Parathyroid Changes Research Articles

Isolated idiopathic hypoparathyroidism that developed in adulthood: a case report

Hypoparathyroidism is a rare endocrine disease. In most cases in adult patients, the cause of hypoparathyroidism is damage or removal of parathyroid glands during surgical interventions on the neck; other causes are rarely observed.Case report. A 52-year-old man with episodes of seizures, intense muscle pain, progressing for 7 years and resistance to treatment with myorelaxant, anxiolytics and nonsteroidal anti-inflammatory drugs was examined and hypocalcemia associated with low parathyroid hormone and excessive urinary calcium excretion was found. Ultrasound examination didn't reveal any changes in parathyroid glands. The patient was diagnosed with idiopathic hypoparathyroidism. Treatment with calcium supplements and active metabolites of vitamin D led to an improvement in clinical symptoms and laboratory parameters.Discussion. Hypoparathyroidism as part of several genetic syndromes was excluded due to the late- onset of the disease and the absence of concomitant diseases. Ultrasound of the parathyroid glands made it possible to rule out metastasis and storage diseases. It is recommended to perform genetic testing of the chromosomes 22 and 10 to exclude rare variants of syndromic hypoparathyroidism with the late-onset in the form of isolated hypocalcemia.

99mTc-MIBI SPECT/CT SCINTIGRAPHY AND ULTRASOUND OF THE ANTERIOR NECK REGION IN DIAGNOSING PARATHYROID GLAND PATHOLOGY IN PATIENTS WITH THYROID NODULES.

SUMMARYParathyroid scintigraphy with 99mTc-MIBI is an imaging technique used in nuclear medicine and performed in patients with suspected hyperparathyroidism (HPT). The objective of this study was to evaluate the role of this technique in patients who, along with suspected HPT, also have thyroid nodules. Retrospective analysis included a period of 8 years (2006-2013). The study included 91 patients with clinical or laboratory suspected HPT. Pathologic changes in parathyroid glands were demonstrated in 47 (70%) of 67 patients with positive scintigraphy. Pathologic changes in parathyroid glands were not evident in the remaining 20 (30%) patients. Out of nine patients with negative scintigraphy results but with suspected enlargement of the parathyroid gland examined by ultrasound, eight (89%) patients did not show pathologic changes in the parathyroid gland, whereas one (11%) patient had evident changes. Eight (54%) of 15 patients with suspected scintigraphy had positive ultrasound findings, as well as fine needle aspiration cytology (FNAC) findings with parathyroid hormone (PTH) determination in the aspirate. Seven (46%) patients had negative FNAC findings and PTH in the aspirate. The study showed scintigraphy to have high sensitivity (98%) in detecting patients with pathologic changes in the parathyroid glands. In patients with suspected HPT, scintigraphy needs to be combined with FNAC and PTH determination in the aspirate due to its low specificity of 28%.

Benign Parathyroid Gland Tumors and their Heterogeneity

Background: Primary hyperparathyroidism (pHPT) can be caused by different pathologic lesions – benign and malignant. The frequencies of changes vary, mainly because different criteria for diagnosis. It is especially visible in the group of benign lesions, which as it turns out, are not uniform in nature. The aim of the study was to attempt to assess the heterogeneity of benign parathyroid lesions, both adenoma and hyperplasia. Methods: Resected benign lesions from consecutive series of 125 patients treated surgically for pHPT, were studied retrospectively. We were looking for a corelation between DNA ploidy, cell proliferation activity (S phase fraction) and the expression of parafibromin and galectin-3. Results: In 74 (59.2%) of patients the diagnosis according to histopathological evaluation was benign adenoma and in 51 (40.8%) parathyroid hyperplasia. Diploid pathologies were found in 72 (57.6%) cases and aneuploid in 53(42.4%). From 74 adenomas, 39 (55%) were considered diploid and 35 (45%) aneuploid. Positive parafibromin expression was observed in 26 (49%) of aneuploid tumors and in 39 (54%) of diploid. Galectin-3 expression was found in 25 (47%) aneuploid and 30 (41%) diploid. In this changes of parathyroid glands, we did not observe any important differences between ploidy of cells and expression of parafibromin (p=0.16) and galectin (p- 0.39). Weak, but important correlation was observed between parafibromin expression and number of cells in S phase fraction in diploid pathologies (p=0.047). There is important, but weak correlation between galectin-3 expression and amount of cells in S phase fraction in aneuploid pathologies (p=0.05). In diploid pathologies, the correlation was not observed (R=0.02, p=0.83). Conclusions: 1) The nature of the cellular ploidy of benign parathyroid lesions indicates the heterogeneity. 2) A negative reactions with parafibromin and positive reactions with galectin-3 were found among adenomas as well as benign parathyroid hyperplasia. 3) In benign parathyroid lesions the expression of parafibromin and galectin-3 correlate with an increase in the number of S phase fraction cells, diploid and aneuploid, respectively.

