Abstract
The last organ to be recognized in man, the parathyroid glands, was discovered in 1880 by Ivar Sandstrom, a Swedish medical student. The discovery attracted little attention initially. Later, with the uncovering of the relationship of the glands to significant bone disease, interest quickened. In the early 1900s, Jacob Erdheim demonstrated that the four parathyroid glands were enlarged in osteomalacia and in rickets and thought it was a compensatory phenomenon. Subsequently, occasional cases of bone disease were encountered in which only a single gland was enlarged. In 1915, Friedrich Schlaugenhaufer suggested that enlargement of a single parathyroid gland might be the cause of the bone disease, not its result. The first parathyroidectomy for von Recklinghausen’s disease of the bone was performed by Felix Mandl in 1925 in Vienna. Subsequently, the parathyroid glands were shown to be affected by a number of primary pathological processes – neoplasia (adenoma and carcinoma) and hyperplasia (wasserhelle cell and chief cell types) – that resulted in overactivity and required surgical removal of one or more of them [1].
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Carney JA (1996) The glandulae parathyroideae of Ivar Sandstrom. Contributions from two continents. Am J Surg Pathol 20:1123–1144
Maxon HR, Elgazzar AH (1988) Parathyroid imaging. In: Gelfand G, Thomas S (eds) Effective use of computers in nuclear medicine. McGraw Hill, New York, pp 485–496
Akerstrom G, Grimelius L, Johansson H, Lundquist H, Pertoft H, Bergstrom R (1981) The parenchymal cell mass in normal human parathyroid glands. Acta Pathol Microbiol Immunol Scand 89(A):367
Grimelius L, Ackerstrom G, Bonderson L, Juhlin C, Johnsson H, Ljunghall S, Rastad J (1991) The role of the pathologist in diagnosis and surgical decision making in hyperparathyroidism. World J Surg 15:698–705
Akerstrom G, Rastad J, Ljunghall S, Johnsson H (1990) Clinical and experimental advances in sporadic primary hyperparathyroidism. Acta Chir Scand 156:23–28
Birkenhager JC, Bouillon R (1996) Asymptomatic hyperparathyroidism. Postgrad Med J 72:323–326
Mitchell BK, Merrell RC, Kinder BK (1995) Localization studies in patients with hyperparathyroidism. Endocrinol Surg 75:483–498
Smith JR, Oates ME (2004) Radionuclide imaging of the parathyroid glands: patterns, pearls, and pitfalls. Radiographics 24:1101–1115
Berland T, Smith SL, Huguet KL (2005) Occult fifth gland intrathyroid parathyroid adenoma identified by gamma probe. Am Surg 71:264–266
Kunstman JW, Kirsch JD, Mahajan A, Udelsman R (2013) Clinical review: parathyroid localization and implications for clinical management. J Clin Endocrinol Metab 98:902–912
Akerstrom G, Malmaeus J, Bergstrom R (1984) Surgical anatomy of human parathyroid glands. Surgery 95:15–21
Ritter CS, Haughey BH, Miller B, Brown A (2012) Differential gene expression by oxyphil and chief cells of human parathyroid glands. J Clin Endocrinol Metab 97:E1499–E1505
Palestro C, Tomas M, Tronco G (2005) Radionuclide imaging of the parathyroid glands. Semin Nucl Med 35:266–276
Akerstrom G, Rudberg C, Grimelius L et al (1986) Histologic parathyroid abnormalities in an autopsy series. Hum Pathol 17:520–527
Heath H III (1991) Clinical spectrum of primary hyperparathyroidism: evolution with changes in medical practice and technology. J Bone Miner Res 6:S63–S70
Fitzpatrick LA (1989) Hypercalcemia in the multiple endocrine neoplasia syndromes. Endocrinol Metab Clin North Am 18:741–752
Skogseid B, Rastad J, Oberg K (1994) Multiple endocrine neoplasia type 1. Endocrinol Metab Clin North Am 23:1–17
