The results of conventional surgery for lithium-associated HPT are poor. The surgical approach should be adjusted for the multiglandular disease that is usually the cause of HPT in patients on chronic lithium therapy.

adrenal lesions are under-reported in clinical practice. Prevalence figures for adrenal incidentalomas should therefore be interpreted with caution, especially in multi-center settings.

The blood supply of 53 normal human parathyroid glands was studied with laser Doppler flowmetry in 45 patients undergoing operations on the thyroid and parathyroid glands. The inferior and superior thyroid arteries and other vessels that might supply the parathyroid glands were occluded so their contribution to parathyroid perfusion could be studied. Occlusion of the main trunk of the inferior thyroid artery resulted in a reduction of blood flow by one-third, and a similar reduction was obtained after occlusion of the superior thyroid artery. The results demonstrate that the blood supply to the parathyroid glands is not as dependent on the inferior thyroid artery as has previously been suggested but that other routes of blood supply may be equally or, in some cases, even more important.

The revascularisation process of transplanted human normal, hyperplastic and adenomatous parathyroid tissue was analysed at 2 and 4 days and 1, 2, 4, 7 and 12 weeks after transplantation to athymic mice. The transplants were examined by light and electron microscopy, immunohistochemistry and autoradiography. Vessels were detected by monoclonal antibodies specific for mouse and human endothelial cells. Immunohistochemistry demonstrated ingrowth of vessels from the host into the transplant and at one week numerous capillary sprouts were observed in the peripheral parts of the transplants. During the first week, peak levels of proliferation (labelling index) were observed in endothelial cells and capsular fibroblasts, and the proliferative capacity of endothelial cells was most pronounced in adenoma transplants. Fenestrated capillaries were observed in hyperplastic and adenomatous transplants, but not in transplants of normal tissue. In conclusion, revascularisation of transplanted human parathyroid tissue is enabled by ingrowth of vessels from the host into the transplant. The proliferative capacity of endothelial cells is higher and the process of maturation is faster in hyperplastic and adenomatous tissue compared to normal tissue.