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The American Journal of Pathology Nov 1986The authors studied the parathyroid glands from 100 previously healthy subjects who died suddenly and were admitted to the Dade County Medical Examiner's (ME) morgue and...
The authors studied the parathyroid glands from 100 previously healthy subjects who died suddenly and were admitted to the Dade County Medical Examiner's (ME) morgue and from 66 inpatients who died at Jackson Memorial Hospital (JMH). Parathyroid glands in patients with diseases (JMH series) were heavier than those in healthy persons (ME series), and both groups of glands were significantly heavier than those previously reported. Mean glandular weight in white subjects was 42.6 +/- 20.3 mg, with a range of 22-103 mg. The 95% upper limit of gland weight for healthy white subjects was 73.1 mg and for black subjects, 91.6 mg. The size and weight exhibited a skewed distribution. Gland weight varied with age, increasing to a maximum in the 41-60 year old age group in all subsets except white women, in whom it continued to increase till after age 70. There was slight correlation (r2 = 0.15) of gland weight with body weight within series and race groups; parenchymal content of the glands was not constant but correlated positively with glandular weight. Glands from both series had a comparable fat content. Fat was unevenly distributed throughout the gland, and its amount was highly variable, ranging between 0 and 90%, with a mean of 26% for white subjects and 24% for black subjects in both series. Therefore, percentage fat may not be used as an index of hyperplasia. Healthy back subjects had heavier glands than healthy white subjects, unaccounted for by differences in body weights; this difference was not statistically significant in subjects with disease. Within the black race, glands were not significantly heavier in disease than in health, and in the few cases with serum calcium determinations, the gland weight did not vary inversely with serum calcium levels as in white subjects, suggesting a basic difference in parathyroid calcium metabolism between the two races.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Autopsy; Black People; Body Weight; Child; Female; Humans; Male; Middle Aged; Organ Size; Parathyroid Glands; Sex Factors; White People
PubMed: 3789088
DOI: No ID Found -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Nov 2007To explore the diagnosis and treatment of the ectopic parathyroid gland in the pyriform sinus. (Review)
Review
OBJECTIVE
To explore the diagnosis and treatment of the ectopic parathyroid gland in the pyriform sinus.
METHOD
Retrospectively analysis of 1 case with ectopic parathyroid gland in the pyriform sinus and retrospectively review the past literatures.
RESULT
The cases with the ectopic parathyroid gland in the pyriform sinus reported in the past literatures included: 2 with parathyroid gland tissues, 3 with hyperplasia, the other 1 with adenoma. The case reported by us was with adenoma.
CONCLUSION
The ectopic parathyroid gland hyperplasia in the pyriform sinus is rarely reported before and it usually causes misdiagnosis. Better knowledge of the different position of the ectopic parathyroid gland hyperplasia in the pyriform sinus will help diagnosing and treating it.
Topics: Choristoma; Female; Humans; Hyperplasia; Middle Aged; Parathyroid Diseases; Parathyroid Glands; Pyriform Sinus
PubMed: 18309653
DOI: No ID Found -
Acta Clinica Croatica Feb 2022Parathyroid scintigraphy with Tc-MIBI is an imaging technique used in nuclear medicine and performed in patients with suspected hyperparathyroidism (HPT). The objective...
Parathyroid scintigraphy with Tc-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%.
Topics: Humans; Parathyroid Glands; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Sestamibi; Thyroid Nodule; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed
PubMed: 35282495
DOI: 10.20471/acc.2021.60.03.12 -
Histology and Histopathology Jan 1990
Comparative Study Review
Topics: Amphibians; Animals; Birds; Humans; Mammals; Microscopy, Electron; Parathyroid Glands; Reptiles; Species Specificity
PubMed: 2134362
DOI: No ID Found -
Physiological Research Apr 2022Inconclusive preoperative imaging is a strong predictor of multiglandular parathyroid disease (MGD) in patients with primary hyperparathyroidism (PHPT). MGD was...
