Inflammatory diseases of the parathyroid gland

Abstract

Talat N, Diaz‐Cano S & Schulte K‐M (2011) Histopathology59, 897–908 Inflammatory diseases of the parathyroid gland Aims: Inflammatory disorders of the parathyroid gland are very rare as compared with those of other endocrine organs. The aim of this study was to provide the first systematic review of this condition. Methods and results: A 42‐year‐old patient underwent surgery for recurrent secondary hyperparathyroidism. Histology showed hyperplastic parathyroiditis defined by a mixed inflammatory infiltrate with active germinal centres. Molecular markers revealed significant upregulation of CD68 in an ischaemic background (hypoxia‐inducible factor 1 upregulation) with mitochondrial reaction (malate dehydrogenase 2 upregulation) and hyperparathyroidism (carbonic anhydrase 4 upregulation). Our case demonstrates true intraparathyroid inflammation with terminal B‐cell differentiation. We searched PubMed, ISI Thompson and Google Scholar up to January 2011, using the terms ‘parathyroiditis’, ‘inflammation of parathyroid gland’, ‘lymphocytic infiltrate’, ‘tuberculosis of the parathyroid’, ‘sarcoidosis’, and ‘graulomatous inflammation’. Three autopsy series, 27 articles and 96 case reports with inflammatory parathyroid disorders were identified. Autopsy series showed lymphocytic infiltrates in up to 16% of all cases. The entire material reported lymphocytic infiltrates (n = 69), parathyroiditis with germinal centres (n = 15), sarcoidosis (n = 6), tuberculosis (n = 4), and other granulomatous diseases (n = 2). Conclusions: Distinct inflammatory and granulomatous processes in the parathyroid gland are rare. Scanty lymphocytic infiltrates are common, and occur in generalized inflammatory conditions or venous congestion. We note the surprising absence of an association between histological proof of parathyroiditis and hypoparathyroidism.

Coexisiting adenoma and granuloma involving the right inferior parathyroid gland with adjacent ectopic thymic tissue

“…Talat et al analysed 11 cases of granulomatous inflammation involving the parathyroid gland reported by others, which included six cases of sarcoidosis, three cases of tuberculosis involving the parathyroid gland and two cases of idiopathic granulomatous inflammation of the parathyroid. Nine out of these 11 cases had coexisting parathyroid adenoma 2. Our case was similar to the two cases of idiopathic granulomatous inflammation which had coexisting parathyroid adenoma.…”

“…This may be due to poor antigenicity of the parathyroid gland or some mechanism protecting against the processes that initiate autoimmunity 2. Talat et al analysed 11 cases of granulomatous inflammation involving the parathyroid gland reported by others, which included six cases of sarcoidosis, three cases of tuberculosis involving the parathyroid gland and two cases of idiopathic granulomatous inflammation of the parathyroid.…”

Parathyroid Adenoma with Prominent Lymphocytic Infiltrate

“…Our case seems to best fit the description for the specific pattern that reads “ the pattern of lymphocytic parathyroiditis is characterized by interstitial lymphocytes away from the vessels with terminal differentiation ( plasma cells ) and/or formation of germinal centres ,” in contrast to the nonspecific pattern “ marked by diffuse lymphocytic infiltrates in the direct vicinity of venules without evidence of lymphocyte maturation or immune-mediated tissue damage ” [4]. …”

“…The term parathyroiditis has been used inconsistently and has neither an agreed classification scheme nor a steady clinical association. It seems that the histological evidence of inflammation within the parathyroids has never been shown to be the definitive pendant of autoimmune hypoparathyroidism or any other parathyroid dysfunction for that matter [4]. As opposed to lymphocytic infiltrations of the parathyroid combined with underlying systemic diseases, such as septicaemia and myocardial infarction, that are not that uncommon as shown by autopsy studies, genuine parathyroiditis as a primary, organ-specific immune process is a rare condition.…”

Glucocorticoid-responsive lymphocytic parathyroiditis and hypocalciuric hypercalcemia due to autoantibodies against the calcium-sensing receptor: a case report and literature review

“…Autoimmune lymphocytic parathyroiditis is a rare cause of parathyroid hormone (PTH)-dependent hypercalcemia (1,2). Non-specific lymphocytic infiltrates in the parathyroid glands are found in 6% of nearly 1000 autopsy cases, whereas true lymphocytic parathyroiditis, defined by more stringent criteria of interstitial lymphocytic infiltrates with plasma cells or germinal centers with or without tissue damage, is found in no more than 0.5% of autopsies of apparently healthy individuals (3). The mechanism underlying autoimmune lymphocytic parathyroiditis is unclear.…”