Secretory disturbance in hyperplastic parathyroid nodules of uremic hyperparathyroidism: Implication for parathyroid autotransplantation

Wallfelt, Chris; Larsson, Rolf; Gylfe, Erik; Ljunghall, Sverker; Rastad, Jonas; Åkerström, Göran

doi:10.1007/bf01655411

Cited by 70 publications

(72 citation statements)

References 30 publications

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“…In addition to the increases in the mass of parathyroid tissue, another important mechanism responsible for 2HPT in uremia is probably the shift in the set-point for calcium-regulated PTH secretion. It has been reported that the control of PTH release by calcium is abnormal in parathyroid cells obtained from nodules (34). A similar abnormality was indicated in nodules with numerous oxyphil and transitional oxyphil cells in hyperplastic parathyroid due to uremia (35).…”

Section: Discussionmentioning

confidence: 58%

Decreased 1,25-dihydroxyvitamin D3 receptor density is associated with a more severe form of parathyroid hyperplasia in chronic uremic patients.

Fukuda¹,

Tanaka²,

Tominaga³

et al. 1993

J. Clin. Invest.

564

264

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The resistance of parathyroid cells to 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in uremic hyperparathyroidism is thought to be caused, in part, by a 1,25(OH)2D3 receptor (VDR) deficiency in the parathyroids. However, results of biochemical studies addressing VDR numbers in the parathyroids are controversial. Several studies have found VDR content to be decreased in the parathyroids of uremic patients and animals, while others have found no such decrease in the parathyroids of uremic animals.To clarify the role of VDR, we investigated VDR distribution in surgically-excised parathyroids obtained from chronic dialysis patients by immunohistochemistry. We classified the parathyroids as exhibiting nodular or diffuse hyperplasia. Our studies demonstrated a lower density of VDR in the parathyroids showing nodular hyperplasia than in those showing diffuse hyperplasia. Even in the parathyroids showing diffuse hyperplasia, nodule-forming areas were present; these areas were virtually negative for VDR staining. A significant negative correlation was found between VDR density and the weight of the parathyroids. These findings indicate that the conflicting results of biochemical studies may be caused by the heterogeneous distribution of VDR; the decreased VDR density in parathyroids may contribute to the progression of secondary hyperparathyroidism and to the proliferation of parathyroid cells that is seen in uremia. (J. Clin.

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Section: Discussionmentioning

confidence: 58%

Decreased 1,25-dihydroxyvitamin D3 receptor density is associated with a more severe form of parathyroid hyperplasia in chronic uremic patients.

Fukuda¹,

Tanaka²,

Tominaga³

et al. 1993

J. Clin. Invest.

564

264

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“…Through pathological evaluations, we also identify glands with diffuse hyperplasia, which we prefer for autotransplantation or to be left in the neck. It has been reported that patients with parathyroid nodular hyperplasia have higher rates of recurrence than those with diffuse hyperplasia after subtotal PTX or total PTX+AT (15). The cost of frozen section analysis is almost equal to that of IOPTH testing at our hospital.…”

Section: Discussionmentioning

confidence: 81%

“…In the preoperative course, identifying the localization of hyperplasic glands with 99m Tec sestamibi and ultrasonography may be insufficient (12)(13)(14)(15). The presence of aberrant localization or an ectopic gland observed through scintigraphy may affect the success of the exploration (16).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Sakman¹,

Parsak²,

Balal³

et al. 2014

Balkan Med J

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Secondary hyperparathyroidism (sHPT) is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events (1). Parathyroidectomy (PTX) is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years (2, 3).When medical treatment fails, subtotal parathyroidectomy (subtotal PTX) with a cervical remnant and total parathyroidectomy with autotransplantation (total PTX+AT) are the standard procedures, although both are associated with high recurrence rates (4-7). A considerable quantity of functioning parathyroid tissue is left after each of these operations in order to prevent possible hypoparathyroidism and the need for longBackground: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims: The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study. Methods: Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two subgroups of total parathyroidectomy with autotransplantation or subtotal parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathyroid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters. Results: The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroidectomy with autotransplantation group (p=0.016). No serious postoperative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subtotal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplantation pre-operative bone symptoms, hypercalcemia, hyperphosphatemia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease. Conclusion: Total parathroidectomy with auto...

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“…Many studies have been conducted on PTH synthesis by parathyroid cells by evaluating the expression of PTH mRNA, and secretion by both in vivo study with dogs or rats and in vitro study of cell cultures [9][10][11][12][13][14][15][16][17][18][19] …”

Section: Discussionmentioning

confidence: 99%

Heterotransplantation of Human Parathyroid Glands into Nude Mice.

et al. 1995

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Abstract.Heterotransplantation of human parathyroid tissues into nude mice was performed to investigate the characteristics of grafted tissues. Grafts prepared from hyperplasia, adenoma and normal glands which were resected at operation were implanted in the gluteus muscle of the recipient mice (female, KSNnu/nu strain). Graft function was evaluated by measuring human intact PTH concentrations in sera of the mice. Serum PTH concentrations 12 weeks after transplantation were correlated with the tissue volume in the mice which received one, two, four or eight pieces of 1 mm3 hyperplastic tissues. Changes in graft function were examined in the mice which received four grafts prepared from hyperplasia, adenoma or normal glands. Transplantation of parathyroid tissues resulted in an increase in PTH concentrations for 4 weeks, reaching a plateau thereafter. The level remained unchanged for 8 weeks. Serum PTH levels in the mice with grafts prepared from hyperplasia or adenoma were significantly higher than in those with grafts from normal glands, though without a significant difference between the mice with grafts from adenoma and from hyperplasia.Serum calcium levels were similar in all three groups.We also observed the response of grafted parathyroid tissue to a low calcium level in sera: there was higher PTH secretion four weeks after the administration of the low calcium diet. The success of heterotransplantation was histologically proven by the presence of grafts which were not atrophic in the muscle 12 weeks after transplantation.Nucleoli were found more frequently, and nuclear pleomorphism was observed in the cells of heterograf ts.

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Secretory disturbance in hyperplastic parathyroid nodules of uremic hyperparathyroidism: Implication for parathyroid autotransplantation

Cited by 70 publications

References 30 publications

Decreased 1,25-dihydroxyvitamin D3 receptor density is associated with a more severe form of parathyroid hyperplasia in chronic uremic patients.

Decreased 1,25-dihydroxyvitamin D3 receptor density is associated with a more severe form of parathyroid hyperplasia in chronic uremic patients.

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Heterotransplantation of Human Parathyroid Glands into Nude Mice.

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