal well. Many sports injuries can heal at home with appropriate care. But it’s a good idea to have a sports medicine physician examine your injury.

What are common types of sports injuries?

Common types of sports injury include:

• Bone fractures.Sudden force applied to a bone can crack or break it, like a fall, collision or sudden twist. Chronic stress on a bone can cause a stress fracture or growth plate fracture.
• Bursitis.Bursitis is a type of repetitive strain injury that affects your bursae. Bursae are soft tissues that provide padding and shock absorption between your bones and other tissues.
• Concussions. A concussion is a brain injury that happens when you hit your head and your brain bounces off the inside of your skull. Contact sports can lead to concussion injuries.
• Contusions. Contusions are bruises. They come from bleeding under your skin. Ordinary bruises are superficial injuries. But a muscle contusion or bone contusion can be more serious.
• Joint dislocation.This occurs when the end of a bone gets forced out of its normal position within a joint. For example, if your shoulder pops out of its socket, it’s been dislocated.
• Muscle strains.A muscle strain occurs when you overextend a muscle and it stretches too far and tears. Most muscle strains are mild, but a severe one can tear all the way through.
• Sprains. A sprain happens when a ligament stretches too far and tears. Ligaments are tough bands of tissue that connect bones and stabilize joints. These injuries can be mild or severe.
• Tendinitis.Tendinitis is a type of repetitive strain injury that affects a tendon. It’s caused by repetitive motions over time. Tendons are connective tissues that connect muscles to bones.

Which body parts get injured the most in sports?

Certain body parts tend to take more stress from sports than others. Since physical activities rely on moving joints, it’s often these joints and the tissues that support them that get injured the most.

Some of these include your:

• Achilles tendon. Your Achilles tendon is the thick cord that connects your calf muscles to your heel bone. Strain on this tendon can cause Achilles tendinitis or Achilles tendon rupture.
• Ankle joint. Your ankle contains three joints, as well as other bones, cartilage, ligaments, muscles and tendons. Common ankle injuries include ankle sprains and ankle fractures.
• Elbow joint. Your elbow joint is prone to overuse injuries from repetitive movements during sports. Tennis elbow and golfer’s elbow are two examples. You can also get elbow bursitis.
• Head. Less than 2 in 10 sports injuries are head injuries, according to the CDC (Centers for Disease Control and Prevention). Most of these are minor, including nosebleeds and tooth loss, but they also include concussions.
• Knee joint. Your knee joint includes several ligaments that you can sprain. Examples include ACL tears and PCL tears. Other common knee injuries include jumper’s knee and runner’s knee.
• Leg muscles. Leg muscle strains are common, including groin pulls and hamstring injuries. A shin splint, which involves the soft tissues around your shin bone, is a common runner’s injury.
• Shoulder joint. Injuries to your shoulder’s rotator cuff, including tears and tendinitis, are sometimes called swimmer’s shoulder. Other shoulder injuries include fracture and dislocation.

What are common sports injury symptoms?

It’s not hard to tell when you’ve got a sports injury. You’ll usually get it while playing or working out. You’ll notice when what you’re doing becomes painful. You may also notice other signs of injury.

Common symptoms include:

• Muscle or bone pain (musculoskeletal pain)
• Bruises, color changes or swelling that you can see
• A bone or joint looking out of place (deformity)
• A hard time moving or putting weight on the body part

What causes sports injuries?

The most common causes of sports injuries include:

• Falls, which account for more than 1 in 4 sports injuries, according to the CDC
• Training too hard or too long (overexertion) or overestimating your abilities, which can cause injury
• Direct impact, which includes being hit by sports equipment or running into another player

Risk factors

Sports injuries are usually accidents, and accidents are often random. But some things can contribute to the risk of an injury. These risk factors may include:

• Not wearing the right gear or using the right safety equipment
• Not warming up or stretching properly before activity
• Starting at an intensity level your body isn’t used to
• Playing aggressive contact sports, like tackle football

How are sports injuries diagnosed?

To diagnose a sports injury, your healthcare provider will start with a physical exam and medical history. They’ll ask you about what happened at the time of the injury and review your symptoms. They might check how your injured body part moves or how it feels when they touch it. Depending on the injury, they might want to look at pictures of the bones or tissues involved.

They’ll get these pictures through imaging tests like:

• X-ray
• CT scan
• MRI

How do you treat a sports injury?

When you first get a sports injury, you can treat it with the RICE method for immediate relief. RICE stands for Rest, Ice, Compression and Elevation. Sometimes, a parent, school nurse or sports medic will apply the RICE method on the field or playground until you can see a healthcare provider. It can help reduce pain and swelling in the acute phase of your injury. But you’ll need different treatment later on.

Many sports injuries can heal at home, though it’s important to have a healthcare provider advise you on your treatment plan. More serious sports injuries may require specialized medical care, like:

• Pain relief. You may need over-the-counter or prescription pain medications.
• Closed reduction. A healthcare provider might need to move a joint back into place.
• Surgery. You might need surgery to repair a tear or fracture, for example.
• A cast or splint. You may need to wear a cast or splint to hold your tissues in place.

After a period of rest, you’ll need to restore strength and flexibility to your injured part. This is the rehabilitation phase of your treatment plan. Your healthcare provider will advise you on when and how to start moving your injured part again. They might refer you to a physical therapist to design a custom exercise plan. Almost any sports injury can benefit from a course of physical therapy.

How do I know if I should seek medical care for a sports injury?

When in doubt, it never hurts to see a qualified healthcare provider about an injury. Repetitive strain injuries, like tendinitis, can sometimes be hard to recognize until you see a provider. You might not realize you have an injury if you can’t connect your symptoms with a specific event. On the other hand, if you have an acute injury, you might not be able to tell how serious it is. Signs to watch for include:

• Severe pain that isn’t getting better
• Extreme bleeding, bruising or swelling
• Obvious deformity, like bones that look out of place
• You can’t move or use the injured part

What can I expect after a sports injury?

The outlook after a sports injury depends on the type and how bad it is. Most sports injuries are minor and can heal in a few days to weeks. Others might need medical interventions or surgery and can take several months to heal. How well you take care of your injury at home can also affect your recovery. Returning to activity too soon can interrupt the healing process. Not moving it enough can also stall it.

What questions should I ask my healthcare provider about my sports injury?

You can ask your provider:

• How should I manage my pain?
• How long should I rest my injury, and when should I start moving it again?
• What types of exercises should I do during rehabilitation?
• When can I return to sports or other intensive activities?
• How should I take care of my injured part when I return to my sport?

What can I do to prevent sports injuries?

Not all injuries are preventable, but there are some practical steps you can take to reduce your risk:

• Get trained. When you start a new activity, make sure you learn and practice safe techniques.
• Gear up. Use the right protective gear and equipment to prevent injuries.
• Start slow. Warm up and stretch before activity. Gradually increase your level of intensity.
• Build fitness. A regular fitness routine will help condition your body for various sports.
• Mix it up. Cross-train or vary your exercise routine. Don’t play the same sport year-round.
• Know your limits. Listen to your body and don’t push it too far. Allow yourself time to recover.

A note from QBan Health Care Services

Sports injuries are common, but most are minor and heal easily. Good training and technique can help prevent injuries. Accidents can still happen, but the health benefits of an active lifestyle outweigh the risks. In general, it’s better for your body to challenge it than not to. The process of injury and recovery can help teach us greater respect for our bodies — their limits, as well as their amazing healing abilities.

Osteopenia is the medical definition for bone density loss. It can become osteoporosis if the bone density loss worsens. Some health conditions, habits and medications can increase your osteopenia risk, but it usually happens naturally as you age. Your provider will suggest treatments that slow down bone loss and improve osteopenia.

What is osteopenia?

Osteopenia is a loss of bone density. Having reduced bone density means your bones don’t have as much mineral content as they should. This can make them weaker and increase your risk of bone fractures (broken bones).

If you have osteopenia, your bone density is lower than average. It can progress to osteoporosis.

Most people need their bone density checked every few years after they turn 50 or enter postmenopause, but you might need yours monitored more often. Visit a healthcare provider for regular checkups. They’ll tell you when you’ll need your bone density tested.

What’s the difference between osteopenia vs. osteoporosis?

Osteopenia is an early sign of osteoporosis. Their names sound so similar because they’re closely related.

Osteopenia is the medical definition for having reduced bone density. Osteopenia is the warning sign that means you have an increased osteoporosis and fracture risk.

If it’s not treated, osteopenia can become osteoporosis. Osteoporosis silently weakens your bones. People with osteoporosis are much more likely to break a bone, especially from falls. If you have osteoporosis, even a minor slip that might not normally cause injuries can lead to fractures.

How common is osteopenia?

Experts estimate that more than 40 million Americans have osteopenia. They think around one-third of adults older than 50 have some degree of bone density loss.

What are osteopenia symptoms?

Osteopenia doesn’t usually cause any symptoms you can feel or notice. That’s why healthcare providers sometimes call osteopenia and osteoporosis silent diseases.

What causes osteopenia?

Osteopenia usually happens naturally as you age. Your bones are living tissue like any other part of your body. It might not seem like it, but they’re constantly growing, changing and reshaping themselves throughout your life.

Most people lose some bone density as they get older. Your bones are densest around age 25 and start breaking down faster than your body can rebuild them after that. This natural decline doesn’t cause issues in most people. However, if you lose too much bone density, you can develop osteopenia, which may mean you’re more likely to have osteoporosis later in your life.