Herfarth KK, Wells SA (1997) Parathyroid glands and the multiple endocrine neoplasia syndromes and familial hypocalciuric hypercalcemia. Semin Surg Oncol 13:114–124
Mallette LE (1994) Management of hyperparathyroidism in multiple endocrine neoplasia syndromes and other familial endocrinopathies. Endocrinol Metab Clin North Am 23:19–36
Duh QY, Hybarger CP, Geist R, Gamsu G, Goodman PC, Gooding GA, Clark OH (1987) Carcinoids associated with multiple endocrine neoplasia syndromes. Am J Surg 154:142–148
Beus KS, Stack BC Jr (2004) Synchronous thyroid pathology in patients presenting with primary hyperparathyroidism. Am J Otolaryngol 25:308–312
Nishiyama RH, Farhi D, Thompson NW (1979) Radiation exposure and the simultaneous occurrence of primary hyperparathyroidism and thyroid nodules. Surg Clin North Am 59:65–75
Ogburn P, Black B (1956) Primary hyperparathyroidism and papillary adenocarcinoma of the thyroid: report of four cases. Mayo Clin Proc 31:295–298
Prinz RA, Barbato AL, Braithwaite SS (1982) Simultaneous primary hyperparathyroidism and nodular thyroid disease. Surgery 92:454–458
Hedman IL, Tisell LE (1984) Associated hyperparathyroidism and non-medullary thyroid carcinoma: the etiological role of radiation. Surgery 95:392–397
Attie JN, Vardhan R (1993) Association of hyperparathyroidism with nonmedullary thyroid carcinoma: review of 31 cases. Head Neck 15:20–23
Burmeister LA, Sandberg M, Carty SE (1997) Thyroid carcinoma found at parathyroidectomy: Association with primary, secondary and tertiary hyperparathyroidism. Cancer 79:1611–1616
Sidhu S, Campbell P (2000) Thyroid pathology associated with primary hyperparathyroidism. Aust N Z J Surg 70:285–287
Bentrem DJ, Angelos P, Talamonti MS (2002) Is preoperative investigation of the thyroid justified in patients undergoing parathyroidectomy for hyperparathyroidism? Thyroid 12:1109–1112
Arem R, Lim-Abrahan MA, Mallette LE (1986) Concomitant Graves’ disease and primary hyperparathyroidism. Influence of hyperthyroidism on serum calcium and parathyroid hormone. Am J Med 80:693–698
Sy WM, Mittal AK (1975) Bone scan in chronic dialysis patients with evidence of secondary hyperparathyroidism and renal osteodystrophy. Br J Radiol 48:878–884
Thompson NW, Eckhauser FE, Harness JK (1982) The anatomy of primary hyperparathyroidism. Surgery 92:814–821
Wang CA (1976) The anatomic basis of parathyroid surgery. Ann Surg 183:271–275
Simeone DM, Sandelin K, Thompson NW (1995) Undescended superior parathyroid gland: a potential cause of failed cervical exploration for hyperparathyroidism. Surgery 118:949–956
Shen W, Duren M, Morita E, Higgins C, Duh QY, Siperstein AE, Clark OH (1996) Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg 131:861–869
Doppman JL, Skarulis MC, Chen CC et al (1996) Parathyroid adenomas in the aortopulmonary window. Radiology 201:456–462
Tezelman S, Shen W, Shaver JK et al (1993) Double parathyroid adenomas: clinical and biochemical characteristics before and after parathyroidectomy. Ann Surg 218:300–309
Bartsch D, Nies C, Hasse C et al (1995) Clinical and surgical aspects of double adenoma in patients with primary hyperparathyroidism. Br J Surg 82:926–929
Nguyen BD (1999) Parathyroid imaging with Tc-99m sestamibi planar and SPECT scintigraphy. Radiographics 19:601–614
Clark OH, Duh QY (1989) Primary hyperparathyroidism: a surgical perspective. Endocrinol Metab Clin North Am 18:701–714
McHenry CR, Lee K, Saadey J et al (1996) Parathyroid localization with technetium-99m-sestamibi: a prospective evaluation. J Am Coll Surg 183:25–30
