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Normocalcemic primary hyperparathyroidism in patients with recurrent kidney stones: pathological analysis of parathyroid glands

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The lack of overt elevation of serum calcium concentration in some patients suffering from primary hyperparathyroidism is an intriguing clinical phenomenon. Previous studies have substantiated abnormal parathyroid tissue in these patients, but the extent and mode of derangements remained largely undefined. The parathyroid tissues from patients of normocalcemic primary hyperparathyroidism (NCPHPT) and those having normal parathyroid glands, hypercalcemic primary hyperplasia, secondary hyperplasia, and adenoma were compared by undertaking quantitative immunohistochemistry analysis on tissue microarray. The statistic results suggested that the parathyroid tissue of NCPHPT approximates more to normal gland than to its counterpart in other groups of parathyroid proliferative diseases in terms of the lack of significant alterations of calcium-sensing receptor (CaSR), chromogranin A (CGA), parathyroid hormone (PTH), and proliferation index (Ki67). On the other hand, the depressed vitamin D receptor (VitDR) and elevated cyclin D1 (CyD1) of NCPHPT indicated the inherent functional abnormalities in parathyroid cells. Our results imply that inherent functional disengagement may exist between CaSR and CyD1 or between CaSR and VitDR or both in parathyroid cells of symptomatic NCPHPT. Lack of enhanced release of CGA and PTH and discordance between proliferative activity and CyD1 expression in parathyroid cells may further hinder the development of hypercalcemia.

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Primary hyperparathyroidism


Normocalcemic primary hyperparathyroidism


Calcium-sensing receptor


Chromogranin A


Parathyroid hormone


Vitamin D receptor


Cyclin D1


Integrated density value


Average density value


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This work was supported by Taipei Veterans General Hospital Research Grant 94-02-48A (to Y.A.H.), National Science Council Grant NSC 91-2314-B-075-066 (to Y.A.H.), and Yen Tjing Ling Medical Foundation Grant CI-92-1-1 (to Y.A.H. and C.H.L.).

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Correspondence to Chen-Hsen Lee.

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Yang, AH., Hsu, CW., Chen, JY. et al. Normocalcemic primary hyperparathyroidism in patients with recurrent kidney stones: pathological analysis of parathyroid glands. Virchows Arch 449, 62–68 (2006).

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