What are the risk factors?

Anyone can develop osteopenia, but some groups of people are more likely to have it, including:

• Adults older than 50
• Sex: Females are four times more likely to have osteopenia
• Women after menopause
• People who smoke or use tobacco products
• People who regularly drink alcohol (more than two drinks per day)

Some health conditions can lower your bone density or worsen osteopenia, including:

• Hyperthyroidism
• Diabetes
• Chronic kidney disease (CKD)
• Malnutrition
• A calcium or vitamin D deficiency
• Hormonal imbalances (like Cushing syndrome)
• Anorexia and other eating disorders
• Autoimmune diseases that affect your bones (like rheumatoid arthritis or collagen defects)

Medications that can increase your osteopenia risk include:

• Diuretics
• Corticosteroids
• Medications used to treat seizures
• Hormone therapy for cancer (including to treat breast cancer or prostate cancer)
• Anticoagulants
• Proton pump inhibitors (PPIs, like those that treat acid reflux, which can affect your calcium absorption)

What are osteopenia complications?

Increasing your bone fracture and osteoporosis risk are osteopenia’s main complications. Osteopenia on its own won’t cause symptoms. But having reduced bone density makes you much more likely to break a bone, even after small injuries or falls.

How is osteopenia diagnosed?

A healthcare provider will diagnose osteopenia with a bone density test. A bone density test is an imaging test that measures the strength of your bones. It uses X-rays to measure how much calcium and other minerals are in your bones.

Checking for changes in your bone density is the best way to catch osteopenia before it becomes osteoporosis. Your provider might suggest you get regular bone density tests if you have a family history of osteoporosis. Females usually need bone density screenings regularly after they turn 50. Males typically need them after age 70.

If you have osteopenia, you’ll probably need a bone density test every few years to see how your bones have changed.

What is the best treatment for osteopenia?

Your provider will suggest osteopenia treatments that slow down your bone loss and strengthen your existing bone tissue. The most important part of treating osteopenia is preventing bone fractures and osteoporosis.

The most common osteopenia treatments include:

• Physical activity and exercise: Staying active can strengthen your bones (and all the tissue connected to them, like your muscles, tendons and ligaments). Your provider might suggest weight-bearing exercises to strengthen your muscles and train your balance. Physical activities that make your body work against gravity like walking, yoga, Pilates and tai chi can improve your strength and balance without putting too much stress on your bones. You might need to work with a physical therapist to find exercises and movements that are right for you.
• Vitamin and mineral supplements: You might need over-the-counter (OTC) or prescription calcium or vitamin D supplements. Your provider will tell you which type you need, how often you should take them and which dosage you’ll need. Most people don’t need prescription medication to treat osteopenia. Your provider may suggest prescription medication to treat osteoporosis if you develop it later.
• Following an eating plan that’s healthy for you: Eating enough, and getting the right kinds of vitamins and minerals, can strengthen your bones (and improve your overall health). Your provider or a registered dietitian can help you create an eating plan that fits your unique needs.

What can I expect if I have osteopenia?

You should expect to monitor your bone density for the rest of your life if you have osteopenia. Most people with osteopenia need their bone density checked every few years. Your provider will tell you how often you’ll need bone density tests.

Can I reverse my osteopenia?

Osteopenia is a natural progression of bone loss. But you can slow it down to prevent osteoporosis. The sooner you know you have osteopenia, the better. Once you start treatment, you may slow down your bone loss so much that you never develop osteoporosis. Some people can reverse osteopenia and regain a typical amount of bone density.

Can you prevent osteopenia?

You usually can’t prevent osteopenia. Everyone naturally loses some bone density as they age, and you can’t stop that from happening. Some of the best ways to strengthen your bones and slow bone loss are the same as the treatments for osteopenia. Talk to your provider about ways to improve your bone health if you’re worried about osteopenia or osteoporosis.

How do I take care of myself?

Some of the best ways to take care of your bones are great ways to support your overall health:

• Stay physically active as often as you can.
• Get plenty of vitamin D and calcium in your diet.
• Limit how much alcohol you drink.
• Avoid smoking and other tobacco products.

When should I see my healthcare provider?

Visit a healthcare provider if you notice any changes in your body that make you worried about your bone health. Tell your provider about any other symptoms you’re experiencing, especially if you have bone pain or trouble moving.

Ask your provider how often you should have your bone density checked, especially if someone in your biological family has osteopenia or osteoporosis.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• How often should I have my bone density checked?
• Do I have any risk factors?
• Which treatments will I need?
• What are some good physical activities to improve my bone health?

A note from QBan Health Care Services

Having osteopenia means you have reduced bone density. Some health conditions and medications can cause it or increase your risk, but it usually happens naturally as you age. Most people’s bone density is at its highest around age 25 and slowly decreases over time after that.

Your healthcare provider will tell you how often you’ll need bone density tests, and which treatments can slow down your bone loss. The most important part of treating osteopenia is helping you prevent osteoporosis.

Hypercalcemia happens when you have higher-than-normal levels of calcium in your blood. It’s usually caused by primary hyperparathyroidism or certain cancers and is treatable with surgery and/or medication.

What is hypercalcemia?

Hypercalcemia happens when you have higher-than-normal levels of calcium in your blood. Hypercalcemia can be mild or severe and temporary or chronic (lifelong).

Calcium is one of the most important and common minerals in your body. Most of your body’s calcium is stored in your bones, but you need calcium in your blood as well. The calcium in your blood helps:

• Your nerves work.
• Make your muscles squeeze together so you can move.
• Your blood clot if you’re bleeding.
• Your heart work properly.

Two hormones called parathyroid hormone and calcitonin control the levels of calcium in your blood and bones. Vitamin D also plays an important role in maintaining calcium levels because your body needs it to absorb calcium from the food you eat.

Your body normally carefully controls the level of calcium in your blood, but certain medications and conditions can result in high blood calcium levels (hypercalcemia).

What is the difference between hypocalcemia and hypercalcemia?

Hypercalcemia and hypocalcemia are medical conditions that both have to do with the amount of calcium in your blood — the difference is how much.

In the medical world, the prefix “hyper-” means “high” or “too much.” Hypercalcemia means you have higher-than-normal calcium in your blood.

The prefix “hypo-” means “low” or “not enough.” Hypocalcemia means you have lower-than-normal levels of calcium in your blood.

Who does hypercalcemia affect?

Hypercalcemia can affect anyone at any age, but it’s most common in females over age 50 (after menopause). In most cases, this is due to an overactive parathyroid gland.

How common is hypercalcemia?

Hypercalcemia affects approximately 1% to 2% of the general population. Most of the cases — about 90% — are due to primary hyperparathyroidism and cancer-related hypercalcemia (hypercalcemia of malignancy).

Is hypercalcemia life-threatening?

Most cases of hypercalcemia aren’t life-threatening and many people don’t have any symptoms. Healthcare providers often catch it early from routine blood tests.

But severe hypercalcemia can cause more serious problems, including:

• Kidney failure.
• Abnormal heart rhythm (arrhythmia).
• Confusion.
• Coma.

What are the symptoms of hypercalcemia?

Since healthcare provider often discover hypercalcemia in its early stage, most people don’t have symptoms.

More severe and/or long-term cases of hypercalcemia may cause the following symptoms:

• More frequent urination and thirst.
• Fatigue.
• Bone pain.
• Headaches.
• Nausea and vomiting.
• Constipation.
• Decrease in appetite.
• Forgetfulness, depression or irritability.
• Muscle aches, weakness, cramping and/or twitches.

What causes hypercalcemia?

More than 25 separate diseases, several medications and even dehydration can cause hypercalcemia. Primary hyperparathyroidism and various kinds of cancers account for the greatest percentage of all people with hypercalcemia.

Primary hyperparathyroidism and hypercalcemia

In primary hyperparathyroidism, one or more of your four parathyroid glands produce too much parathyroid hormone — the hormone responsible for controlling blood calcium levels.

Your parathyroid glands are located behind your thyroid gland in your neck. Normally, they work with your kidneys, bones and intestines to carefully regulate the level of blood calcium. But sometimes a parathyroid gland becomes overactive, resulting in excess parathyroid hormone release and elevated blood calcium levels.

Cancers that can cause hypercalcemia

About 2% of all cancers are associated with hypercalcemia, and cancer-related hypercalcemia cases (also called hypercalcemia of malignancy) often have a rapid onset and are severe. Certain types of cancer that can cause hypercalcemia include:

• Lung cancer.
• Breast cancer.
• Multiple myeloma (cancer that forms in a type of white blood cell).
• Renal cell carcinoma (a type of kidney cancer).
• Certain cancers of the blood (leukemia).
• Lymphoma (cancer of the lymphatic system).
• Rhabdomyosarcoma (muscle cell cancer).

Medications that can cause hypercalcemia

Common medications and supplements that can cause hypercalcemia include:

• Hydrochlorothiazide and other thiazide diuretics (prescribed for high blood pressure and edema).
• Lithium.
• Excessive intake of vitamin D, vitamin A or calcium supplements.

Taking too much calcium carbonate in the form of Tums® or Rolaids® is actually one of the more common temporary causes of hypercalcemia.

Other causes of hypercalcemia

Other less common causes of hypercalcemia include:

• Lung diseases such as sarcoidosis and tuberculosis.
• Kidney failure.
• Thyrotoxicosis.
• Being bedridden/immobilized for a prolonged time.
• Paget’s disease of the bone.