Bergenfelz A, Tennvall J, Valdermarsson S et al (1997) Sestamibi versus thallium subtraction scintigraphy in parathyroid localization: a prospective comparative study in patients with predominantly mild primary hyperparathyroidism. Surgery 121:601–605
Rogers LA, Fetter BF, Peete WPJ (1969) Parathyroid cyst and cystic degeneration of parathyroid adenoma. Arch Pathol 88:476–479
Fallon MD, Haines JW, Teitelbaum SL (1982) Cystic parathyroid gland hyperplasia-hyperparathyroidism presenting as a neck mass. Am J Clin Pathol 77:104–107
Turner WJD, Baergen RN, Pellitteri PK, Orloff LA (1996) Parathyroid lipoadenoma: case report and review of the literature. Otolaryngol Head Neck Surg 114:313–316
Fleischer J, Becker C, Hamele-Bena D et al (2004) Oxyphil parathyroid adenoma: a malignant presentation of a benign disease. J Clin Endocrinol Metab 89:5948–5951
Cummings CW (2005) Otolaryngology: head and neck surgery, 4th edn. Mosby, Philadelphia
Cheng L, Bostwick DG (2011) Endocrine pathology. In: Essentials of Anatomic Pathology, 3rd edn. Springer, Berlin, pp 927–928
Rinsho N (1995) Primary hyperparathyroidism, pathologic findings and ultrastructure. Jpn J Clin Med 53:861–863
Baglin A, Junien C, Prinseau J (1991) Mechanism of parathyroid cell proliferation in primary hyperparathyroidism. Presse Med 20:803–808
Cook M, Qureshi Y, Todd C, Cummins R (2012) An unusual ectopic location of a parathyroid carcinoma arising within the thyroid gland. J Clin Endocrinol Metab 97:1829–1833
Lack CA, Rarber JL, Rubin E (1999) The endocrine system. In: Rubin E, Farber JL (eds) Pathology, 3rd edn. Lippincott-Raven, Philadelphia, pp 1179–1183
Kilgore EJ, Teigen EL, Cowan RJ (1996) Imaging of transplanted parathyroid tissue in a patient with recurrent hyperparathyroidism. Clin Nucl Med 21:383–386
Chen CC, Premkumar A, Hill SC, Skarulis MC, Spiegel AM (1995) Tc-99m sestamibi imaging of a hyperfunctioning parathyroid autograft with Doppler ultrasound and MRI correlation. Clin Nucl Med 20:222–225
Lee VS, Spritzer CE, Coleman RE, Wilkinson RH Jr, Coogan AC, Leight GS Jr (1995) Hyperparathyroidism in high-risk surgical patients: evaluation with double-phase technetium-99m sestamibi imaging. Radiology 197:627–633
Walker RP, Paloyan E, Gopalsami C (2004) Symptoms in patients with primary hyperparathyroidism: muscle weakness or sleepiness. Endocr Pract 10:404–408
Wang CA (1977) Parathyroid re-exploration: a clinical and pathological study of 112 cases. Ann Surg 186:140
Assalia A, Inabnet WB (2004) Endoscopic parathyroidectomy. Otolaryngol Clin North Am 37:871–886
Thomas SK, Wishart GC (2003) Trends in surgical techniques. Nucl Med Commun 24:115–119
O’Doherty MJ, Kettle AG (2003) Parathyroid imaging: preoperative localisation. Nucl Med Commun 24:125–131
Erdman WA, Breslau NA, Weinreb JC, Weatherall P, Setiawan H, Harrell R, Snyder W (1989) Noninvasive localization of parathyroid adenomas: a comparison of X-ray computerized tomography, ultrasound, scintigraphy and MRI. Magn Reson Imaging 7:187–194
Auffermann W, Gooding GA, Okerlund MD, Clark OH, Thurnher S, Levin KE, Higgins CB (1988) Diagnosis of recurrent hyperparathyroidism: comparison of MR imaging and other imaging techniques. Am J Roentgenol 150:1027–1033
Peck WW, Higgins CR, Fisher MR, Ling M, Okerland MD, Clark OH (1987) Hyperparathyroidism: comparison of MR imaging with radionuclide scanning. Radiology 163:415–420
Levin KE, Gooding GA, Okerlund M, Higgins CB, Norman D, Newton TH, Duh QY, Arnaud CD, Siperstein AE, Zeng QH et al (1987) Localizing studies in patients with persistent or recurrent hyperparathyroidism. Surgery 102:917–925
