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La Clinica Terapeutica May 2021Tertiary hyperparathyroidism (HPT III) occurs when an excess of parathyroid hormone (PTH) is secreted by parathyroid glands, usually after longstanding secondary... (Review)
Review
Tertiary hyperparathyroidism (HPT III) occurs when an excess of parathyroid hormone (PTH) is secreted by parathyroid glands, usually after longstanding secondary hyperparathyroidism. Some authorities reserve the term for secondary hyperparathyroidism that persists after successful renal transplantation. Long-standing chronic kidney disease (CKD) is associated with several metabolic disturbances that lead to increased secretion of PTH, including hyperphosphatemia, calcit-riol deficiency, and hypocalcaemia. Hyperphosphatemia has a direct stimulatory effect on the parathyroid gland cell resulting in nodular hyperplasia and increased PTH secretion. Prolonged hypocalcaemia also causes parathyroid chief cell hyperplasia and excess PTH. Af-ter correction of the primary disorder CKD by renal transplant, the hypertrophied parathyroid tissue fails to resolute, enlarge over and continues to oversecrete PTH, despite serum calcium levels that are within the reference range or even elevated. They also may become resistant to calcimimetic treatment. The main indication for treatment is persistent hypercalcemia and/or an increased PTH, and the primary treatment is surgery. Three procedures are commonly performed: total parathyroidectomy with or without autotransplantation, subtotal parathyroidectomy, and limited parathyroidectomy. It is important to remove superior parts of thymus as well. The most appropriate surgical procedure, whether it be total, subtotal, or anything less than subtotal including "limited" or "focused" parathyroidectomies, continues to be unclear and controversial. Surgical complications are rare, and para-thyroidectomy appears to be a safe and feasible treatment option for HPT III.
Topics: Humans; Hyperparathyroidism, Secondary; Hyperphosphatemia; Hyperplasia; Hypocalcemia; Kidney Transplantation; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Renal Insufficiency, Chronic; Transplantation, Autologous
PubMed: 33956045
DOI: 10.7417/CT.2021.2322 -
Human Pathology Apr 1986
Topics: Aging; Humans; Hyperplasia; Organ Size; Parathyroid Glands
PubMed: 3957342
DOI: 10.1016/s0046-8177(86)80470-1 -
Kidney International. Supplement Jul 2006Marked parathyroid hyperplasia develops in patients with chronic kidney disease, especially those with long dialysis vintage. Although progression of hyperplasia is... (Review)
Review
Marked parathyroid hyperplasia develops in patients with chronic kidney disease, especially those with long dialysis vintage. Although progression of hyperplasia is associated with downregulation of vitamin D receptor and calcium-sensing receptor, initial abnormality that triggers and maintains parathyroid cell proliferation, as well the critical abnormality for the progression of diffuse hyperplasia to nodular hyperplasia, still remains to be elucidated. It is quite important for the optimal management of renal osteodystrophy to recognize the development of nodular hyperplasia, because the cells in nodular hyperplasia are usually resistant to medical therapy and further treatment of such patients often leads to vascular calcification. For this purpose, size and blood supply of enlarged parathyroid glands have been used as good clinical markers. Furthermore, we have recently shown that the serum fibroblast growth factor 23 level can be used for predicting refractory hyperparathyroidism. Once nodular hyperplasia develops in any of the enlarged parathyroid glands, such patients need to be treated by parathyroid intervention including percutaneous ethanol injection therapy. In addition, as direct vitamin D injection therapy has been shown to induce regression of hyperplasia, it may become possible to reverse or normalize established nodular hyperplasia if we can develop new agents with such effects in the near future.
