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Abstract
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.
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Article info
Publication history
Accepted:
March 30,
1992
Footnotes
☆Supported by the Swedish Medical Research Council.
Identification
Copyright
© 1993 Published by Elsevier Inc.
