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At least 343 records · Page 19Linked to original sources

PubMed2003

Efficacy of direct injection of calcitriol into the parathyroid glands in uraemic patients with moderate to severe secondary hyperparathyroidism.

INTRODUCTION: Secondary hyperparathyroidism (2HPT) is a common complication in uraemic patients. When medical therapy, including high doses of intravenous calcitriol, fails to suppress the pathological secretion of parathyroid hormone (PTH), one of the newly developed interventional techniques, such as percutaneous ethanol injection therapy (PEIT), is an option before taking the surgical solution. A protocol for direct calcitriol injection therapy and a discussion of its effectiveness and limitations for an enlarged parathyroid gland(s) are presented. METHODS: Nine patients were selected according to the Japanese Guideline for Selective PEIT. Using the same technique as PEIT, a dose of calcitriol that was approximately 200-300% of the calculated volume of the selected parathyroid gland was injected directly into the gland under ultrasonographic guidance. RESULTS: In six cases, the intact PTH concentration decreased to <360 pg/ml. The total volume of the enlarged parathyroid gland(s) also decreased to 54.7% of the initial volume. The blood supply to the treated glands, as evaluated by colour Doppler imaging, appeared to diminish transiently after injection, probably from the volume effect of this procedure. The number of enlarged parathyroid glands was not a limiting factor for this therapy; however, a grossly enlarged parathyroid gland (>2000 mm(3)) appeared to be resistant to this intervention and an intrathoracic parathyroid gland was found in a non-responsive case. None of the patients had any severe complications, such as nerve palsy or massive haemorrhage. CONCLUSION: This new approach to the control of 2HPT is recommended as an alternative pharmacological parathyroidectomy to surgical therapy.

Calcitriol↗

PubMed1993

[Genetic hypertension in the rat is partially dependent of parathyroid glands. Results of a crossed transplantation trial].

The parathyroid hypertensive factor (PHF) is present in the plasma of SHR rats. The authors of this study set out to determine whether this factor was also present in the Lyon (LH male and female) and Milan (MHS male) hypertensive rats. Five week old normotensive rats (LN and MNS) were transplanted with the parathyroid glands of LH and MHS rats immediately after parathyroidectomy (PTX). Plasma calcium fell rapidly after PTX but returned to physiological levels, confirming the functional activity of the graft. Systolic blood pressures of transplanted rats were significantly higher than normotensive LN and MNS controls. These results confirm the role of the parathyroid glands in the genesis of hypertension in Lyon and Milan male and female rats. They suggest that PHF may be implicated in the hypertensive mechanisms of these two models of genetic hypertension.

Animals↗

PubMed1983

Parathyroid gland of the freshwater snake Natrix piscator Schneider.

The structure and function of the parathyroid glands of freshwater snake, Natrix piscator, were studied. N. piscator has two pairs of parathyroid glands which are composed of cell cords of typical endocrine appearance, and follicles are absent. Parathyroidectomy was followed by significant (P less than 0.001) hypocalcemia and hyperphosphatemia throughout the 5th week of experimental period. Following parathyroidectomy, calcium and phosphate concentrations in bone were significantly (P less than 0.05) increased after 5 weeks; however, these values in muscle were not significantly changed. Tetany was also observed in parathyroidectomized snakes. Histological structure and function of the glands do not appear to vary seasonally. Administration of parathyroid gland extract of this ophidian reptile into rats caused significant (P less than 0.05) elevation of serum calcium.

Animals↗

PubMed1981

Bone pathology and parathyroid gland activity in hypocalcemic magnesium-deficient chicks.

Growing chicks fed magnesium-deficient (150 ppm Mg) diets for 14 or 21 days developed significant hypomagnesemia and hypocalcemia compared to control chicks fed 1,000 ppm Mg. The hypocalcemia was accompanied by significant parathyroid gland hyperactivity, suggesting that magnesium deficiency did not impair parathyroid gland function. Despite parathyroid gland hyperactivity, however, bone resorption was decreased in the magnesium-deficient chicks, although bone formation was not affected by magnesium depletion. The decrease in bone resorption in the magnesium-deficient chicks was correlated with significant bone magnesium depletion and resulted in increased bone calcium content. These findings suggested that the development of hypocalcemia in magnesium-deficient chicks was related to decreased bone resorption, due to impaired osteocytic function rather than parathyroid gland insufficiency. The results also offer an explanation for the decrease in skeletal responsiveness to PTH which has been reported during magnesium depletion.

Animals↗

PubMed2000

Preoperative contrast-enhanced MRI of the parathyroid glands in hyperparathyroidism.