Morphological changes of parathyroid glands and thymus of rats after correction of induced immunosupression

The aim of the research was to investigate the features of the electron microscopic structure of rats' parathyroid glands and thymus after correction of cyclophosphamide-induced immunosuppression with imunofan.Material and methods. The study was performed on 24 male rats weighing 180±10 g. The animals of the experimental series were injected cyclophosphamide once intramuscularly at a dosage of 200 mg/kg. Immunocorrection was achieved by administering imunofan once a day at 50 mcg/kg for 1, 3, 5, 7, 9 days. The second group consisted of intact rats. The animals were withdrawn from the experiment on 3rd and 30th day after the drugs administration. We studied the ultrastructure of organs in the rats of the control group and after immunostimulation.Results. It was established that on the 3rd day after correction of induced immunosuppression imunofan parathyroid nuclei characterized by uneven surface due to numerous invaginations of nuclear membranes. In separate cells sporadic pyknosis of nuclei is determined. The number of secretory granules decreases, the amount of glycogen and lipid droplets increases. In the thymus characteristic signs of an accidental involution occur. After 30 days after the administration of immunotropic drugs, the number of active dark parathyrocytes increased. In the nucleoli, the predominance of the granular component over the fibrillar component is revealed. Well-developed organelles of protein synthesis were found in the cytoplasm of cells. In the cortex of the thymus, an increased number of plasma cells is observed, a recovery of the population of both lymphoid cells and microenvironment cells, in particular macrophages, is noted. Conclusions. On the 3rd day after the administration of immunotropic drugs, a decrease in the number of secretory granules, pyknosis of nuclei and multiple invaginations of nuclear membranes are revealed in segregated cells. The use of an immunocorrector leads to the development of organelles of protein synthesis and an increase in the number of secretory granules in the cytoplasm of cells on the 30th day after administration of the drugs. In the cortical zone of the thymus there is an active cells proliferation. The dynamics of changes in the electron microscopic structure of rats' parathyroid glands and thymus indicates a high degree of reactivity of the organs in response to the administration of immunotropic drugs.

The morphological changes in parathyroid glands, caused simulated prolonged influence of heavy metal salts

The main problem today is environmental pollution with heavy metal salts. Biological activity and their ability to accumulate in the environment and the body leads to the disruption of many systems and organs. Parathyroid glands are important regulators of calcium homeostasis, which affects a lot of physiological processes in the body. Therefore, the work is devoted to the study of the morphological and functional characteristics of the parathyroid glands of laboratory rats under conditions of prolonged use of a combination of heavy metal salts. Study of the peculiarities of the structure and functional activity of the glands was carried out on adult male rats (n = 12). The animals were divided into groups: the first — its control, the second — rats, which received a water solution of a mixture of salts of heavy metals. The material was taken on the 90th day of the experiment. Histological preparations were made 5–7 microns thick, stained with hematoxylin and eosin. Study of the linear parameters of the parathyroid glands was carried out on the largest longitudinal section. The area of the glands and cells, the thickness of the capsule and the layer of connective tissue in the parenchyma of the organ were measured. During the laboratory study of the blood of rats, the content of calcium and magnesium was determined, as well as the activity of parathyroid hormone. Conducted statistical treatment of the data. It has been established that with long-term admission of a combination of salts of heavy metals into the organism of rats leads to morphological changes in the parenchyma and stroma of the glands, there are changes in the content of calcium and magnesium in the biochemical parameters of blood, as well as inhibition of parathormone secretion. In the future, it is planned to study the morphofunctional features of the parathyroid glands in the process of readoptation after consuming a combination of heavy metal salts.

