Single and multigland disease in primary hyperparathyroidism: Clinical follow‐up, histopathology, and flow cytometric DNA analysis

Abstract

Two-hundred seventy-four patients with primary hyperparathyroidism had selective removal of enlarged parathyroid glands. Biopsies were taken from all parathyroid glands. Normal-size glands were not resected irrespective of their histological appearance. After a mean follow-up of 13.5 years the rates of persistent and recurrent hyperparathyroidism Were, respectively, 3.6% and 0.7%. Transient and permanent hypoparathyroidism occurred in 24% and 2.5% of the patients. The microscopic appearance of enlarged glands and of biopsies taken from normal-size glands were reviewed by two pathologists. Normal parathyroid glands Were distinguished from abnormal glands fairly accurately (sensitivity 93%, specificity 80%). Microscopic classification of abnormal parathyroid glands as adenomas or hyperplastic glands correlated poorly with the gross classification as single or multigland disease. Flow cytometric DNA analysis of paraffin embedded parathyroid tissue showed significant differences for DNA index, % S-phase and % G2M (.0 < 0.001). bifferentiatlng single from multigland disease by means of DNA analysis was not possible. In conclusion, removal of only enlarged parathyroid glands results in acceptable rates of persistent and recurrent hyperparathyroidism. Biopsies should only be taken sparingly to prevent transient and permanent hypoparathyroidism. Microscopic examination and flow eytometric DNA analysis can differentiate normal from abnormal parathyroid glands ~ but are unable to differentiate abnormal glands into single or multigland disease.

25-hydroxy vitamin D deficiency causes parathyroid incidentalomas

“…Since then the same recommendation has been made in endocrine surgery texts based on this paper [2]. Although this group did not report any permanent hypoparathyroid hypocalcaemia, others have reported that this occurs more often when healthy parathyroid glands are biopsied/resected [3,4]. Carnaille et al have reported that the normal size of a parathyroid gland is 6× 4×2 mm [1].…”

The role of hyperplasia in multiple parathyroid adenomas

“…Initially, flow cytometry was used, which was able to distinguish between normal and abnormal glands and not the different pathologic conditions. 24 This was followed by the use of immunohistochemical markers such as those for chromogranin and PTH, 25 which actually helped give credence to the concept of monoclonality of adenoma. Clonal analysis has confirmed that parathyroid adenomas are monoclonal.…”

Use of a Rapid Intraoperative Parathyroid Hormone Assay in the Surgical Management of Parathyroid Disease

“…[1][2][3] Others argue in favor of bilateral cervical exploration in all patients with primary hyperparathyroidism in order to avoid missing multiple adenomas or unrecognized hyperplasia. [4][5][6] The recent development of a rapid parathyroid hormone (PTH) immunoradiometric assay now allows intraoperative determination of serum PTH levels and thus may be used to confirm resection of all hyperfunctioning parathyroid tissue.…”