Abstract
The following points of interest are discussed: the frequency, classification, pathological patterns, clinical aspects and the role of hyperparathyroidism (HPT) in the genesis of calcium lithiasis. The steps of the diagnostic screening adopted at the Urological Clinic of the University of Genova are described. The problems of pathogenesis and classification of HPT are however far from a uniform, definitive and satisfactory solution. We still distinguish, for the sake of simplicity, between primary and secondary HPT. The latter form may become autonomous (tertiary HPT) and unable to respond to correction of the basic defect. From a histopathological standpoint, the distinction between adenoma and hyperplasia on the one part and between mild hyperplasia and normal glands on the other, is still fraught with difficulties. On clinical grounds, the work-up for screening, diagnosis of nature and location and, closely related, indications for surgery, suffers from these drawbacks. Fortunately, however, diagnostic methods today are sufficiently reliable to lead to a correct diagnosis in most cases.
A brief survey of personal experience is presented, consisting of over 200 evaluable patients. Surgery was performed in 38, including 24 orthotopic adenomas, 4 ectopic adenomas, and 10 diffuse hyperplasias. Six of the latter cases were treated with total parathyroidectomy and autotransplantation in the forearm.
Follow-up of operated patients ranges between a few months and 8 years. No recurrent HPT and no recurrence of urolithiasis have been observed in our series.
Keywords
- Parathyroid Gland
- Primary Hyperparathyroidism
- Parathyroid Adenoma
- Normal Gland
- Permanent Hypoparathyroidism
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Albright, F. and Reifenstein, E.G.: The parathyroid glands and metabolism bone disease. Williams and Wilkins Co., Baltimore, 1948.
Barilla, E.D. and Pak, C.Y.C.: Pitfalls in parathyroid evaluation in patients with calcium urolithiasis. Urol. Res. 7: 177, (1979).
Black, W.C., III: Correlative light and electron microscopy in primary hyperparathyroidism. Arch. Pathol. 88: 225, (1969).
Beazley, R.M., Costa, J, and Ketcham, A.S.: Re-operative parathyroid surgery. Am. J, Sug. 130: 427, (1975).
Bone, G.H. III, Snyder, W.H. III and Pak, C.Y.C.: Diagnosis of hyperparathyroidism. Ann. Rev. Med. 28: 111, (1977).
Bracci, U. and Basso, A.: L’iperparatiroidismo in Urologia. Chir. Urol, 4: 13, (1962).
Carmignani, G., Belgrano, E. and Puppo, P.: L’iperparatiroidismo in Urologia. Urologia XLIV: 3, (1977).
Chigot, P.L.: Chirurgie de 1’hyperparathyroidie. J. Chir. 93: 579, (1967).
Coe, F.L. and Kavalach, A.G.: Hypercalciuria and hyperparathyroidism in patients with calcium nephrolithiasis. N. Engl. J. Med. 291: 1344, (1974),
Davies, D.R.: The surgery of primary hyperparathyroidism. Clin. Endocrin. Metabol. 3: 253, (1974).
Doppman, J.L., Nelson, G.L., Evens, R.G. and Hammond, W.G.: Selective superior and inferior thyroid vein catheterization: venographic anatomy and potential application. Invest. Radiol. 4: 97, (1969).
Doppman, J.L., Mallette, L.E., Marx, S.J., Monchick, J.M., Broadus, A., Spiegel, A.M., Beazley, R. and Aurbach, G.D.: The localization of abnormal mediastinal parathyroid glands. Radiology 115: 31, (1975).
Doppman, J.L., Murray, F.B., Koehler, J.O. and Marx, S.J.: Computed assisted tomography, J, Computed Assisted Tomography 1: 30, (1977).
Esselstyn, C.B.: Parathyroid pathology: its relation to choice of operation for hyperparathyroidism. Surg. Clin. North Am. 59: 77, (1979).
Giuliani, L., Carmignani, G., Belgrano, E., Martorana, G. and Puppo, P.: Doppio adenoma paratiroideo: insufficienza renale e turbe psichiche. Presentazione di un caso. Recenti acquisizioni diagnostico-terapeutiche. Arch. It. Urol. 46: 259, (1975).
Giuliani, L., Carmignani, G., Belgrano, E. and Puppo, P.: Die selektive Parathormon-bestimmung als Lokalisationsmittel der Nebenschilddrüsenadenoma beim primären Hyperparathyroidismus. Urologe A 17: 23, (1978).
Giuliani, L., Carmignani, G., Belgrano, E. and Puppo, P.: Value of selective parathormone radioimmunoassay in primary hyperparathyroidism. Urology 13: 156, (1979).
Kato, T., Hattori, T., Miura, K. and Sato, M.: Application of thyroid lymphography to preoperative localization of hyperfunctioning parathyroid adenomas. Ann. Surg. 179: 387, (1974).
Johansson, H., Thoren, L., Werner, I. and Grimelius, L.: Normocalcemic hyperparathyroidism; kidney stones and idiopathic hypercalciuria. Surgery 77: 691, (1975).
Paloyan, E., Lawrence, A.M. and Baker, W.H.: Near total parathyroidectomy. Surg. Clin. North. Am. 49: 43, (1969).
Roth, S.I., Wang, C. and Potts, J.T.: The team approach to primary hyperparathyroidism. Hum. Pathol. 6: 645, (1975).
Samuels, B.I., Dowdy, A.H. and Lecky, J.W.: Parathyroid thermography. Radiology 104: 575, (1972).
Schmidt-Gayk H. and Rohen, H.D.: Urinary excretion of cyclic adenosine monophosphate in the detection and diagnosis of primary hyperparathyroidism. Surg. Gynec. Obstet. 137: 439, (1973).
Scholz, D.A., Purneil, D.C., Edis, A.J., Van Heedern, J.A. and Woolner, L.B.: Primary hyperparathyroidism with multiple parathyroid gland enlargement. Review of 53 cases. Mayo Clin. Proc. 53: 792, (1978).
Silverberg, S.G.: Imprints in the intraoperative evaluation of parathyroid disease. Arch. Pathol. 99: 378, (1978).
Silverman, R. and Yalow, R.S.: Heterogeneity of parathyroid hormone: clinical and physiologic implications. J. Clin. Invest. 52: 1958, (1973).
Wang, C. and Rieder, S.U.: A density test for the intraoperative differentiation of parathyroid hyperplasia from neoplasia. Ann. Surg. 187: 63, (1978).
Wells, A.S., Gunnells, J.C. and Shelburne, J.D.: Transplantation of the parathyroid glands in man: clinical indication and results. Surgery 78: 34, (1975).
Wells, A.S., Ross, A.J., Dale, J.K. and Gray, R.S.: Transplantation of the parathyroid glands: current status. Surg. Clin. North Am. 59: 167, (1979).
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1981 Plenum Press, New York
About this chapter
Cite this chapter
Giuliani, L. (1981). Physiopathology and Diagnosis of Hyperparathyroidism. In: Pavone-Macaluso, M., Smith, P.H., Vercellone, A., Maiorca, R., Rotolo, U. (eds) Advances in Nephrourology. Ettore Majorana International Science Series, vol 9. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-8944-6_23
Download citation
DOI: https://doi.org/10.1007/978-1-4684-8944-6_23
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4684-8946-0
Online ISBN: 978-1-4684-8944-6
eBook Packages: Springer Book Archive