Цитофлавин при послеоперационном гипопаратиреозе в эксперименте

Целью исследования было определение эффективности включения в схему коррекции послеоперационного гипопаратиреоза препарата цитофлавин. Исследование проведено на 20 животных (беспородных кроликах). Выявлено, что операции на щитовидной железе у кроликов (модель гипопаратиреоза по методу Лопухина Ю. М.) сопровождаются морфологическими изменениями паращитовидных желез, при этом дистрофически-деструктивные реакции нарастают до 3 сут эксперимента и сохраняются до 7 сут наблюдения. Включение цитофлавина (1 раз в сутки в течение 7 дней внутривенно капельно в дозе 1,5 мг/кг) в фармакотерапию экспериментального гипопаратиреоза у кроликов способствует уменьшению дистрофических проявлений на 3 сут, а к 7 сут отмечались компенсаторно-восстановительные проявления в структурной организации паращитовидных желез.

EXPERIMENTAL JUSTIFICATION FOR THE USE OF ANTIHYPOXANT THERAPY FOR THE PREVENTION AND TREATMENT OF POSTOPERATIVE HYPOPARATHYROIDISM

The purpose of our work was to investigate the morphological and histochemical changes of parathyroid glands (PTG) after thyroidectomy in the experiment and to substantiate the use of antihypoxantantioxidant therapy in the postoperative period. Taking into account the urgency of the problem of postoperative hypoparathyroidism in endocrine surgery, there are many unsolved issues regarding the avoidance of possible development of this complication and methods of correction of postoperative hypocalcemia. The problem of postoperative hypoparathyroidism is an important medical and social aspect. Transient hypoparathyroidism is often accompanied by fluctuations in blood calcium levels, and therefore it requires constant laboratory control and constant correction of therapeutic doses of replacement therapy. Instead, a permanent form of postoperative hypoparathyroidism can lead to disability of the patient, and therefore has an important social significance. Therefore, there is an acute issue of preventing the development of this complication. In this connection, this experimental study was performed. All studies were performed on 20 rabbits. Modeling of hypoparathyroidism was carried out according to Lopukhin Yu.M. (1971). Depending on the post-operative period management, all animals were divided into 2 groups. Group 1 (9 animals) in the postoperative period, for the purpose of analgesia, received 50% solution of Analgin at a dose of 2 ml twice a day. With the aim of detoxification, NaCl 0.9% was administered (through a constant catheter) was injected intravenously – twice at a dose of 100 ml per day. Group 2 (9 animals), in addition to the above-mentioned treatment, received the medicine Cytoflavin at a dose of 1.5 mg/kg 2 times a day intravenously during 7 days. The control group included 2 rabbits, which were removed PTG, and then their morphology was studied normally. Thus, we have found that surgical interventions on the thyroid gland are accompanied by morphological changes in the parathyroid glands, while degenerative-destructive reactions are intensified until the third day of the experiment and their signs stay at the seventh day. The use of Cytoflavin reduces the manifestations of dystrophy during the third day and up to the seventh day there are compensatory-reconstructive manifestations in the structural organization of PTG.