How is hypercalcemia diagnosed?

Hypercalcemia is a fairly common finding on routine blood tests such as a comprehensive metabolic panel (CMP) or basic metabolic panel (BMP), which include a calcium blood test. These tests allow healthcare providers to detect abnormally high calcium levels early.

The following blood calcium levels indicate different levels of diagnosis and severity of hypercalcemia:

• Mild hypercalcemia: 10.5 to 11.9 milligrams per deciliter (mg/dL).
• Moderate hypercalcemia: 12.0 to 13.9 mg/dL.
• Hypercalcemic crisis (a medical emergency): 14.0 to 16.0 mg/dL.

If you have symptoms of hypercalcemia or are at risk for developing hypercalcemia due to having a certain kind of cancer, your provider will order different blood tests to determine if you have hypercalcemia. If your blood calcium level is elevated, your provider will review your medications and medical history and conduct a physical exam.

If there’s no obvious cause to your elevated levels, your provider may ask you to see an endocrinologist, a provider who specializes in hormone-related conditions, who will provide further evaluation and testing.

What tests will be done to diagnose this condition?

Your healthcare provider may order any of the following tests to help diagnose hypercalcemia and its cause:

• Calcium blood test.
• Parathyroid hormone (PTH) blood test.
• PTH-related protein (PTHrP) blood test.
• Vitamin D blood test.
• Calcium urine test.

If your provider suspects primary hyperparathyroidism is causing hypercalcemia, they’ll likely recommend an imaging test to see if there are any growths on your parathyroid gland(s) or if they’re enlarged. Different imaging tests for this purpose include:

• Ultrasound test.
• Nuclear medicine imaging, specifically a parathyroid scan.
• CT (computed tomography) scan.

How is hypercalcemia treated?

Treatment of hypercalcemia depends on what’s causing it and how severe it is. In mild cases of hypercalcemia, your healthcare provider may tell you to:

• Drink more water.
• Switch to a non-thiazide diuretic or blood pressure medication.
• Stop taking or lower your dose of calcium-rich antacid tablets.
• Stop taking or lower your dose of calcium supplements and calcium-containing supplements, such as multivitamins.

If the hypercalcemia is due to an overactive parathyroid gland, your provider will most likely recommend surgery to have the overactive parathyroid gland(s) removed.

If the hypercalcemia is due to cancer, your provider may suggest any of the following medications:

• Bisphosphonates, such as pamidronate and zoledronic acid.
• Denosumab (XGEVA®), a bone-strengthening medication, for people with cancer-caused hypercalcemia who don’t respond to bisphosphonates.

If the hypercalcemia is severe, and/or causing significant symptoms, your provider may recommend immediate hospitalization for IV fluids and other treatments.

What is the prognosis (outlook) for hypercalcemia?

Prognosis, like treatment, depends on the cause and severity of hypercalcemia. When hypercalcemia happens due to a benign condition or temporary situation, it generally has a good prognosis.

People who have hypercalcemia due to cancer often experience symptoms and require frequent hospitalizations.

What are the complications of hypercalcemia?

Complications of long-term hypercalcemia are rare since calcium levels are checked in routine blood panels and healthcare providers usually catch hypercalcemia early, but complications can include:

• Calcium deposits in your kidney (nephrocalcinosis) that cause poor kidney function.
• Kidney failure.
• Kidney stones.
• High blood pressure (hypertension).
• Depression.
• Bone cysts.
• Bone fractures.
• Osteoporosis.

How can I prevent hypercalcemia?

Not all cases of hypercalcemia can be prevented, but avoiding excess intake of calcium pills and calcium-based antacid tablets can help.

Be sure to talk with your healthcare provider if you have a family history of high calcium, kidney stones or parathyroid conditions. Avoid taking dietary supplements, vitamins or minerals without first discussing them with your provider.

When should I see my healthcare provider about hypercalcemia?

If you have a family history of hypercalcemia and/or hyperparathyroidism, talk to your healthcare provider about your risk for developing hypercalcemia.

If you’re experiencing symptoms of hypercalcemia, contact your healthcare provider.

A note from QBan Health Care Services

Getting a new diagnosis can be stressful. Know that hypercalcemia is treatable and that symptoms usually go away once your calcium levels are back to normal. If you have cancer that can cause hypercalcemia, your provider will likely want to regularly monitor your blood calcium levels. Don’t be afraid to ask your healthcare team questions about hypercalcemia and its management.

Hypocalcemia happens when the level of calcium in your blood (not your bones) is too low. Several different health conditions can cause hypocalcemia. The symptoms of hypocalcemia depend on how mild or severe it is. It is treatable and can last for a short time or be chronic depending on the cause.

What is hypocalcemia?

Hypocalcemia is a treatable condition that happens when the levels of calcium in your blood are too low.

Many different health conditions can cause hypocalcemia, and it’s often caused by abnormal levels of parathyroid hormone (PTH) or vitamin D in your body. Hypocalcemia can be mild or severe and temporary or chronic (lifelong).

What is calcium and what does it do?

Calcium is one of the most important and common minerals in your body. Most of your body’s calcium is stored in your bones, but calcium is needed in your blood as well.

The calcium in your blood helps your nerves work, helps make your muscles squeeze together so you can move, helps your blood clot if you are bleeding and helps your heart work properly. A low level of calcium in your blood (hypocalcemia) can hinder your body’s ability to perform these important functions. You also need calcium in your bones to make them strong.

If you don’t consume enough calcium in your diet, your body takes calcium from your bones to use in your blood, which can weaken your bones. Hypocalcemia happens when there are low levels of calcium in your blood, not your bones.

The levels of calcium in your blood and bones are controlled by two hormones called parathyroid hormone and calcitonin. Vitamin D also plays an important role in maintaining calcium levels because it’s needed for your body to absorb calcium.

Who gets hypocalcemia?

Hypocalcemia can affect people of all ages, including infants. The age at which someone could develop hypocalcemia usually depends on the cause. For example, if an infant has hypocalcemia, it’s often because of a genetic disorder.

How common is hypocalcemia?

Healthcare professionals and researchers have not yet determined how common hypocalcemia is. This is likely because hypocalcemia is usually a side effect of other health issues.

Hypocalcemia is a common side effect of having your thyroid removed (thyroidectomy). Approximately 7% to 49% of people have temporary hypocalcemia after thyroidectomy.

What are the symptoms of hypocalcemia?

People who have mild hypocalcemia often have no symptoms (are asymptomatic). The symptoms of hypocalcemia depend on if it’s mild or severe.

Symptoms of mild hypocalcemia can include:

• Muscle cramps, especially in your back and legs.
• Dry, scaly skin.
• Brittle nails.
• More coarse hair than what’s normal for you.

If left untreated, over time hypocalcemia can cause neurologic (affecting the nervous system) or psychologic (affecting the mind) symptoms, including:

• Confusion.
• Memory problems.
• Irritability or restlessness.
• Depression.
• Hallucinations.

Severe hypocalcemia (very low levels of calcium in your blood) can cause the following symptoms:

• Tingling in your lips, tongue, fingers and/or feet.
• Muscle aches.
• Muscle spasms in your throat that make it difficult to breathe (laryngospasm).
• Stiffening and spasms of your muscles (tetany).
• Seizures.
• Abnormal heart rhythms (arrhythmia).
• Congestive heart failure.

What causes hypocalcemia?

There are many complex functions and factors involved with maintaining a steady level of calcium in your blood and body. Because of this, several different health conditions and disorders can cause hypocalcemia.

Most of the time, an issue with your parathyroid hormone (PTH) levels and/or vitamin D level(s) is involved with the cause of hypocalcemia. This is because PTH helps control the level of calcium in your blood and vitamin D helps your body absorb calcium.

The three most common causes of hypocalcemia include:

• Hypoparathyroidism: Hypoparathyroidism happens when your parathyroid glands (four small pea-sized glands behind your thyroid in your neck) don’t make enough parathyroid hormone (PTH). Low levels of PTH cause low levels of calcium in your body. You can have hypoparathyroidism from an inherited disorder or from having one or more of your parathyroid glands or your thyroid gland surgically removed.
• Vitamin D deficiency: Vitamin D helps your body absorb calcium properly, so a lack of vitamin D in the body can cause low levels of calcium in your blood (hypocalcemia). Vitamin D deficiency can be caused by an inherited disorder or by not getting enough sunlight or not consuming enough vitamin D.
• Kidney failure (renal failure): Hypocalcemia in chronic renal failure is due to an increased level of phosphorus in your blood and decreased renal production of a certain kind of vitamin D.

Other causes of hypocalcemia include:

• Certain medications: Bisphosphonates, corticosteroids, rifampin, calcitonin, chloroquine, cinacalcet, Denosumab, Foscarnet and plicamycin can all cause hypocalcemia.
• Pseudohypoparathyroidism: This is an inherited disorder that causes your body to not respond properly to the normal amount of parathyroid hormone (PTH) it has. Your body acts like it doesn’t have enough PTH when it actually has normal levels of PTH.
• Hypomagnesemia: Your parathyroid glands need magnesium to make and release parathyroid hormone (PTH), so when your magnesium is too low (hypomagnesemia), not enough PTH is produced and blood calcium levels are also lower (hypocalcemia).
• Pancreatitis: Approximately 15% to 88% of people who have acute pancreatitis will have hypocalcemia.
• Certain rare genetic disorders: Genetic mutations, such as DiGeorge syndrome, can cause hypocalcemia.

