Normocalcemic primary hyperparathyroidism in patients with recurrent kidney stones: pathological analysis of parathyroid glands

Abstract

The lack of overt elevation of serum calcium concentration in some patients suffering from primary hyperparathyroidism is an intriguing clinical phenomenon. Previous studies have substantiated abnormal parathyroid tissue in these patients, but the extent and mode of derangements remained largely undefined. The parathyroid tissues from patients of normocalcemic primary hyperparathyroidism (NCPHPT) and those having normal parathyroid glands, hypercalcemic primary hyperplasia, secondary hyperplasia, and adenoma were compared by undertaking quantitative immunohistochemistry analysis on tissue microarray. The statistic results suggested that the parathyroid tissue of NCPHPT approximates more to normal gland than to its counterpart in other groups of parathyroid proliferative diseases in terms of the lack of significant alterations of calcium-sensing receptor (CaSR), chromogranin A (CGA), parathyroid hormone (PTH), and proliferation index (Ki67). On the other hand, the depressed vitamin D receptor (VitDR) and elevated cyclin D1 (CyD1) of NCPHPT indicated the inherent functional abnormalities in parathyroid cells. Our results imply that inherent functional disengagement may exist between CaSR and CyD1 or between CaSR and VitDR or both in parathyroid cells of symptomatic NCPHPT. Lack of enhanced release of CGA and PTH and discordance between proliferative activity and CyD1 expression in parathyroid cells may further hinder the development of hypercalcemia.

Normocalcemic and Normohormonal Primary Hyperparathyroidism: Laboratory Values and End‐Organ Effects

“…Abstracts of the remaining 194 studies were assessed for eligibility, and 60 nonrelevant articles were excluded. Full‐text articles were then assessed, and 82 articles were excluded 7–59 …”

Normokalsemik Hiperparatiroidizm: Primer hiperparatiroidizmin yeni bir klinik tipi

“…Ayrıca ameliyat edilen nkHPT'li grupta adenom oranları hiperkalsemik pHPT'li grup ile benzer (sırası ile %92, %100) olmasına rağmen patolojik bez ağırlığı hiperkalsemik gruba göre daha düşük bulunmuştur. Başka bir çalışmada nkHPT'li hastaların paratiroid dokusunda kalsiyuma duyarlı reseptör (CaSR) ekspresyonunda değişiklik saptanmamıştır (23). nkHPT'li hastalarda kalsiyum yüklemesi ile parathormonda yetersiz baskılama saptanmıştır (5).…”

Primary and Secondary Hyperparathyroidism Testing and Assays

“…Up to 20% of patients with pHPT may have a normal Ca t concentration, usually at or near the upper limit of the normal Ca t range. These patients have been more readily identifi ed among renal stone patients with hypercalciuria [4][5][6][7] and among osteoporotic females [ 8 ] . Their Ca t may always remain normal or fl uctuate between high normal and slightly elevated values [ 9 ] .…”