Miller DL, Doppman JR, Shawker TH, Krudy AG, Norton JA, Vucich JJ et al (1987) Localization of parathyroid adenomas in patients who have undergone surgery. Part I. Noninvasive imaging methods. Radiology 162:133–137
Kettle A, O’Doherty M (2006) Parathyroid imaging: how good is it and how should it be done? Semin Nucl Med 36:206–211
Taillefer R, Boucher Y, Potviuc C et al (1992) Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with Tc-99m sestamibi (double phase study). J Nucl Med 33:1801–1807
Dontu VS, Kettle AG, O’Doherty MJ, Coakley AJ (2004) Optimization of parathyroid imaging by simultaneous dual energy planar and single photon emission tomography. Nucl Med Commun 25:1089–1093
Vaz A, Griffiths M (2011) Parathyroid imaging and localization using SPECT/CT: initial results. J Nucl Med Technol 39:195–200
Takahashi H et al (2013) Fusion images of MIBI SPECT and MDCT improve diagnostic performance of localization study in hyperparathyroidism with multigland disease. J Nucl Med 54:44p
Sundin A, Johansson C, Hellman P, Bergstrom M, Ahlstrom H, Jacobson GB et al (1996) PET and parathyroid L-[carbon-11]methionine accumulation in hyperparathyroidism. J Nucl Med 37:1766–1770
Cook GJR, Wong JCH, Smellie WJB, Young AE, Maisey MN, Fogelman I (1998) [11C] Methionine positron emission tomography for patients with persistent or recurrent hyperparathyroidism. Eur J Endocrinol 139:195–197
Beggs AD, Hain SF (2005) Localization of parathyroid adenomas using 11C-methionine positron emission tomography. Nucl Med Commun 26:133–136
Weber T, Maier-Funk C, Ohlhauser D, Hillenbrand A, Cammerer G et al (2013) Accurate preoperative localization of parathyroid adenomas with C-11 methionine PET/CT. Ann Surg 257:1124–1128
Quak E, Lheureux S, Renzik Y et al (2013) F18-Choline, a novel tracer for parathyroid adenoma? J Clin Endocrinol Metab 98(8):3111–3112
O’Doherty MJ, Kettle AG, Wells P, Collins RE, Coakley AJ (1992) Parathyroid imaging with technetium 99m-sestamibi: preoperative localization and tissue uptake studies. J Nucl Med 33:313–318
Piwnica-Worms D, Chiu ML, Budding M, Kronauge JF, Kramer RA, Croop JM (1993) Functional imaging of multidrug resistant P-glycoprotein with an organotechnetium complex. Cancer Res 53:977–984
Neumann DR, Esselstyn CB, MacIntyre WJ, Go RT, Obuchowski NA, Chen EQ et al (1996) Comparison of FDG-PET and sestamibi SPECT in primary hyperparathyroidism. J Nucl Med 37:1809–1815
Civelek AC, Ozalp E, Donovan P, Udelsman R (2002) Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperthyroidism. Surgery 131:149–157
Bonjer HJ, Bruining HA, Valkema R, Lameris JS, de Herder WW, van der Harst E, Pols HA (1997) Single radionuclide scintigraphy with 99m-technetium-sestamibi and ultrasonography in hyperparathyroidism. Eur J Surg 163:27–32
De Feo ML, Colagrande S, Biagini C, Tonarelli A, Bisi G, Vaggelli L, Borrelli D, Cicchi P, Tonelli F, Amorosi A, Serio M, Brandi ML (2000) Parathyroid glands: combination of 99mTc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology 214:393–402
Slater A, Gleeson FV (2005) Increased sensitivity and confidence of SPECT over planar imaging in dual-phase sestamibi for parathyroid adenoma detection. Clin Nucl Med 30:1–3
Ishibashi M, Nishida H, Okuda S, Suekane S, Hayabuchi N (1998) Localization of parathyroid glands in hemodialysis patients using Tc-99m sestamibi imaging. Nephron 78:48–53
Klieger P, O’Mara R (1998) The diagnostic utility of dual phase Tc-99m sestamibi parathyroid imaging. Clin Nucl Med 23:208–211