Challenges in differential diagnosis between primary and secondary forms of hyperparathyroidism

Hyperparathyroidism is a disease characterized by excessive secretion of parathyroid hormone (PTH) in the chief cells of parathyroid glands. There are three types of hyperparathyroidism: primary, secondary, and tertiary depending on the cause of this disease. By the secondary hyperparathyroidism calcium-sensing receptors (CaSR) and vitamin D receptors (VDR) lead to disturbance of phosphorus-calcium exchange and to development of a parathyroid glands hyperplasia. Treatment of secondary hyperparathyroidism with vitamin D showed the efficiency not only in normalization of clinical laboratory indicators but also in involution of changes in parathyroid glands. We represent the clinical case of a patient with secondary hyperparathyroidism caused by hypovitaminosis D, parathyroid hyperplasia more than 1 cm. The long-term oral therapy with active vitamin D led to the positive dynamics of PTH levels, as well as complete reduction of parathyroid lesion.

ОПЫТ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ВТОРИЧНОГО ГИПЕРПАРАТИРЕОЗА

Surgical treatment of secondary hyperparathyroidism (HPT) in patients having renal replacement therapy (RRT) is a current problem. The aim of our study was to optimize the treatment of secondary HPT based on the comparative analysis of effectiveness of the surgeries with different extents. We conducted a retrospective analysis of the results of surgical treatment of uremic HPT in 34 patients. 36 surgeries were performed including 34primary (16subtotal parathyroidecomies (PTE), 13total parathyroidecomies (total PTEI), 5total parathyroidecomies with central neck dissection and resection of superior mediastinum and superior thymus horns (total PTEII)) and 2repeated surgeries (total PTEII and parathyroidadenomectomy). Gross examination of 134 surgical specimens revealed dyssynchronous pathological changes in parathyroid glands (PTG), normal PTG structure was found in 2cases. Recurrent HPT was found in 3 cases, persistent HPT – in 9cases, hypoparathyroidism – in 5cases after subtotal PTE and in 9 cases after total PTE with autotransplantation (p=0,267). Target values of parathyroid hormone were registered in 8patients, including 4 patients after subtotal PTE and 4 patients after total PTE (p>0,95). Morbidity was similar in all types of surgeries (p>0,5). Analysis of morbidity determined that simultaneous surgery of thyroid gland increased the risk of laryngeal paralysis (р=0,028). The decrease in occurrence of secondary HPT persistence (with the source accessible for removal through cervical approach) at total PTE based on the removal of parathyroid glands of all localizations accessible through cervical approach (including thyroid gland lobes with diagnosed ectopia, central cervical fat pad, superior mediastinum and superior thymus horns) was registered (NNT=4).

SECONDARY HYPERPARATHYROIDISM AND BROWN TUMOR IN DIALYZED PATIENTS

Secondary hyperparathyroidism is one of the most common complications of chronic renal failure (CRF). Its pathogenesis is multifactorial and still not completely understood. Pathological mechanism of hypocalcemia, hyperphosphatemia and calcitriol deficiency are basic characteristics of CRF and main reason for morphological changes in parathyroid glands and hyperparathyroidism (HP). We present a case of a female patient born in 1975. At the age of 10, a urinary infection was diagnosed for the first time and treated. Six years later, as nausea and vomiting started, CRF based on bilateral reflux was diagnosed and the patient was included in the hemodialysis treatment. The patient was again examined in 1997, when biochemical parameters, including the level of parathyroid hormone, ultrasonography of the neck, scintigraphy of the skeleton and densitometry revealed secondary HP. Parathyreoidectomy was perfomed in 1998. During the follow up period, a tumefaction on a ramus mandibulae dex. was noticed, which was cytologically diagnosed as osteitis fibrosa, “brown tumor”, a rare complication of the secondary HP. Surgery was performed and PHD was granuloma gigantocelulare. Prevention and therapy of secondary HP is a problem that demands early actions to avoid possible complications.

Unusual Changes in Parathyroid Glands in Patients with Chronic Renal Failure1

Unusual Changes in Parathyroid Glands in Patients with Chronic Renal Failure¹

Unusual Changes in Parathyroid Glands in Patients with Chronic Renal Failure

Unusual Changes in Parathyroid Glands in Patients with Chronic Renal Failure

The effect of cimetidine on parathyroid function and histopathology in primary hyperparathyroidism.

