Reappraisal of Parathyroid Pathology in Hyperparathyroidism

Esselstyn, Caldwell B.; Levin, Howard S.; Eversman, John J.; Schumacher, O. Peter; Skillern, Penn G.

doi:10.1016/s0039-6109(16)40290-2

Cited by 39 publications

(8 citation statements)

References 6 publications

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“…Traditionally, routine bilateral neck exploration has been advised in patients with HPT because of the uncertainty of the site of the tumor in patients with a single adenoma and also because of the possibility of multiple gland disease being present. Despite some earlier views to the contrary [7,8], it is now quite clear that the vast majority of patients with HPT, perhaps 80-90%, have a solitary adenoma as the underlying cause [1][2][3][4][5]. If the site of this single tumor can be localized preoperatively, there seems little justification for routine exploration of the contralateral side of the neck in this large subgroup of patients.…”

Section: Discussionmentioning

confidence: 99%

Scan‐directed unilateral cervical exploration for parathyroid adenoma: A legitimate approach?

1990

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Thallium-Technetium isotope subtraction scanning was used routinely as a preoperative localization investigation in 90 patients with primary hyperparathyroidism who were submitted to "first-time" cervical exploration from 1985 to 1988. When the scintigram demonstrated a single focus of activity suggesting the site of a solitary parathyroid adenoma, a scan-directed exploration was carried out. If the tumor was found at the location suggested by the scan, it was then removed and the ipsilateral normal parathyroid was biopsied. The contralateral side of the neck was not explored in these patients. A total of 48 patients underwent unilateral cervical exploration while the remaining 42 individuals had a standard bilateral neck operation performed. The difference in operating times for patients who had a solitary adenoma and who underwent unilateral and bilateral neck exploration, respectively, was statistically highly significant (71 minutes versus 97 minutes, p less than 0.001). At mean follow-up of 16.8 months, no patient who had a unilateral neck exploration performed for solitary parathyroid adenoma demonstrated persistent or recurrent hypercalcemia.

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Section: Discussionmentioning

confidence: 99%

Scan‐directed unilateral cervical exploration for parathyroid adenoma: A legitimate approach?

1990

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“…Likewise in primary chief cell hyperplasia, one of the main difficulties may be the distinction between normal glands and glands which are hyperplastic but of normal or near normal size (Block, et al, 1967;Castleman, Schantz and Roth, 1976). It is presumably this difficulty which among others had resulted in recent reports (Straus and Paloyan, 1969;Esselstyn, et al, 1974;Haff and Armstrong, 1974) of an increasing incidence of hyperplasia, which in turn has led some workers (Paloyan and Lawrence, 1976) to advocate subtotal parathyroidectomy in all cases of primary hyperparathyroidism. This apparent increase of hyperplasia has not been seen in our own hospital nor in some other centres (Castleman, et al, 1976).…”

Section: Discussionmentioning

confidence: 99%

The normal parathyroid gland at autopsy: The significance of stromal fat in adult patients

Dekker

Dunsford

Geyer

1979

The Journal of Pathology

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Traditionally half of the cell population of the adult parathyroid gland is considered to be stromal fat. A marked decrease of stromal fat has been observed at autopsy of adult patients, the functional significance of which is unknown. In order to investigate this phenomenon, the stromal and parenchymal fat of the parathyroid glands of 33 adult patients who died with no known hormonal abnormalities were evaluated. Stromal fat was much less than 50 per cent, i.e., less than 10 per cent., in the majority of cases, while parenchymal fat was ample in all cases. This finding, especially if compared to cases with hyperparathyroidism, indicates the lack of functional specificity of change in stromal fat, whereas, alteration in parenchymal fat appears to be a better anatomical register of normal or abnormal parathyroid function.

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“…The clinical setting, particularly the family history, may be crucial to the correct diagnosis, as may the observations of the experienced surgeon. The problem of the "tissue diagnosis" is reviewed else where (6,(23)(24)(25). We find that the operational terms "single-gland involvement" and "multiple-gland involvement" as used by Paloyan & Lawrence (23) are quite useful.…”

Section: Selection Of Patients For Surgerymentioning

confidence: 98%

“…Although it is not clear why generalized hyperplasia should occur as a primary abnormality, in many series the diagnosis of primary hyperplasia has been made in approximately 10-20% of cases (4,5). Interestingly, in a recent study biopsies were taken from every parathyroid gland identifi ed, and microscopic evidence of hyperplasia was found in about one half of cases (6). The states in which parathyroid hyperfunction occurs in response to hypocal cemic influences are termed secondary hyperparathyroidism.…”

Section: Pathophysiologymentioning

confidence: 99%

Diagnosis of Hyperparathyroidism

Bone¹,

Snyder²,

Pak³

1977

Annu. Rev. Med.

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States of hypersecretion of PTH may occur primarily, or in response to other physiologic abnormalities. Primary hyperparathyroidism must be considered in the differential diagnosis of hypercalcemia, nephrolithiasis, metabolic bone disease, and pancreatitis and peptic-ulcer disease. The clinical manifestations of this disease have become more subtle with improved detection. The serum calcium level is almost always elevated, and when it it accompanied by relatively high serum PTH levels or increased urinary cAMP excretion, the diagnosis is usually secure. Findings of hypophosphatemia, decreased renal tubular reabsorption of phosphorus, hypercalciuria, and characteristic roentgenographic changes support the diagnosis of hyperparathyroidism, but are not prerequisites for that diagnosis. Most cases will come to operation, and experienced intraoperative assessment is necessary for the correct distinction between multiglandular disease and that involving only a single gland. We expect that a clearer understanding of the histopathologic features of these diseases, and improvement in the methods for measurement of PTH will be the main areas of advancement in the diagnosis of hyperparathyroidism in the next few years.

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Reappraisal of Parathyroid Pathology in Hyperparathyroidism

Cited by 39 publications

References 6 publications

Scan‐directed unilateral cervical exploration for parathyroid adenoma: A legitimate approach?

Scan‐directed unilateral cervical exploration for parathyroid adenoma: A legitimate approach?

The normal parathyroid gland at autopsy: The significance of stromal fat in adult patients

Diagnosis of Hyperparathyroidism

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