Inconclusive preoperative imaging is a strong predictor of multiglandular parathyroid disease (MGD) in patients with primary hyperparathyroidism (PHPT). MGD was investigated in a cohort of 17 patients with PHPT (mean age 64.9 years, total calcium 2.75 mmol/l and parathyroid hormone (PTH) 113.3 ng/l) who underwent 18F-fluorocholine PET/CT (FCH) imaging before surgery. The initial MIBI SPECT scintigraphy (MIBI) and/or neck ultrasound were not conclusive or did not localize all pathological parathyroid glands, and PHPT persisted after surgery. Sporadic MGD was present in 4 of 17 patients with PHPT (24 %). In 3 of 4 patients with MGD, FCH correctly localized 6 pathological parathyroid glands and surgery was successful. Excised parathyroid glands were smaller (p <0.02) and often hyperplastic in MGD than in single gland disease. In two individuals with MGD, excision of a hyperplastic parathyroid gland led to a false positive decline in intraoperative PTH and/or postoperative serum calcium. Although in one patient it was associated with partial false negativity, parathyroid imaging with FCH seemed to be superior to neck ultrasound and/or MIBI scintigraphy in MGD.
Topics: Aged; Calcium; Humans; Hyperparathyroidism, Primary; Middle Aged; Parathyroid Glands; Positron Emission Tomography Computed Tomography; Technetium Tc 99m Sestamibi
PubMed: 35275696
DOI: 10.33549/physiolres.934851 -
Der Chirurg; Zeitschrift Fur Alle... Jan 2019
Topics: Humans; Hypocalcemia; Hypoparathyroidism; Parathyroid Glands; Thyroidectomy; Transplantation, Autologous
PubMed: 30478482
DOI: 10.1007/s00104-018-0770-7 -
Frontiers in Endocrinology 2023The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal... (Review)
Review
The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal PGs to prevent postoperative hypoparathyroidism and the thorough removal of parathyroid lesions. Existing conventional imaging techniques have certain limitations in the real-time exploration of PGs. In recent years, a new, real-time, and non-invasive imaging system known as the near-infrared autofluorescence (NIRAF) imaging system has been developed to detect PGs. Several studies have confirmed that this system has a high parathyroid recognition rate and can reduce the occurrence of transient hypoparathyroidism after surgery. The NIRAF imaging system, like a magic mirror, can monitor the PGs during surgery in real time, thus providing great support for surgeries. In addition, the NIRAF imaging system can evaluate the blood supply of PGs by utilizing indocyanine green (ICG) to guide surgical strategies. The NIRAF imaging system and ICG complement each other to protect normal parathyroid function and reduce postoperative complications. This article reviews the effectiveness of the NIRAF imaging system in thyroidectomies and parathyroidectomies and briefly discusses some existing problems and prospects for the future.
Topics: Humans; Parathyroid Glands; Optical Imaging; Parathyroidectomy; Hypoparathyroidism; Indocyanine Green; Monitoring, Intraoperative
PubMed: 37284221
DOI: 10.3389/fendo.2023.1160902 -
Nephron. Clinical Practice 2010Cinacalcet, an allosteric modulator of the calcium-sensing receptor, effectively reduces serum parathyroid hormone (PTH). It was examined whether a regression of... (Comparative Study)
Comparative Study
BACKGROUND/AIM
Cinacalcet, an allosteric modulator of the calcium-sensing receptor, effectively reduces serum parathyroid hormone (PTH). It was examined whether a regression of parathyroid glands in hemodialysis patients with secondary hyperparathyroidism was induced by cinacalcet treatment.
METHODS
Ultrasonography of the parathyroid glands was performed to examine the changes in the parathyroid gland volumes after cinacalcet treatment in 58 patients.
RESULTS
After cinacalcet treatment, serum calcium, phosphate, alkaline phosphatase, and intact PTH significantly decreased (p < 0.0001). The total volumes of the parathyroid glands were significantly decreased 6 months after cinacalcet treatment (942 +/- 747 vs. 708 +/- 550 mm(3), p < 0.0005). There was a significant positive correlation between the parathyroid gland volumes at the start of cinacalcet treatment and the volume reduction in parathyroid glands (r = 0.716, p < 0.0001). Of the 58 patients, the total parathyroid gland volume was decreased in 42 patients and increased in 16 although the doses of cinacalcet, phosphate binders or vitamin D were not significantly different. In both groups, the intact PTH serum levels were significantly decreased after cinacalcet treatment.
CONCLUSION
Cinacalcet treatment in patients with secondary hyperparathyroidism significantly reduced the total parathyroid gland volume in a short 6-month period. This study suggests that cinacalcet treatment may postpone parathyroidectomy and/or reduce cases.
Topics: Aged; Cinacalcet; Female; Follow-Up Studies; Humans; Hyperparathyroidism, Secondary; Kidney Failure, Chronic; Male; Middle Aged; Naphthalenes; Organ Size; Parathyroid Glands; Prospective Studies; Renal Dialysis; Treatment Outcome; Ultrasonography
PubMed: 20413997
DOI: 10.1159/000313035 -
Frontiers in Endocrinology 2023During intraoperative autofluorescence, the imaging intensity of diseased parathyroid glands is often lower than that of normal parathyroid glands, and some diseased...