Topics: Anti-Infective Agents, Local; Biomarkers; Bone Density Conservation Agents; Calcinosis; Chronic Disease; Ethanol; Fibroblast Growth Factor-23; Fibroblast Growth Factors; Hyperparathyroidism, Secondary; Hyperplasia; Kidney Diseases; Parathyroid Glands; Receptors, Calcitriol; Receptors, Calcium-Sensing; Vitamin D
PubMed: 16810308
DOI: 10.1038/sj.ki.5001594 -
Advances in Anatomic Pathology Jan 2023Hyperparathyroidism is a common endocrine disorder characterized by elevated levels of parathyroid hormone and hypercalcemia and is divided into 3 types: primary,... (Review)
Review
Hyperparathyroidism is a common endocrine disorder characterized by elevated levels of parathyroid hormone and hypercalcemia and is divided into 3 types: primary, secondary, and tertiary. Distinction between these types is accomplished by correlation of clinical, radiologic, and laboratory findings with pathologic features. Primary hyperparathyroidism occurs sporadically in 85% of cases with the remaining cases associated with multiple familial syndromes. The pathologic manifestations of primary hyperparathyroidism include parathyroid adenoma, parathyroid hyperplasia, and parathyroid carcinoma. Recent advances in the understanding of the pathogenesis of parathyroid disease has helped to refine the diagnosis and classification of parathyroid lesions. The identification of multiple clonal proliferations in traditional multiglandular parathyroid hyperplasia has led to the adoption by the World Health Organization (WHO) of the alternate term of primary hyperparathyroidism-related multiglandular parathyroid disease. Additional nomenclature changes include the adoption of the term atypical parathyroid tumor in lieu of atypical parathyroid adenoma to reflect the uncertain malignant potential of these neoplasms. Clinical and morphologic features characteristic of familial disease have been described that can help the practicing pathologist identify underlying familial disease and provide appropriate management. Use of ancillary immunohistochemistry and molecular studies can be helpful in classifying parathyroid neoplasms. Parafibromin has proven useful as a diagnostic and prognostic marker in atypical parathyroid tumors and parathyroid carcinomas. This review provides an update on the diagnosis and classification of parathyroid lesions considering the recent advances in the understanding of the molecular and clinical features of parathyroid disease and highlights the use of ancillary studies (immunohistochemical, and molecular) to refine the diagnosis of parathyroid lesions.
Topics: Humans; Hyperparathyroidism, Primary; Hyperplasia; Parathyroid Glands; Parathyroid Neoplasms; Adenoma
PubMed: 36315270
DOI: 10.1097/PAP.0000000000000379 -
Nephrology, Dialysis, Transplantation :... Jul 2007
Review
Topics: Animals; Calcium; Drug Evaluation, Preclinical; Humans; Hyperparathyroidism, Secondary; Hyperplasia; Parathyroid Glands; Receptors, Calcitriol; Receptors, Calcium-Sensing
PubMed: 17449493
DOI: 10.1093/ndt/gfm177 -
Archives of Surgery (Chicago, Ill. :... Jul 1992Pathologically enlarged parathyroid glands offer the surgeon a vital medium for studying parathyroid anatomy. The advantages include gland magnification, rapid-section...
Pathologically enlarged parathyroid glands offer the surgeon a vital medium for studying parathyroid anatomy. The advantages include gland magnification, rapid-section diagnosis to aid dissections, and postoperative clinical and laboratory responses to check for "missed" or supernumerary glands. In this series, each of 71 patients had at least four hyperplastic glands. Both mediastinal and intrathyroidal glands occurred in nine instances (13%), supernumerary glands in eight (11%), and ectopic neck glands in seven (10%). In total, anomalous parathyroid glands occurred in almost half (46%) of these patients with parathyroid hyperplasia.
Topics: Humans; Hyperplasia; Mediastinum; Parathyroid Glands; Parathyroidectomy; Reoperation; Thyroid Gland; Transplantation, Autologous; Transplantation, Heterotopic
PubMed: 1524481
DOI: 10.1001/archsurg.1992.01420070073014 -
Chirurgia (Bucharest, Romania : 1990) 2019The secondary hyperparathyroidism (sHPT) affects all patients with chronic renal failure in different degrees. The chronic kidney disease is often associated with...
The secondary hyperparathyroidism (sHPT) affects all patients with chronic renal failure in different degrees. The chronic kidney disease is often associated with multiple severe comorbidities, therefore the figures for mortality are higher than in the general population. The failure of medical treatment is an indication for surgical treatment. The recurrence of the disease in secondary hyperpara-thyroidism after surgical treatment using total parathyroid with autotransplantation or subtotal parathyroidectomy may be a challenge due to hyperplasia of the remaining tissue. The purpose of this retrospective study was to highlight the risk factors for the occurrence of glandular hyperplasia in patients with secondary hyperparathyroidism and to determine optimal surgery approach for secondary hyperparathyroidism in order to minimize relapse rates. Parathyroid size evaluation may suggest the presence of nodular hyperplasia contributing to an early parathyroidectomy and at the same time selecting the best surgical treatment for sHPT patients. As resistance to medical therapy is due to the presence of nodular hyperplasia, some authors recomends subtotal parathyroidectomy with the excision of these glands, with the remaining parathyroids tissue and function controlled by medical therapy (20).
