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

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Abstract

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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Abbreviations

PHPT:

Primary hyperparathyroidism

NCPHPT:

Normocalcemic primary hyperparathyroidism

CaSR:

Calcium-sensing receptor

CGA:

Chromogranin A

PTH:

Parathyroid hormone

VitDR:

Vitamin D receptor

CyD1:

Cyclin D1

IDV:

Integrated density value

ADV:

Average density value

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Acknowledgements

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.).

All experiments comply with the laws of Taiwan.

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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). https://doi.org/10.1007/s00428-006-0222-5

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  • DOI: https://doi.org/10.1007/s00428-006-0222-5

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