How is hypocalcemia diagnosed?

You have hypocalcemia if your total serum (blood) calcium concentration is less than 8.8 mg/dL. Your healthcare provider may find mild hypocalcemia incidentally (by chance) from routine blood tests or by testing for other conditions.

What tests will be done to diagnose the cause of hypocalcemia?

Healthcare providers use a calcium concentration blood test to diagnose hypocalcemia. Figuring out and diagnosing the cause of hypocalcemia is just as important as diagnosing the hypocalcemia itself.

Your healthcare provider may perform the following tests or procedures to try to determine the cause of your hypocalcemia or to be sure your hypocalcemia isn’t affecting other parts of your body:

• Other blood tests: Your healthcare provider may do more blood tests to check your levels of magnesium, phosphorus, parathyroid hormone (PTH) and/or vitamin D.
• EKG (electrocardiogram): An EKG is a procedure that uses electrodes attached to your chest to measure your heart rhythm. Hypocalcemia can cause an abnormal heart rhythm.
• Bone imaging tests: Bone imaging tests could be used to see if you have calcium issues in your bones, such as osteomalacia or rickets.

How is hypocalcemia treated?

Oral calcium supplements are the most common treatment for hypocalcemia. Treating the cause of hypocalcemia is just as important as treating the hypocalcemia itself. If you’re taking a medication that is causing your hypocalcemia, your healthcare provider may change it or adjust it in order to return your calcium levels to normal.

What medications and treatments are used for hypocalcemia?

The following treatments and medications are often used for hypocalcemia:

• Oral calcium pills: Calcium pills or supplements may be used to restore your calcium to normal levels.
• Vitamin D supplement: People who have chronic hypocalcemia often take a vitamin D supplement along with calcium pills so that their bodies can properly absorb the calcium.
• Synthetic form of parathyroid hormone (PTH): If you have hypoparathyroidism that is causing hypocalcemia, your healthcare provider may have you take a synthetic form of PTH.
• IV calcium gluconate: If your hypocalcemia is severe and you are experiencing muscle cramps or spasms (tetany), you may receive an IV of calcium gluconate in the hospital.
• Other medications: Depending on the cause of your hypocalcemia, you may have to take other medications to treat/and or manage the cause.

What is the prognosis (outlook) for hypocalcemia?

Hypocalcemia is a treatable condition. Symptoms of hypocalcemia usually go away once your calcium levels are back to normal. If left untreated, severe hypocalcemia can cause life-threatening complications such as seizures and congestive heart failure. Be sure to contact your healthcare provider if you’re experiencing symptoms and go to the nearest hospital if you are experiencing severe symptoms.

How long will I have hypocalcemia?

Depending on the cause, you could have temporary or chronic (lifelong) hypocalcemia. Ask your healthcare provider how long you can expect to have hypocalcemia and how long you’ll have to take medication.

Can I die from hypocalcemia?

Hypocalcemia can be potentially life-threatening if it’s not diagnosed and treated in time. Be sure to contact your healthcare provider if you’re experiencing symptoms.

What are the risk factors for hypocalcemia?

Risk factors for developing hypocalcemia can include having:

• Vitamin D deficiency.
• A parathyroid disorder or parathyroid gland surgery.
• Thyroid removal surgery (thyroidectomy).
• A family history of genetic conditions such as certain genetic mutations, genetic vitamin D disorder or DiGeorge syndrome.

Can I prevent hypocalcemia?

Unfortunately, there’s nothing you can do to prevent hypocalcemia. Although it may seem that eating and drinking more calcium could prevent hypocalcemia, a lack of calcium in your diet usually doesn’t affect the amount of calcium in your blood. Maintaining adequate calcium intake, however, is important for bone health.

When should I see my healthcare provider?

Be sure to contact your healthcare provider if you’re experiencing symptoms of hypocalcemia. If you have chronic hypocalcemia, it’s important to see your healthcare provider regularly so that you can be sure your calcium levels are healthy and that your treatment is working.

What questions should I ask my doctor if I have hypocalcemia?

If you’ve been diagnosed with hypocalcemia, it may be helpful to ask your healthcare provider the following questions:

• What caused my hypocalcemia?
• How long will I have hypocalcemia?
• How long will I have to take medication for my hypocalcemia?
• When will my symptoms go away once I start my medication for hypocalcemia?
• Are my children or family members at risk of developing hypocalcemia?

A note from QBan Health Care Services

Getting a diagnosis can be scary. Know that hypocalcemia is treatable and that symptoms usually go away once your calcium levels are back to normal with treatment. Don’t be afraid to ask your healthcare team questions about your hypocalcemia and its management.

Pituitary adenomas are benign tumors on your pituitary gland. They’re noncancerous, but they can interfere with normal pituitary function and cause certain health conditions. Healthcare providers treat pituitary adenomas with surgery, medication, radiation or a combination of these therapies.

What is a pituitary adenoma?

A pituitary adenoma is a benign (noncancerous) growth on your pituitary gland. Unlike cancer, it doesn’t spread to other parts of your body. But as pituitary adenomas grow, they can put pressure on nearby structures and cause symptoms.

What is the pituitary gland?

Your pituitary is a small gland about the size of a pea that’s joined to your hypothalamus (the base of your brain) right behind your nose. It has two lobes: the anterior (front) lobe and the posterior (back) lobe. Each lobe releases different hormones.

Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, muscles and other tissues.

Your pituitary gland releases several important hormones, including:

• Adrenocorticotropic hormone (ACTH or corticotropin).
• Antidiuretic hormone (ADH, or vasopressin).
• Follicle-stimulating hormone (FSH).
• Growth hormone (GH).
• Luteinizing hormone (LH).
• Oxytocin.
• Prolactin.
• Thyroid-stimulating hormone (TSH).

Your pituitary gland also tells other endocrine system glands to release hormones. Of note, pituitary adenomas can affect the production and release of a single hormone or a combination of hormones.

Healthcare providers categorize pituitary adenomas based on whether or not they produce extra hormones.

• Functioning (secreting) adenomas: These adenomas release extra pituitary hormones, which cause certain symptoms and/or conditions depending on the hormone it releases.
• Nonfunctioning (non-secreting) adenomas: These adenomas don’t release hormones, but they can compress nearby structures if they grow (see below). The most common adenomas most healthcare providers diagnose are nonfunctioning pituitary adenomas.

Healthcare providers also categorize pituitary adenomas based on their size:

Microadenomas: These adenomas are smaller than 10 millimeters or 1 centimeter.

Macroadenomas: These adenomas are larger than 10 millimeters. Macroadenomas are twice as common compared to microadenomas. They’re also more likely to cause lower than normal levels of one or more pituitary hormones. This is known as hypopituitarism.

Is a pituitary adenoma a brain tumor?

Even though your pituitary gland is an endocrine structure that’s not technically a part of your brain (it’s actually attached to your brain), healthcare providers consider pituitary adenomas brain tumors. They represent about 10% of primary brain tumors.

Who do pituitary adenomas affect?

Pituitary adenomas can occur at any age but are more common in people in their 30s or 40s. Women are more likely to have pituitary adenomas.

How common are pituitary adenomas?

Pituitary adenomas make up 10% to 15% of all tumors that develop within your skull. About 77 out of 100,000 people have a pituitary adenoma, but researchers think adenomas actually occur in as many as 20% of people at some point in their lives. As many people with pituitary adenomas, especially microadenomas, are asymptomatic, they’re usually never found.

What are the symptoms of a pituitary adenoma?

The symptoms of pituitary adenomas can vary widely depending on several factors, including:

• If it’s large enough to damage your pituitary gland or nearby structures (mass effect).
• If it’s a functioning (hormone secreting) pituitary adenoma with symptoms based on the type of hormone it secretes.

Pituitary macroadenomas typically present with mass effects — meaning their large size can apply pressure to or damage nearby tissues, causing compressive symptoms, including:

Vision problems

Approximated 40% to 60% of people with a pituitary macroadenoma have impaired vision (blurry or double vision) from the adenoma. The adenoma compresses your optic chiasm, leading to visual field defects like the loss of peripheral vision (side vision).

Headaches

People with pituitary adenomas often report having headaches. This could be due to pressure on nearby tissues, but as headaches are a common symptom in general, people could have them for other reasons as well.

Hormonal deficiency

Pituitary macroadenomas can cause one or more pituitary hormone deficiencies due to damage to your pituitary gland tissue. This can result in an underactive pituitary gland, also known as hypopituitarism.

Each pituitary hormone deficiency causes different symptoms.

• A deficiency of LH and FSH hormones leads to low testosterone (LH) and estrogen (FSH), a condition known as hypogonadism. Symptoms of hypogonadism include hot flashes and vaginal dryness, erectile dysfunction and decreased facial/body hair growth in men,, mood swings, decreased libido/sex drive and fatigue.
• A deficiency of TSH results in low thyroid hormone production, a condition known as hypothyroidism. Symptoms of hypothyroidism include fatigue, constipation, slow heart rate, dry skin, swelling of extremities and diminished reflexes.
• A deficiency of ACTH means you don’t produce as much cortisol, a condition known as adrenal insufficiency. Symptoms of adrenal insufficiency include low blood pressure, nausea, vomiting, abdominal pain and poor appetite.
• A deficiency of GH results in low growth hormone production, also known as growth hormone deficiency. You’ll have different symptoms depending on how old you are. In adults, a lack of GH results in fatigue and decreased muscle mass.