Recent evidence suggests that cimetidine given pre-operatively in primary hyperparathyroidism (1 degree HPT) might cause structural changes in parathyroid glands, while its suppressive effects on the disease are disputable. To determine these possible changes we studied 38 patients with 1 degree HPT who underwent parathyroidectomy. In 14 of these (group I) cimetidine was given pre-operatively (1000 mg orally daily for 4 weeks). The remaining 24 patients (group II) did not take any drug. Parathyroid function was estimated by nephrogenous cAMP (NcAMP) and serum immunoreactive parathyroid hormone (iPTH) measurements. Histological examination of the parathyroids was made by conventional techniques. In group I at the end of cimetidine treatment, the only change observed was a small but significant (p less than 0.05) decrease of plasma calcium (-0.77 mg/dl). Histologically, the glands of group I--compared with those of group II--showed the following findings: increased gland mass: mean increase 1050 mg (adenomas) and 700 mg (hyperplasias); central oedema in all the cases of group I only; increased (about 50 per cent) cellular size and intranuclear 'inclusions' in 10 out of 14 cases of group I only. It is concluded that treatment with cimetidine in 1 degree HPT is followed by histopathologic alterations leading to increased size of the diseased parathyroids.

Parathyroid pathology in hyperparathyroidism secondary to chronic renal failure.

Weights and histopathological changes in parathyroid glands were evaluated in relation to clinical and biochemical parameters in 42 patients who underwent parathyroidectomy for hyperparathyroidism (HPT) secondary to chronic renal failure. There was a positive relation (r = 0.71, p less than 0.01) between duration of renal insufficiency and total parathyroid glandular weight. The glandular weight was also closely related to the serum levels of parathyroid hormone (r = 0.67, p less than 0.01). No correlation was found between total parathyroid glandular weight or histopathological findings and clinical symptoms, serum levels of calcium, phosphate, alkaline phosphatases, calcium X phosphorus product or radiological evidence of bone disease. The enlargement of the glands was mostly uniform in the individual patient and all patients showed multiple gland involvement. This indicates that when parathyroid surgery is performed in patients with uraemia and secondary HPT, a radical approach, i.e. total parathyroidectomy with autotransplantation or subtotal parathyroidectomy, should always be used. In smaller glands only diffuse hyperplasia of parenchymal cells was generally found; fat cells were present in near-normal amounts. With increasing glandular weight, fat cells were more sparse and nodularity was common. In general, the proportion of oxyphil cells increased parallel with the total glandular weight, suggesting that this cell type is sensitive to stimulation. As a group, patients undergoing conservative renal treatment had suffered longer with renal disease, had larger parathyroid glands with more nodularity, and had more oxyphil cells than those undergoing parathyroidectomy while on haemodialysis.

Histological changes in parathyroid glands in subclinical and clinical renal disease. An autopsy investigation.

In an autopsy material of patients with varying degrees of renal impairment, the parathyroid glands were examined regarding glandular and parenchymal cell weights and cellular types and arrangement. The findings were related to the different stages of renal disease. The study comprised 69 cases--29 females and 40 males. Their mean age was 74 years (range 33-98 years). There was a positive relation between serum creatinine level and total parathyroid parenchymal cell weight (r=0.37, p less than 0.01) and an inverse correlation between kidney weights and parathyroid parenchymal cell weight (r=-0.24, p less than 0.05). The patients with the most advanced renal impairment had significantly higher mean total glandular and mean total parenchymal weights than those with less pronounced renal disease. Nodular arrangement and an increased number of oxyphil and transitional oxyphil cells were noted in cases with advanced histological kidney changes but normal serum creatinine levels. This nodularity as well as the frequency of oxyphil cells increased in parallel with deterioration of renal function. The two most important factors that influenced the proportion of oxyphil cells were the parenchymal cell weights and the age of the patient. It is concluded that signs of stimulation of the parathyroids are present already in early stages of renal disease, in some cases before renal dysfunction is clinically manifested.