Mazzeo S, Caramella D, Lencioni R, Molea N, De Liperi A, Marcocci C, Miccoli P, Iacconi P, Bossio GB, Viacava P, Lazzeri E, Bartolozzi C (1996) Comparison among sonography, double-tracer subtraction scintigraphy, and double-phase scintigraphy in the detection of parathyroid lesions. AJR Am J Roentgenol 166:1465–1470
Goris ML, Basso LV, Keeling C (1991) Parathyroid imaging. J Nucl Med 32:887–889
Elgazzar AH, Maxon HR, Hertzberg V et al (1985) Parathyroid scintigraphy with and without thyroid hormone suppression. Proceedings of the Eastern Great Lakes Chapter, Society of Nuclear Medicine, Niagara Falls, New York
Takebayashi S, Hidai H, Chiba T, Takaga Y, Nagatani Y, Matsubara S (1999) Hyperfunctional parathyroid glands with Tc-99m MIBI scan: semiquantitative analysis correlated with histologic findings. J Nucl Med 40:1792–1797
Bernard F, Lefebvre B, Beuvon F, Langlois MF, Bisson G (1995) Rapid washout of technetium 99m MIBI from a large parathyroid adenoma. J Nucl Med 36:241–243
Sandrock D, Merino MJ, Norton JA, Neumann RD (1993) Ultrastructural histology correlates with results of Thallium-201/Tc-99m parathyroid subtraction scintigraphy. J Nucl Med 34:24–29
Carpentier A, Jeannotte S, Verrault J, Lefebvre B, Bisson G, Mongeau CJ et al (1998) Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI and oxyphil cell count. J Nucl Med 39:1441–1444
Pinero A, Rodriguez JM, Ortiz S, Soria T, Bermejo J, Claver MA et al (2000) Relation of biochemical, cytologic, and morphologic parameters to the result of gammagraphy with technetium 99m sestamibi in primary hyperparathyroidism. Otolaryngol Head Neck Surg 122:851–855
Naddaf S, Anim JJ, Farghaly MM, Behbehani AE, Alshomar KA, Elgazzar AH (2005) Ultrastructure of hyperfunctioning parathyroid glands: does it explain various patterns of sestamibi uptake. JNM 45:78
Bleier B, LiVolsi V, Chalian A et al (2006) Technetium Tc 99m sestamibi sensitivity in oxyphil cell-dominant parathyroid adenomas. Arch Otolaryngol Head Neck Surg 132:779–782
Kao A, Shiau YC, Tsai SC, Wang JJ, Ho ST (2002) Technetium-99m methoxyisobutylisonitrile imaging for parathyroid adenoma: relationship to P-glycoprotein or multidrug resistance-related protein expression. Eur J Nucl Med Mol Imaging 29:1012–1015
Nichols K, Tomas M, Tronoco G, Palestro C (2011) Sestamibi parathyroid scintigraphy in multigland disease. Nucl Med Commun 33:43–50
Caixas A, Berna L, Hernandez A, Tebar FJ, Madariaga P, Vegazo O, Bittini AL, Moreno B, Faure E, Abos D, Piera J, Rodriguez JM, Farrerons J, Puig-Domingo M (1997) Efficacy of preoperative diagnostic imaging localization of technetium 99m-sestamibi scintigraphy in hyperparathyroidism. Surgery 121:535–541
Mudun A, Kocak M, Unal S, Cantez S (1995) Tc-99m MIBI accumulation in remnant thymus: a cause of false-positive interpretation in parathyroid imaging. Clin Nucl Med 20:379–380
Desai S, Yuille DL (1993) Visualization of a recurrent carcinoid tumor and an occult distant metastasis by technetium-99m-sestamibi. J Nucl Med 34:1748–1750
Ugur O, Bozkurt MF, Hamaloglu E, Sokmensuer C, Etikan I, Ugur Y, Sayek I, Gulec SA (2004) Clinicopathologic and radiopharmacokinetic factors affecting gamma probe-guided parathyroidectomy. Arch Surg 139:1175–1179
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Elgazzar, A.H., Alenezi, S.A. (2015). Parathyroid Gland. In: Elgazzar, A. (eds) The Pathophysiologic Basis of Nuclear Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-06112-2_8
Download citation
DOI: https://doi.org/10.1007/978-3-319-06112-2_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-06111-5
Online ISBN: 978-3-319-06112-2
eBook Packages: MedicineMedicine (R0)