What symptoms do functioning pituitary adenomas cause?

A functioning, or secreting, pituitary adenoma releases excess hormone(s). Functioning pituitary adenomas can cause several different symptoms depending on which pituitary hormone(s) they release.

As your body normally regulates the hormone levels in your body for optimum health, extra pituitary hormones from a functioning adenoma can lead to the following conditions:

Prolactinomas (lactotroph adenomas)

Prolactinomas (lactotroph adenomas) make excess prolactin, a condition known as hyperprolactinemia. Prolactinomas account for about 4 out of 10 pituitary tumors. They’re the most common type of pituitary adenoma.

High prolactin levels can disrupt normal reproductive functions by interfering with hormones produced by your testicles or ovaries. Symptoms include:

• Male and female infertility.
• Milky discharge from your nipples when not pregnant, which is known as (galactorrhea).

Somatotroph adenomas

Somatotroph adenomas make excess growth hormone (also known as somatotropin) and make up about 2 in 10 pituitary tumors.

Somatotroph adenomas cause different symptoms depending on your age.

In adults, these adenomas are a common cause of acromegaly, a rare but serious condition that results from too much growth hormone. It affects your body’s bones and tissues and causes them to grow in abnormal ways. Over time, it can lead to enlarged hands, feet or head size and a rounded face with poorly defined features. It also affects important metabolic functions like blood sugar (glucose) regulation and can increase the size of your heart muscle.

In children and adolescents, somatotroph adenomas are the cause of gigantism (also called pediatric acromegaly and pituitary gigantism). High levels of growth hormone in their body cause them to grow very tall.

Corticotroph adenomas

Corticotroph adenomas make extra adrenocorticotropic hormone (ACTH). They account for about 1 in 10 pituitary tumors. ACTH triggers your adrenal glands to make steroid hormones, including cortisol.

Corticotroph adenomas cause Cushing’s syndrome (excess cortisol). This causes several symptoms, including:

• High blood pressure.
• Muscle weakness.
• Easy bruising.
• Wide (> 1 centimeter), purple stretch marks over your belly.
• Osteoporosis.
• Compression fractures.
• Type 2 diabetes mellitus.

Thyrotroph adenomas

Thyrotroph adenomas make excess thyroid-stimulating hormone (TSH) and are very rare. TSH stimulates your thyroid gland to make and release thyroid hormone.

Excess TSH results in excess thyroid hormone, which causes a condition called hyperthyroidism and speeds up your metabolism. This results in symptoms like:

• Rapid heart rate.
• Unexplained weight loss.
• Loose stools (poop).
• Sweating.
• Hand tremors.
• Anxiety.

Hyperthyroidism has many other causes — pituitary adenomas are a rare cause of the condition.

Gonadotroph adenomas

Gonadotroph adenomas make excess gonadotropins, which are luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Gonadotroph adenomas are very rare.

These adenomas can cause irregular menstruation (periods) and ovarian hyperstimulation syndrome (OHSS). It can also cause enlarged testicles, a deeper voice, balding on your temples and rapid facial hair growth.

They can also cause precocious (early) puberty in children.

What causes pituitary adenomas?

Scientists aren’t sure of the exact cause of pituitary adenomas.

But some adenomas have been linked to accidental changes, or mutations in DNA, the material within a cell that makes up our genes. These changes cause the cells in your pituitary gland to grow out of control, making a mass (growth). The genetic changes can be passed down from parents to children (inherited), but they usually happen randomly.

Pituitary adenomas are also associated with certain genetic conditions, including:

• Multiple endocrine neoplasia type 1.
• Multiple endocrine neoplasia type 4.
• Carney complex.
• X-LAG syndrome.
• Succinate dehydrogenase-related familial pituitary adenoma.
• Neurofibromatosis type 1.
• Von Hippel–Lindau syndrome.

Having one of these conditions makes it more likely that you’ll develop a pituitary adenoma, but you can still have an adenoma without having one of these conditions.

How are pituitary adenomas diagnosed?

The diagnostic process for pituitary adenomas depends on what kind of adenoma you have and if it’s causing symptoms or not.

If you have a hormone-secreting pituitary adenoma, your healthcare provider will likely diagnose you with the condition it causes based on your symptoms before diagnosing the adenoma. This is because many conditions that result from excess hormones can have many different causes — not just pituitary adenomas. This is also true of hypopituitarism (pituitary hormone deficiency) causes.

Sometimes, healthcare providers find pituitary adenomas by accident when you get an imaging test of your brain for another condition. In these cases, the adenoma is usually small and nonfunctioning.

What tests will be done to diagnose a pituitary adenoma?

If your healthcare provider thinks you might have a pituitary adenoma, they’ll do a full review of your symptoms and your medical background and will perform a physical exam.

They may order any of the following tests:

• Blood tests: Depending on your symptoms, your healthcare provider may order blood tests to check certain hormone levels.
• Imaging tests: An MRI (magnetic resonance imaging) scan or CT (computed tomography) scan of your head can provide images of the structures inside of your head. These tests can confirm the diagnosis of a pituitary adenoma.
• Eye exam: If you’re having problems with your vision, your healthcare provider might have you take a visual field test to check your eye function. Large pituitary adenomas can put pressure on the nerves that connect your eyes to your brain and cause vision issues.

How is a pituitary adenoma treated?

Healthcare providers usually treat pituitary adenomas with surgery, medicine, radiation or a combination of these therapies. As each pituitary adenoma is different, you and your healthcare team will come up with a treatment plan that works best for you.

Surgery to remove pituitary adenomas

If you have a pituitary adenoma that’s causing a hormonal imbalance, your healthcare provider will likely recommend surgery to remove all or part of the adenoma. Depending on the size of the adenoma and the severity of your symptoms, you may need multiple surgeries.

Your surgeon will likely use a type of surgery called transsphenoidal surgery to remove the pituitary adenoma, which involves going through your nose and sphenoid sinus, a hollow space in your skull behind your nasal passages and below your brain, to perform surgery. Surgeons use this technique for 95% of pituitary tumors.

If the adenoma is too large to remove through your sinus cavity, your surgeon may open your skull (transcranial surgery) to get to your pituitary and the adenoma. This is a rare surgery technique for pituitary adenomas.

Medication to treat pituitary adenomas

Healthcare providers can treat some types of pituitary adenomas with medication that shrinks the adenoma and relieves symptoms.

If you have a prolactinoma (the most common kind of pituitary adenoma), you’ll likely receive dopamine agonist therapy medications, such as cabergoline (Dostinex®) or bromocriptine (Cycloset®), as the first course of treatment for several months.

In 80% of cases, these medications shrink the prolactinoma, and prolactin levels return to normal. If the medication doesn’t work, your healthcare provider will likely recommend surgery.

Radiation therapy for pituitary adenomas

Radiation therapy uses high-energy X-rays to shrink adenomas or tumors. Healthcare providers use a special form of radiation therapy called stereotactic radiosurgery for pituitary adenomas, which uses a high dose of radiation aimed precisely at the adenoma from more than one direction to keep the adenoma from growing.

What are the side effects of pituitary adenoma treatment?

As a result of surgeries and/or radiation therapy, approximately 60% of people with pituitary adenomas develop hypopituitarism after treatment, a condition in which there’s a lack of production of one, multiple, or all of your pituitary hormones. Hypopituitarism is treatable with hormone replacement medications.

Complications from surgery to remove a pituitary adenoma can include:

• Bleeding.
• Cerebrospinal fluid (CSF) leaks.
• Meningitis.
• Diabetes insipidus, which is a condition that results in partial or complete antidiuretic hormone deficiency from the posterior pituitary gland. This condition causes you to urinate large quantities of diluted urine resulting in sodium (salt) excess in your body.

Common side effects of dopamine agonists that healthcare providers prescribe to treat prolactinomas include headaches, nausea, vomiting, dizziness and sometimes increased compulsive behavior.

Possible side effects of radiation therapy include:

• Pituitary hormonal deficiency.
• Impaired fertility.
• Vision loss and brain injury (rare).
• Tumor development several years after treatment (rare).

What is the prognosis (outlook) for pituitary adenomas?

The prognosis (outlook) depends on the size and type of pituitary adenoma you have.

When treatment destroys the adenoma, most people with adenomas can return to full, healthy lives. In some cases, adenoma treatment results in low hormone levels, and you have to take lifelong hormone medicines to replace what you’ve lost.

Adenomas tend to recur (come back), which means you may need treatment again. About 18% of people with nonfunctioning adenomas and 25% of people with prolactinomas will need more treatment at some point.

Can you live with a pituitary adenoma?

As long as a pituitary adenoma is small and doesn’t cause any symptoms, you can live with it. In fact, most people find out they have a pituitary adenoma when they get an imaging test of their head for another reason. But if the adenoma continues to grow, you may need to eventually receive treatment for it.

If you have a large and/or functioning pituitary adenoma, you’ll likely need treatment as some pituitary adenomas can cause symptoms that greatly impact your health and quality of life.

What are the complications of an untreated pituitary adenoma?

If left untreated, some pituitary adenomas — mainly macroadenomas and functioning (secreting) adenomas — can cause serious health issues. The health issues largely depend on which hormone the adenoma secretes (see Causes and Symptoms section above).

