This paper is only available as a PDF. To read, Please Download here.
Background. Operation on rare patients with mainly a severe renal stone disease and considerably elevated urinary calcium excretion has substantiated the association of parathyroid gland abnormalities with normocalcemia. This study examines incidence, structure, and functional characteristics of enlarged parathyroid glands of patients with normocalcemia scheduled for thyroid surgery.
Methods. Eleven enlarged parathyroid glands weighing 110 to 1000 mg were discovered in 9 (1.5%) of 594 patients with normocalcemia undergoing thyroid operation. The preoperative total serum calcium concentration was 2.30 to 2.52 mmol/L and less than 2.38 mmol/L in four of the nine patients. Intact serum parathyroid hormone and alkaline phosphatase levels were elevated in only one individual, and all patients showed normal serum creatinine values.
Results. All but three of the 11 enlarged parathyroid glands exhibited microscopic abnormality on routine histopathologic examination, including staining for cytoplasmic fat with oil red 0. Immunohistochemical staining with a monoclonal antibody recognizing the functionally important calcium receptor of the parathyroid cell surface and analysis of the calcium-regulated cytoplasmic Ca2+ concentration of dispersed parathyroid cells substantiated that only a single gland of 130 mg had no discernible functional abnormality.
Conclusions. The findings underline the diagnostic difficulties of parathyroid histopathology and support the presence of disturbed parathyroid hormone secretion even in normocalcemic patients with enlarged parathyroid glands. The functional derangement of these glands substantiates the indication for their surgical excision even in patients exhibiting midnormal serum calcium concentrations, although their possible contribution to the development of a clinically overt hyperparathyroidism can only be speculated.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Activation of Ca2+ influx into parathyroid cells by external cation binding.in: 2nd ed. Calcium regulation and bone metabolism: basic and clinical aspects. vol 9. Elsevier Science, Amsterdam1987: 33-38
- Monoclonal anti-parathyroid antibodies revealing defect expression of a calcium receptor mechanism in hyperparathyroidism.World J Surg. 1988; 12: 552-558
- Defective regulation of the cytosolic Ca2+ activity in parathyroid cells from patients with hyperparathyroidism.Biosci Rep. 1984; 4: 909-915
- The parathyroid glands.in: Kovaks K Asa SL Functional endocrine pathology. Blackwell Scientific, Oxford1991: 375-395
- Clinical effects of parathyroid surgery in normocalcaemic patients with recurrent renal stones.Acta Chir Scand. 1980; 146: 161-169
- Clinical characteristics and surgical treatment of sporadic primary hyperparathyroidism with emphasis on chief cell hyperplasia.Surgery. 1990; 107: 13-19
- Disturbance of basal and stimulated serum levels of intact parathyroid hormone in primary hyperparathyroidism.Surgery. 1991; 110: 47-53
- Primary hyperparathyroidism: epidemiology, diagnosis and clinical picture.World J Surg. 1992; 15: 681-687
- Parathyroid adenomas and glands in normocalcemic hyperparathyroidism.Am J Pathol. 1976; 83: 475-484
- Normocalcemic hyperparathyroidism, kidney stones, and idiopathic hypercalciuria.Surgery. 1975; 77: 691-696
- Long-term effects of surgery for normocalcaemic hyperparathyroidism.Acta Chir Scand. 1987; 153: 331-336
- Peroperative fat staining of frozen sections in primary hyperparathyroidism.Am J Pathol. 1979; 95: 663-741
- Parathyroid histology and cytology with monoclonal antibodies recognizing a calcium sensor of parathyroid cells.Am J Pathol. 1989; 135: 321-328
- Monoclonal antiparathyroid antibodies interfering with a Ca2+-sensor of human parathyroid cells.Biochem Biophys Res Commun. 1987; 143: 570-574
- 500-kilodalton calcium sensor regulating cytoplasmic Ca2+ in cytotrophoblast cells of human placenta.J Biol Chem. 1990; 265: 8275-8279
- Modulation of the Ca2+-sensing function of parathyroid cells in vitro and in hyperparathyroidism.Biochim Biophys Acta. 1988; 968: 253-260
- Alteration in density, morphology and parathyroid hormone release of dispersed parathyroid cells from patients with hyperparathyroidism.Acta Pathol Microbiol Immunol Scand. 1986; 94: 253-261
- A new chamber for tissue culture.in: 2nd ed. Proc Soc Exp Biol Med. 100. 1959: 125-127
- Cytoplasmic Ca2+ concentration of single normal human and bovine parathyroid cells measured by dual wavelength microfluorometry.Biosci Rep. 1987; 7: 705-712
- Prevalence of hypercalcaemia in a health screening in Stockholm.Acta Med Scand. 1976; 200: 131-137
- Primary hyperparathyroidism: incidence, morbidity and potential economic impact in a community.N Engl J Med. 1980; 302: 189-193
- Prevalence of hypercalcaemia in a health survey: a fourteen-year follow-up study of serum calcium values.Eur J Clin Invest. 1988; 18: 39-46
- Histologic parathyroid abnormalities in an autopsy series.Hum Pathol. 1986; 17: 520-527
- Optimal screening for patients with hyperparathyroidism with use of serum calcium observations: a decision-theoretical analysis.Scand J Clin Lab Invest. 1983; 43: 699-707
- Tumors of the parathyroid glands.in: 2nd ed. Atlas of tumor pathology. Armed Forces Institute of Pathology, Washington, DC1978: 1-94
- Regulation of parathyroid hormone release and cytosolic Ca2+ by extracellular calcium in dispersed and cultured bovine and pathological human parathyroid cells.J Clin Invest. 1985; 75: 49-57
- Relationship between external and cytoplasmic calcium concentrations, parathyroid hormone release and weight of parathyroid glands in human hyperparathyroidism.J Endocrinol. 1988; 116: 457-464
- Monoclonal antibodies with exclusive reactivity against parathyroid cells and tubule cells of the kidney.in: 2nd ed. Proc Natl Acad Sci USA. 84. 1987: 2990-2994
- Sarcoidosis, hypercalcemia and hyperparathyroidism.Scand J Respir Dis. 1972; 53: 259-264
- Hyperparathyroidism after treatment with radioactive iodine: not only a coincidence?.Surgery. 1989; 106: 1025-1027
- Hyperparathyroidism subsequent to neck irradiation: risk factors.Cancer. 1985; 56: 1529-1533
- Calcium homeostasis: hypercalcemia and hypocalcemia.in: Martin Dunitz, London1989: 1-248
- Calcium metabolism in the rat: a temporal self-organized model.Am J Physiol. 1988; 254: 134-149
- Reversible resistance to the renal action of parathyroid hormone in man.Clin Sci Mol Med. 1976; 51: 59-69
- The renal sensitivity for endogenous parathormone in patients with primary hyperparathyroidism, vitamin D deficiency and renal stones.Horm Metab Res. 1986; 18: 485-489
Accepted: March 30, 1992
☆Supported by the Swedish Medical Research Council.
© 1993 Published by Elsevier Inc.