BACKGROUND
During intraoperative autofluorescence, the imaging intensity of diseased parathyroid glands is often lower than that of normal parathyroid glands, and some diseased glands especially those in secondary hyperparathyroidism (HPT) show heterogeneous intensities. This study aimed to investigate the reasons for these findings.
METHODS
After formalin and paraffin fixation and bivalve cutting, 18 diseased glands from patients with primary HPT, 35 diseased parathyroid glands from patients with uremic HPT, and the surrounding thyroid and thymus tissues were measured using near-infrared autofluorescence with a Fluorobeam imaging system (Fluoptics, France). None of the tissues were stained with indocyanine green. Hematoxylin and eosin staining matched the intensity of the autofluorescence.
RESULTS
Using the bright white intensity of the adult normal parathyroid gland as a reference (index score of 2), the chief cells and oxyphilic cell tissues of the diseased parathyroid had the same intensity score of 2 as that of the normal parathyroid gland, and the clear water parathyroid cell had a weaker intensity score (1-1.5). Their glandular architecture, including the trabecular, follicular, or solid arrangements, did not affect the level of intensity. The thymus, thyroid, fat, fibrosis, and necrosis had very low intensities (scores of 0). The red blood cell-hemorrhage appeared dark black (intensity score -1). The thickness of the fibrotic capsule varied in the diseased parathyroid glands; however, only a very thin capsule was observed in the normal parathyroid glands.
CONCLUSIONS
Various degrees of fibrotic capsules in the diseased parathyroid gland may be the main factor contributing to the lower intensity during autofluorescence, and different cell types, necrosis, fibrosis, and hemorrhage may explain the appearance of heterogeneous intensity in the diseased parathyroid glands.
Topics: Adult; Humans; Parathyroid Glands; Eosine Yellowish-(YS); Epithelial Cells; Erythrocytes; Necrosis
PubMed: 37732116
DOI: 10.3389/fendo.2023.1233610 -
Surgery Feb 2019Although parathyroid glands have been found to exhibit autofluorescence with near-infrared fluorescence imaging, it is unknown if autofluorescence characteristics vary...
BACKGROUND
Although parathyroid glands have been found to exhibit autofluorescence with near-infrared fluorescence imaging, it is unknown if autofluorescence characteristics vary between hyperfunctioning and normofunctioning glands. The hypothesis was that pattern of autofluorescence exhibited by hyperfunctioning versus normofunctioning parathyroid glands would be different.
METHODS
This is an Institutional Review Board-approved, prospective clinical study. Patients underwent bilateral neck exploration for primary hyperparathyroidism, during which autofluorescence from each gland was assessed with near-infrared fluorescence imaging. Pattern and intensity of autofluorescence between hyperfunctioning and normofunctioning parathyroid glands were compared.
RESULTS
Overall, 199 parathyroid glands were identified in 50 patients (single gland disease, n = 31; multigland disease, n = 19). Autofluorescence was detected from 96% (n = 192) of parathyroid glands, all of which exhibited a higher intensity autofluorescence than the background tissues. Parathyroid gland location was revealed by near-infrared fluorescence imaging before dissection in 26% (n = 52). A total of 77 glands that were large or firm were excised and 122 were preserved because of normal appearance. Hyperfunctioning parathyroid glands had a lower mean normalized autofluorescence intensity than normofunctioning parathyroid glands (1.8, and 2.6, respectively, P < .001). Moreover, hyperfunctioning parathyroid glands more often exhibited a heterogeneous pattern of autofluorescence (75% and 5%, respectively, P < .001). On multivariate analysis, only parathyroid gland hyperfunction correlated with normalized autofluorescence intensity. On receiver operative characteristic curve, optimal cutoff of normalized autofluorescence intensity to differentiate hyperfunctioning from normofunctioning parathyroid glands was 2.0.
CONCLUSION
Our results indicate that hyperfunctioning and normofunctioning parathyroid glands exhibit different patterns of autofluorescence in hyperparathyroidism. Given these findings, autofluorescence pattern could be implemented as another adjunctive parameter for gland assessment during parathyroid exploration.
Topics: Adenoma; Female; Fluorescence; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy; Prospective Studies; Sensitivity and Specificity; Software; Spectroscopy, Near-Infrared
PubMed: 30274733
DOI: 10.1016/j.surg.2018.08.006