A very rare complication of untreated pituitary adenomas is pituitary apoplexy. This is a medical emergency that’s caused by bleeding either into or out of your pituitary gland.

Pituitary apoplexy is commonly caused by bleeding inside a pituitary adenoma. Your pituitary is damaged when the tumor suddenly enlarges. It either causes bleeding into your pituitary gland or blocks the blood supply to your pituitary. The larger the adenoma, the higher the risk for pituitary apoplexy.

Pituitary apoplexy usually has a quick onset of symptoms, which can be life-threatening. Symptoms often include:

• Severe headache.
• Paralysis of the eye muscles, causing double vision or problems opening an eyelid.
• Loss of peripheral vision or loss of all vision in one or both eyes.
• Low blood pressure, nausea and vomiting due to acute adrenal insufficiency.
• Personality changes due to the sudden narrowing of one of the arteries in your brain (anterior cerebral artery).

Although pituitary apoplexy is rare, it’s serious. If you have symptoms of pituitary apoplexy, call 911 or have a loved one take you to the nearest emergency room as soon as possible.

Can pituitary adenomas be prevented?

Unfortunately, there’s nothing you can do to prevent developing a pituitary adenoma. Most pituitary adenomas occur randomly, but they’re also associated with certain rare genetic conditions as noted above.

If you have a first-degree relative (sibling or parent) who has one of these conditions, you may want to get genetic testing to check to see if you have it as well. This may help screen for and catch a pituitary adenoma in its early phases. Your healthcare provider may recommend regular blood tests of your pituitary hormone levels to increase the odds of finding and treating a pituitary tumor before it creates problems.

When should I see my healthcare provider about a pituitary adenoma?

Call your healthcare provider if you have problems with your vision and/or have headaches that don’t go away or keep coming back, particularly if they’re toward your forehead.

If you’ve been diagnosed with a pituitary adenoma, you’ll likely need to see your healthcare provider regularly to monitor the adenoma and to make sure your treatment is working.

A note from QBan Health Care Services

Finding out you have a tumor can be scary. The good news is that pituitary adenomas are almost always benign (noncancerous), and treatment leads to good outcomes in most cases. Remember that your healthcare provider is your partner in achieving your best health outcomes, so be sure to keep them up-to-date with any changes in how you feel.

Parathyroid adenomas are abnormal growths on your parathyroid glands. This upsets how the glands manage your body’s calcium levels. Increased calcium levels in your blood can lead to kidney stones, osteoporosis and other health problems. Surgery to remove the abnormal gland(s) is the treatment of choice and cures the condition.

What is a parathyroid adenoma?

An adenoma is a benign (noncancerous) growth that appears on one or more of your parathyroid glands.

An adenoma causes your parathyroid gland to make more parathyroid hormone than your body needs, a condition called primary hyperparathyroidism. Too much parathyroid hormone upsets your body’s normal calcium balance, which increases the amount of calcium in your bloodstream.

A similar but less common condition, called secondary hyperparathyroidism, can occur if you have chronic kidney failure.

What are parathyroid glands and what do they do?

Your parathyroid glands are located in your neck, around your thyroid gland. Most people have four pea-sized, oval-shaped parathyroid glands. The job of your parathyroid is to release parathyroid hormone, which helps manage how your body uses calcium.

Cells in your brain, heart, nerves, bones and digestive system all need calcium to function properly. “Communication” between your parathyroid and bloodstream helps keep calcium at its normal level. Parathyroid hormone takes calcium from your bone and increases reabsorption from your kidney and gut to maintain normal bloodstream levels.

Who develops parathyroid adenoma?

Approximately 100,000 Americans develop primary hyperparathyroidism each year. Women are three times more likely to develop parathyroid adenomas than men. Adenomas are most common in those 50 to 70 years old.

What are the symptoms of parathyroid adenoma?

Too much calcium in your blood (hypercalcemia) can cause a number of symptoms and medical conditions including:

• Feeling tired and weak.
• Confusion, memory loss.
• Depression, irritability or mental confusion.
• Kidney stones.
• Bone and joint pain, osteoporosis, bone breaks.
• Abdominal pain, heartburn, nausea and vomiting.
• Constipation.
• General aches and pains from no obvious cause.
• High blood pressure (hypertension).
• Increased urination.

You may not have, or recognize that you have, symptoms before they are discovered in routine blood work your healthcare provider may have ordered as a part of your general health care.

What causes a parathyroid adenoma to develop?

Scientists don’t know the cause of most parathyroid adenomas. About 10% are thought to be passed along through parents (inherited). Radiation exposure to your head and neck area as a child or young adult also may increase your risk of adenomas. Lack of enough calcium in your diet long-term is also thought to raise your risk.

Primary hyperparathyroidism is the medical condition that results from having adenomas. Hyperparathyroidism may be caused by one or more adenomas, four adenomas (a condition called hyperplasia), or cancer (which is very rare, less than 1% of all parathyroid cases).

A single parathyroid adenoma is the cause in up to 85% of cases, two adenomas cause 4% to 5% of cases and four adenomas cause 10% to 12% of hyperparathyroidism cases.

What are the complications of parathyroid adenoma if it’s not treated?

Untreated parathyroid adenomas cause a rise in calcium levels in your blood. An extremely high amount can cause:

• Irregular heartbeats (cardiac arrhythmia).
• Parathyroid crisis (a clinical event in which a person experiences mental changes that can lead to nervous system failure and coma).
• Death.

How are parathyroid adenomas diagnosed?

Parathyroid adenomas are usually discovered when a higher-than-normal calcium level shows up in a routine blood test. Your provider may also ask if you take thiazide diuretics or lithium. These two medications can raise the level of calcium in your blood. Your healthcare provider then confirms the diagnosis of primary hyperparathyroidism with a test that shows higher-than-normal parathyroid hormone levels in your blood.

It’s important to understand that primary parathyroid disease is diagnosed by looking at the calcium and parathyroid hormone levels only. The fact that you may or may not have symptoms doesn’t matter in terms of making the diagnosis.

Once the diagnosis has been made, your healthcare provider may order more tests to gather more information and check for complications. These might include:

• A special type of imaging method to determine if there are one or more adenomas.
• A CT scan to check for calcium deposits in your kidney and urinary tract.
• Bone densitometry to measure bone loss.
• A 24-hour urine test to measure the amount of calcium lost in your urine.

How are parathyroid adenomas treated?

The most common treatment is surgery to remove the enlarged gland (or glands). Surgery cures the issue up to 95% of the time.

If you are too ill to have surgery, medication may be the only option. The different medications don’t reduce the extra amount of parathyroid hormone in the blood. Instead, they prevent the loss of calcium from bone. Hormone replacement therapy or other treatments for this condition must be taken for the rest of your life.

A prescription medication called cinacalcet (Sensipar®) reduces both calcium and parathyroid hormone levels in people with chronic kidney failure (secondary hyperparathyroidism). Its use in primary hyperparathyroidism is still being studied.

If I don’t have symptoms, do I need surgery?

Surgery is the most common treatment for parathyroid adenoma, even if you don’t have symptoms.

The removal of one or more of your parathyroid glands (parathyroidectomy) can make you feel better, improving the overall quality of your life. More importantly, parathyroidectomy can prevent osteoporosis and kidney stones.

If I decide to have surgery, what should I expect?

Several weeks before surgery, your surgeon will order tests to locate one or more overactive parathyroid gland(s). These tests may include:

• An ultrasound of your neck.
• A scan that uses a drug called Tc-sestamibi.

If imaging identifies a particular parathyroid gland that has an adenoma, your surgeon will look for that particular gland first during surgery. However, all four parathyroid glands need to be identified during the scan. This imaging is very important in terms of planning your surgery. Even if no parathyroid gland is seen on imaging, the diagnosis still remains and your surgeon would still recommend surgery.

What surgical steps are taken to remove parathyroid adenomas?

1. A small incision is made in the front of your neck under general anesthesia.
2. All four parathyroid glands are inspected during surgery. The surgeon takes out the abnormal parathyroid. If one or two abnormal parathyroid glands are found, they are removed and the remaining normal parathyroid gland can maintain a normal calcium level.
3. If all four parathyroid glands are abnormal, then 3 1/2 of the glands are removed. Some parathyroid tissue needs to be left in your body to maintain normal calcium levels.
4. Parathyroid hormone levels are checked during surgery. If the diseased parathyroid gland(s) have all been removed, the parathyroid hormone level should drop by at least 50%.

Parathyroid glands removed during surgery will be checked by a pathologist (frozen evaluation) for confirmation that the parathyroid gland was indeed hyperactive.

Finding all four parathyroid glands during the surgery provides the highest cure rate in the long term.

What are the risks of having surgery?

All surgeries have risks. With parathyroid surgery, you might experience:

• Short-term or permanently low calcium levels in your blood (hypocalcemia). Symptoms of hypocalcemia include numbness/tingling in the fingers and around the mouth and muscle cramps.
• If you have three or more parathyroid glands removed, you’ll definitely experience low calcium symptoms in the first week after surgery.

To reduce these risks:

Take calcium and vitamin D supplements for the first two weeks after surgery, in the amount and as often as instructed by your healthcare provider. If you’ve had 3 1/2 glands removed, you may be instructed to take an even higher dosage of calcium.

What should I expect following surgery to remove my parathyroid glands?