Topics: Humans; Hyperparathyroidism, Secondary; Hyperplasia; Kidney Failure, Chronic; Parathyroid Glands; Parathyroidectomy; Retrospective Studies; Risk Factors
PubMed: 31670635
DOI: 10.21614/chirurgia.114.5.594 -
Nephrology, Dialysis, Transplantation :... 1996Calcitriol pulse therapy has markedly changed the management of secondary hyperparathyroidism in chronic dialysis patients. However, there are still many patients even... (Review)
Review
Calcitriol pulse therapy has markedly changed the management of secondary hyperparathyroidism in chronic dialysis patients. However, there are still many patients even resistant to this therapy. Our observation of parathyroid size by ultrasonography revealed that these patients usually have enlarged parathyroid glands larger than 0.5 cm3. Such large parathyroid glands are composed of nodular hyperplasia with monoclonal cell proliferation, whose calcitriol receptor density is lower than that of diffuse hyperplasia, thus more resistant to calcitriol. Based on such a pathophysiological model, we have shown that destruction of the largest parathyroid gland was sufficient to restore the responsiveness to calcitriol therapy in these refractory patients. By using colour Doppler ultrasonography, we could also optimize the site and volume of ethanol injection and could detect the recurrence of parathyroid cell growth easily, with lower risk of complications. This selective route of drug delivery to parathyroid glands can be also used for direct injections of calcitriol solution as we have reported. Thus, evaluation of parathyroid size by sensitive ultrasonography is an essential marker for the management of parathyroid hyperfunction in chronic dialysis patients. It is also suggested that ultrasonographic intervention of parathyroid hyperplasia may not only be a useful and safe adjunct to calcitriol pulse therapy, but may also serve as a new therapeutic modality for parathyroid diseases in future.
Topics: Calcitriol; Ethanol; Humans; Hyperplasia; Kidney Failure, Chronic; Parathyroid Glands; Prognosis; Renal Dialysis; Ultrasonography; Vitamin D
PubMed: 8840327
DOI: 10.1093/ndt/11.supp3.125 -
Clinical Calcium May 2007Parathyroid gland (PTG) is a unique endocrine organ in which the quiescent glandular cells begin to proliferate in the progressive course of renal failure, leading to... (Review)
Review
Parathyroid gland (PTG) is a unique endocrine organ in which the quiescent glandular cells begin to proliferate in the progressive course of renal failure, leading to secondary hypereparathyroidism (SHPT). SHPT is characterized by continuous over-secretion of parathyroid hormone (PTH) and parathyroid hyperplasia, and the major contributing factors are a deficiency of active vitamin D, hypocalcemia and phosphate retention. Many experimental and human studies have revealed that the down-regulations of vitamin D receptor (VDR), calcium (Ca) -sensing receptor (CaSR), and retinoid X receptor (RXR) in parathyroid hyperplasia of SHPT, especially nodular hyperplasia, which is a severe form of hyperplasia. These also contribute to progression of parathyroid hyperplasia. Recently, mechanisms by which active vitamin D and Ca regulate parathyroid hyperplasia via their receptors have been clarified. In this paper, we review mechanisms for progression of parathyroid hyperplasia and the possibility for regression of parathyroid hyperplasia.
Topics: Animals; Calcium; Humans; Hyperplasia; Parathyroid Glands; Vitamin D
PubMed: 17470994
DOI: No ID Found -
Surgery Feb 1993It has been clearly shown clinically that parathyroid tissue can be successfully autotransplanted and even allotransplanted if the host is immunosuppressed. Engraftment... (Review)
Review
It has been clearly shown clinically that parathyroid tissue can be successfully autotransplanted and even allotransplanted if the host is immunosuppressed. Engraftment is almost always successful; however, if abnormal tissue has been transplanted, its function will continue to be abnormal if the same intrinsic (e.g., primary parathyroid hyperplasia) or extrinsic (renal osteodystrophy) stimulation existing before grafting continues in the postoperative period. In these patients the secretion of parathyroid hormone from the grafted parathyroid tissue can be shown to progressively increase with time. Although parathyroid autotransplantation is most frequently performed clinically for renal osteodystrophy, there is controversy about the operation, and some surgeons prefer the technique of 3 1/2 gland parathyroidectomy. Because of the generally good results with total parathyroidectomy and autotransplantation in patients with primary parathyroid hyperplasia, this procedure seems to be the operation of choice in this clinical setting. The clearest indication for parathyroid autotransplantation is in patients with radical operations on the thyroid gland or other head and neck organs where the parathyroids have been damaged or their viability is questioned.
Topics: Chronic Kidney Disease-Mineral and Bone Disorder; Humans; Hyperparathyroidism; Hyperplasia; Parathyroid Glands; Postoperative Complications; Transplantation, Autologous
PubMed: 8430361
DOI: No ID Found