After surgery, your symptoms should stop within about one month. Surgery to remove the parathyroid glands or glands that have become overactive due to adenomas is highly successful. The cure rate is over 95%

The benefits of surgery to remove the diseased parathyroid glands include:

• Higher bone density.
• Lower risk of broken bones.
• Reduced risk of kidney stones.

Can parathyroid adenoma be prevented?

No, there’s no way to prevent the development of growths on your parathyroid glands.

A note from QBan Health Care Services

Having parathyroid adenomas is a condition that may or may not have noticeable symptoms at first. Most of the time, your healthcare provider suspects that you have an adenoma after routine blood work shows you have an elevated calcium level. Even though you may not have symptoms, surgery is the recommended treatment for most people. Without surgery, high calcium levels in your blood can lead to other health problems, including kidney stones, osteoporosis and other symptoms that will affect the quality of your life long term. Surgery to remove the abnormal parathyroid glands cures primary hyperparathyroidism.

An adrenal adenoma is a benign (noncancerous) tumor that forms in your adrenal glands. It’s the most common type of adrenal gland tumor. Most adrenal adenomas don’t produce symptoms or require treatment. However, some adenomas may cause your adrenal glands to secrete excess hormones, like cortisol.

What is an adrenal adenoma?

Adrenal adenomas are benign (noncancerous) tumors in your adrenal glands. Your adrenal glands are small, triangular glands located atop both of your kidneys. They secrete hormones that help your body respond to stress. Your adrenal glands also release hormones that regulate your blood sugar, blood pressure and immune system, among other essential functions.

Your adrenal glands have two parts, your adrenal cortex and your adrenal medulla. Your adrenal cortex secretes hormones, including cortisol and aldosterone. The adrenal medulla produces dopamine, epinephrine and norepinephrine. Adrenal adenomas form in your adrenal cortex.

Adrenal adenomas don’t usually cause symptoms or require treatment. Some may lead to the overproduction of one or more normal adrenal hormones.

What types of adrenal adenomas are there?

Adrenal adenomas are either functioning or nonfunctioning.

• Functioning (active) adrenal adenomas secrete excess adrenal gland hormones and may cause symptoms that require treatment.
• Nonfunctioning (inactive) adrenal adenomas don’t produce excess adrenal hormones. Most adrenal adenomas are nonfunctioning. They don’t cause symptoms or require treatment.

Neither type of tumor is likely to become cancer, but a nonfunctional adrenal adenoma can become functional.

Can an adrenal adenoma become cancerous?

Adrenal adenomas can become cancerous, but this is rare. The most common cancerous tumor that forms in your adrenal glands is adrenocortical carcinoma. Like adrenal adenomas, functioning adrenocortical carcinoma tumors secrete excess hormones. They may cause symptoms similar to functioning adrenal adenomas.

Only about 1 in 1 million people develop adrenocortical carcinoma. The majority of adrenal tumors are benign (noncancerous).

Who do adrenal adenomas affect?

Anyone can get an adrenal adenoma, although the likelihood increases with age. Approximately 3% to 9% of people have adrenal adenomas. They’re the most common type of adrenal gland tumor.

How does an adrenal adenoma affect my body?

Functioning adrenal adenomas can cause your adrenal glands to secrete excess amounts of one or more types of hormone. As a result, you may experience symptoms of certain adrenal disorders, including:

• Cushing’s syndrome (hypercortisolism): This condition occurs when your adenoma secretes too much cortisol. Tumors in your pituitary gland most often cause Cushing’s syndrome, but adrenal tumors can also lead to Cushing’s syndrome. Symptoms include high blood pressure, weight gain (especially around your middle) and sexual dysfunction. It can increase your likelihood of diabetes.
• Primary aldosteronism (Conn’s syndrome): This condition occurs when your adenoma secretes too much aldosterone. Signs and symptoms include low potassium levels, high blood pressure, headache, fatigue and muscle weakness.
• In rare instances, an adrenal adenoma may secrete excess sex hormones. Too many androgens (for example, testosterone) in females may lead to irregular periods, increased body hair (hirsutism), a deeper voice, etc. Too much estrogen in males may cause decreased sex drive and erectile dysfunction.

What are the symptoms of an adrenal adenoma?

Functioning adrenal adenomas may produce symptoms related to having excess hormones in your body, especially excess cortisol (Cushing’s syndrome) or excess aldosterone (Primary aldosteronism).

Signs and symptoms may include:

• Headache.
• Muscle weakness or occasional numbness.
• Fatigue and achiness (like backaches).
• High blood pressure (hypertension).
• High blood sugar levels or diabetes.
• Low potassium levels.
• Stretch marks on your abdomen.
• Weight gain, especially in your upper body.
• Mood changes (feeling anxious, panicked or depressed).

Females may experience irregular menstrual cycles and increased masculine characteristics (virilization). Males may experience sexual dysfunction.

What causes adrenal adenomas?

Researchers don’t know what causes an adrenal adenoma or other benign adrenal gland tumors to form. Still, certain genetic conditions may increase your risk, including:

• Multiple endocrine neoplasia, type 1 (MEN1).
• Familial adenomatous polyposis (FAP).
• Carney complex.
• Li-Fraumeni syndrome.
• Multiple endocrine neoplasia type 2 (MEN2).
• Neurofibromatosis Type 1.

Obesity and tobacco use may also increase your chances of having an adrenal adenoma.

How are adrenal tumors diagnosed?

Many people don’t realize they have an adrenal adenoma until their healthcare provider discovers an adrenal gland tumor during an imaging procedure for an unrelated medical condition. These tumors are sometimes called “incidentalomas” because they’re found incidentally, or by chance.

Your healthcare provider will first determine whether a tumor is cancerous (for example, adrenocortical carcinoma) or benign (for example, adrenal adenoma). If it’s an adrenal adenoma, they’ll perform tests to determine whether it’s secreting excess hormones.

What tests are used to diagnose adrenal adenoma?

Your healthcare provider will perform a physical exam and ask you about your symptoms and medical history. They may perform any of the following tests to learn more about your tumor:

• Blood or urine test: A blood or urine test allows your healthcare provider to check for elevated hormone levels that may be a sign of a functioning tumor. You may need to collect your urine for 24 hours so they can test it for elevated cortisol.
• Imaging: A CT scan is the most commonly used imaging procedure used to diagnose adrenal adenoma. In some instances, your healthcare provider may order an MRI instead. Imaging helps them determine whether a tumor is malignant or benign. For example, larger tumors (more than 4 centimeters) are more likely to be cancerous than smaller tumors.
• Biopsy: Your healthcare provider may perform a fine-needle aspiration if other tests don’t provide enough information about whether a tumor is cancer or an adrenal adenoma. During this procedure, they’ll use a thin hollow needle to remove tissue from the tumor. A lab specialist, called a pathologist, examines the tissue underneath a microscope to check for signs of cancer.

Other tests may include adrenal vein sampling or a metaiodobenzylguanidine (MIBG) scan.

What is the treatment for adrenal adenoma?

Your treatment depends on whether the tumor is nonfunctioning or functioning (secreting excess hormones). If a nonfunctioning tumor is small, your healthcare provider may recommend periodic CT scans to ensure it doesn’t increase in size or become functional. If the tumor grows rapidly or gets bigger (usually nearing 5 centimeters), your healthcare provider may recommend surgery. Large tumors and rapid growth increase the likelihood of a tumor becoming cancerous.

Treatments for functioning tumors almost always involve surgery. Treatments include:

• Adrenalectomy (adrenal gland removal): Your healthcare provider may remove your adrenal gland via laparoscopy if the tumor is benign and small. During a laparoscopy, they make tiny cuts into your abdomen and perform the surgery through the incisions. For a larger tumor or one that may be cancerous, your healthcare provider may perform surgery by making a larger incision in your back. In some instances, your remaining adrenal gland may make enough hormones to keep you healthy. In others, you may need hormone therapy to supplement the lack of hormones.
• Medications: If you’re not a candidate for surgery, your healthcare provider may prescribe medicines that prevent the adenoma from making excessive amounts of hormones. You may also receive medications for several weeks to help stabilize your hormone levels following an adrenalectomy.

What is the long-term prognosis after treatment for adrenal adenoma?

Treatment outcomes associated with adrenalectomy are excellent. Removing the affected adrenal gland often relieves the symptoms related to functional adrenal adenomas.

Can adrenal gland tumors be prevented?

Adrenal gland tumors, including adrenal adenoma, can’t be prevented. The risk factors for adrenal adenoma often depend on your genes. Still, you can develop an adrenal adenoma even if no one in your family has a history of adrenal gland tumors.

How do I take care of myself?

Follow your healthcare provider’s guidance about how often you should be tested if you’ve been diagnosed with a nonfunctioning adrenal adenoma. Depending on your tumor, your healthcare provider may recommend periodic CT scans or hormone testing.

What questions should I ask my doctor?

• What type of adrenal gland tumor do I have?
• Is it benign or cancerous?
• What is the likelihood that my tumor could become cancerous?
• Is it a functioning or nonfunctioning tumor?
• Do I need treatment?
• What treatments would you recommend?
• Will I need hormone therapy as part of my treatment/recovery?

A note from QBan Health Care Services

Don’t be too alarmed if your healthcare provider finds an adrenal gland tumor during an imaging procedure. Most often, these tumors are harmless. If your tumor turns out to be an adrenal adenoma, your healthcare provider can run tests to see if it’s causing an overproduction of hormones. If it is, surgery can help. If your tumor is nonfunctioning, your healthcare provider can monitor it to ensure it doesn’t negatively impact your hormones. If there’s a concern that it could become malignant, your healthcare provider can remove it.

A thyroid nodule is an unusual lump (growth) of cells on your thyroid gland. They’re common, almost always noncancerous (benign) and usually don’t cause symptoms. In rare cases, they’re cancerous.

What are thyroid nodules?

A thyroid nodule is an unusual lump (growth) of cells on your thyroid gland.

Your thyroid gland is a small, butterfly-shaped endocrine gland located in your neck, below your Adam’s apple. It produces the hormones thyroxine (also called T4) and triiodothyronine (also called T3). These hormones play a role in certain bodily functions, including:

• Metabolism.
• Body temperature.
• Mood and excitability.
• Pulse and heart rate.
• Digestion.

Thyroid nodules are classified as:

• Solitary (a single nodule).
• Multiple (more than one nodule).
• Cystic (fluid-filled).
• Solid.

More than 90% of detected nodules in adults are noncancerous (benign), but they may represent thyroid cancer in approximately 4.0% to 6.5% of cases. Even though most thyroid nodules aren’t cancer, they can sometimes be a sign of and/or cause of thyroid disease.

Who do thyroid nodules affect?

Anyone can have a thyroid nodule, including children and adults. However, they’re about four times more common in females than males.

They also occur more often in people who live in countries where food isn’t fortified with iodine. (Iodine is necessary for your thyroid gland to make hormones.)

Other factors that lead to an increased risk of thyroid nodules include:

• History of thyroid radiation.
• Family history of thyroid nodules or thyroid cancer.
• Increasing age.
• Iron-deficiency anemia.
• Smoking.
• Obesity.
• Metabolic syndrome.
• Alcohol consumption.
• Increased levels of insulin-like growth factor-1 (a hormone).
• Uterine fibroids.

How common are thyroid nodules?

Thyroid nodules are common. Healthcare providers detect them in approximately 5% to 7% of adults during a physical examination. Ultrasound imaging reveals that 20% to 76% of adults have thyroid nodules.

Thyroid nodules are less common in children.

When should I worry about thyroid nodules?

In most cases, thyroid nodules aren’t a cause for concern. But even though the vast majority of thyroid nodules are benign, some thyroid nodules do contain thyroid cancer.

For this reason, you should see your healthcare provider so they can evaluate the nodule to be sure it’s benign. As with all cancer, the earlier it can be diagnosed and treated, the better.

What symptoms can thyroid nodules cause?

Most thyroid nodules don’t cause symptoms. However, if you have several nodules or large nodules, you may be able to see them.

In rare cases, nodules can grow big enough to cause symptoms like:

• Trouble with swallowing or breathing.
• Hoarseness or voice changes.
• Pain in the front of your neck.
• Enlargement of your thyroid gland (goiter).

Hyperfunctioning thyroid nodules can lead to overproduction of thyroid hormones, also known as hyperthyroidism. Symptoms of hyperthyroidism include:

• Rapid heartbeat (palpitations).
• Feeling shaky and/or nervous.
• Weight loss.
• Increased appetite.
• Diarrhea and more frequent bowel movements.
• Difficulty sleeping.
• Enlarged thyroid gland (goiter).
• Light or missed menstrual periods.

Thyroid nodules may also be associated with low thyroid hormone levels (hypothyroidism). Symptoms of hypothyroidism include:

• Fatigue.
• Numbness and tingling in your hands.
• Weight gain.
• Dry, coarse skin and hair.
• Constipation.
• Depression.
• Frequent, heavy menstrual periods.

What causes thyroid nodules?

Researchers don’t know why most thyroid nodules form. Nodules can form for various reasons, and there are different types, including:

• Colloid nodules: These are one or more overgrowths of normal thyroid tissue. These growths are not cancer (benign). They may grow large, but they don’t spread beyond your thyroid gland. These are the most common type of thyroid nodules.
• Thyroid cysts: These are growths that are filled with fluid or partly solid and partly filled with fluid. Cystic nodules pose a low risk for cancer (malignancy) and are either monitored or biopsied if they’re larger than 2 centimeters.
• Inflammatory nodules: These nodules develop as a result of long-term (chronic) (inflammation) of your thyroid gland. These growths may or may not cause pain.
• Multinodular goiter: Sometimes an enlarged thyroid (goiter) is made up of many nodules (which are usually benign).
• Hyperfunctioning thyroid nodules: These nodules produce extra thyroid hormone, which may lead to the development of hyperthyroidism. Hyperthyroidism requires treatment.
• Thyroid cancer: Cancer is the biggest concern when thyroid nodules form. Fortunately, thyroid cancer is very rare — it’s found in less than 6.5% of all thyroid nodules.

How are thyroid nodules diagnosed?

Sometimes you can feel or see a thyroid nodule yourself, or your healthcare provider may discover it during a physical exam. Your provider may also discover a nodule with an imaging test done for another reason.

Even though thyroid nodules are almost always noncancerous (benign), the small chance that it could be cancer means that most thyroid nodules need some type of evaluation.

What tests will be done to diagnose and evaluate thyroid nodules?

Your healthcare provider may order any of the following tests to help diagnose and evaluate a thyroid nodule:

• Thyroid blood test: This test checks the levels of thyroid hormone in your blood. The hormone levels are usually normal even if you have nodules, but they can be abnormal in some cases and point to thyroid disease.
• Ultrasound: This is an imaging test that uses sound waves to create pictures of your thyroid gland. It can determine if a nodule is solid or a fluid-filled cyst. (The risk of cancer is higher in solid nodules.) This test also checks on the growth of nodules and helps find nodules that are difficult to feel. In addition, providers sometimes use ultrasound to help guide the placement of the needle during a fine-needle biopsy.
• Fine-needle biopsy: With this test, your provider uses a very thin needle to take a sample of cells from one or more thyroid nodules. They then send the samples to a laboratory for evaluation. Most nodules are noncancerous. However, if the test results are inconclusive, your provider may repeat this test. They may also suggest you have surgery to remove the nodules to make an accurate diagnosis.
• Thyroid uptake scan: In this test, you take a small amount of radioactive iodine orally. Your provider will check to see how much of the radioactive iodine the thyroid nodules absorb and how much is absorbed by normal thyroid tissue. This will provide further information about the thyroid nodules, helping your provider determine the likelihood of cancer.

How are thyroid nodules treated?

Treatment depends on the type of thyroid nodule. Treatment options include:

• No treatment/watch and wait: If the nodules aren’t cancerous, you and your healthcare provider may decide that you don’t need to be treated at this time. You’ll see your provider regularly so they can check for any changes in the nodules.
• Radioactive iodine: Your provider may use radioactive iodine to treat hyperfunctioning thyroid nodules and goiters with several nodules. Your thyroid gland absorbs the radioactive iodine, causing the nodules to shrink.
• Surgery: Surgery to take out the nodules is the best treatment for nodules that are cancerous, cause obstructive symptoms like breathing or swallowing issues and are “suspicious” (they can’t be diagnosed without being surgically removed and examined).

What is the prognosis for thyroid nodules?

The prognosis for noncancerous (benign) thyroid nodules is great. They often don’t need treatment, and only about 1% of benign thyroid nodules cause thyroid disease, which is treatable.

The prognosis for cancerous (malignant) thyroid nodules varies greatly depending on several factors, including:

• The type of cancer.
• Your age at diagnosis.
• The size of the nodule/tumor.
• If it’s spread to nearby tissues, such as lymph nodes.
• If it’s spread (metastasized) to distant parts of your body.

If you have thyroid cancer, your healthcare provider will be able to give you a more accurate prognosis.

Can thyroid nodules be prevented?

Since researchers don’t know what causes the majority of thyroid nodules, you can’t prevent them in most cases.

You can, however, try to decrease your risk of developing them by managing certain risk factors. For example, if you have obesity, talk to your healthcare provider about attaining a healthy weight for you. If you smoke cigarettes, try to quit. It’s also important to make sure you get enough iodine in your diet. If you use iodized table salt, you’re likely consuming enough.

Studies have shown that people who take oral birth control and/or statins may have a reduced risk of developing thyroid nodules.

When should I see my healthcare provider about a thyroid nodule?

If you notice a bump on your thyroid, it’s important to see your healthcare provider. Even though the majority of thyroid nodules are benign and cause no other symptoms, it’s still important to have the nodule evaluated in the small chance that it’s cancer.

If you’ve been diagnosed with a thyroid nodule and are taking the “watch and wait” approach, you’ll need to see your provider regularly so that they can monitor the nodule for any changes.

How do thyroid nodules affect children?

Thyroid nodules are much less common in children than in adults, but researchers aren’t sure of the exact numbers.

There’s an increased risk of thyroid cancer in nodules found in children and adolescents compared to adults. However, over 75% of nodules found in children and adolescents are noncancerous (benign).

The symptoms, diagnosis and treatment of thyroid nodules for children are the same as for adults (as detailed in the above sections).

A note from QBan Health Care Services

Thyroid nodules are very common, and they’re usually not a cause for concern. However, it’s still important to see your healthcare provider if you notice a lump on your thyroid (in the front of your neck). They may run some tests to make sure it’s benign. If you have any questions about your risk of developing thyroid cancer or thyroid disease, talk to your provider. They’re available to help you.