RATIONALE AND OBJECTIVES: To evaluate the sensitivity of contrast-enhanced MRI in the preoperative detection of abnormal parathyroid glands in patients with clinical evidence of hyperparathyroidism. METHODS: Twenty-eight patients with biochemical evidence of hyperparathyroidism underwent contrast-enhanced preoperative MRI of the parathyroid glands. Two blinded readers assessed the MR images by consensus, and MR results were subsequently correlated with those from surgery (location, diameter, weight) and histopathology. RESULTS: MRI depicted 32 of 39 surgically proved abnormal parathyroid glands (sensitivity 82%; 95% confidence interval, 66%-92%), and 1 of 114 (0.9%) was incorrectly considered abnormal. All ectopic glands were correctly identified (2 mediastinal, 1 submandibular). Sensitivity was superior for adenomas but less for hyperplasia (adenomas 87%; 95% confidence interval, 67%-97%; hyperplasia 75%; 95% confidence interval, 47%-92%). Among all lesions, atypical signal characteristics on MRI were observed in 34% of lesions (9% hyperintense signals on T2- and T1-weighted images; 25% isointense signals on T2- and T1-weighted images), with improved lesion detection after contrast administration in 17% of lesions. CONCLUSIONS: MRI of the parathyroid glands presented a sensitive imaging modality, thus demonstrating its high potential to preoperatively detect abnormal glands. Moreover, in a minor proportion of patients with atypical parathyroid lesion characteristics, contrast administration may increase lesion detectability.

Adenoma↗

PubMed1979

Density determinations of human parathyroid glands by density gradients.

The densities of human parathyroid glands were measured in density gradient columns of various media. Percoll (an aqueous colloidal solution of polyvinylpyrrolidone-coated silica), equilibrated to 300 mOsm with sodium chloride, was found to be the ideal gradient medium for density measurements of tissues with a density greater than 1.0 g/ml. which includes most parathyroid glands. The densities of the glands varied between 0.96 and 1.06 g/ml. Density measurements in gradients of Percoll were simple and reproducible and were made with an accuracy of approximately 0.001 g/ml. In other gradient media (aqueous solutions of sucrose and Ficoll, and organic solvents) there was a drift in density caused by osmotic or lipid-solving effects of the media. For measurements of densities less than 1.0 g/ml no ideal gradient medium was found, but a silicon oil or carbon tetrachloride/kerosone gradient could be used with somewhat reduced accuracy. It is concluded that the density gradient technique with the use of Percoll is potentially useful as a complement to routine histopathological parathyroid diagnosis, as glandular density is a good indicator of the relative proportions of parenchymal and fat tissue.

Adipose Tissue↗

PubMed2006

Sestamibi scintigraphy, topography, and histopathology of parathyroid glands in secondary hyperparathyroidism.

BACKGROUND: Several imaging techniques presently are available to assess the location of hyperplastic parathyroid glands. The purpose of the present study is to assess the place of dual-phase technetium Tc 99m-sestamibi (MIBI) scintigraphy in the preoperative localization of hyperplastic parathyroid glands in patients with severe secondary hyperparathyroidism (SHPT). METHODS: We studied 35 consecutive adult white hemodialysis patients undergoing a first parathyroidectomy after performing MIBI scintigraphy. Hyperplasia of the parathyroid glands was classified as diffuse (DH) or nodular (NH). Statistical analysis was conducted by comparing patients with MIBI-negative (no focal area of increased uptake) with MIBI-positive (> or = 1 focal area of increased uptake) results and stratifying parathyroid glands according to location (superior and inferior). RESULTS: MIBI scintigraphy showed focal areas of increased uptake in at least 1 gland in 25 patients (71.4%). Total number of focal areas of increased uptake was 42 of 121 glands removed (sensitivity, 34.7%; specificity, 100%). One hundred one glands showed NH and 20 glands showed DH. The 25 patients with MIBI-positive results had 85 pathological glands removed, and the 10 patients with MIBI-negative results had 36 pathological glands removed: in the former, most glands showed NH (77 of 85 glands; 90.6%), and in the latter, 24 of 36 glands showed NH (66.7%; P = 0.004 at chi-square test). The sensitivity of MIBI scintigraphy for distinguishing specific subtypes of hyperplasia was 37.6% (38 of 101 glands) for NH and 20.0% (4 of 20 glands) for DH (P = 0.0005). The following values were significantly greater in inferior compared with superior glands: (1) estimated weight (2.1 +/- 0.8 versus 1.6 +/- 1.2 g; P = 0.04), (2) percentage of MIBI positivity (34 of 42 inferior glands [80.9%] versus 8 of 42 superior glands [19.1%]; P = 0.0001), and (3) percentage of localization permitted by MIBI scintigraphy (34 of 63 inferior glands [54.0%] versus 8 of 58 superior glands [13.8%]; P = 0.0001). Thus, NH, although equally distributed between inferior (53 of 63 glands) and superior (48 of 58 glands) glands, showed a percentage of MIBI positivity significantly greater in inferior (34 of 53 glands [64.1%]) compared with superior glands (8 of 48 glands [16.7%]; P = 0.0001). CONCLUSION: MIBI scintigraphy did not show high sensitivity in identifying hyperplastic glands, although it was able to identify those with NH better than those with DH. Thus, MIBI scintigraphy has limited value preoperatively for patients with SHPT. Estimated weight, percentage of MIBI positivity, and percentage of localization permitted by MIBI scintigraphy were significantly greater in inferior glands.

Adult↗

PubMed1975

The parathyroid glands of the Mongolian gerbil (Meriones unguiculatus).

The parathyroid glands of adult Mongolian gerbils were studied under an operation microscope, as well as with the aid of conventional light microscopy, and transmission and scanning electron microscopy. The mean serum level of calcium was 5.1 mEq/1 and that of phosphorus was 4.8 mg/100 ml. The animals possessed two small parathyroid glands, usually situated anteriorly and slightly laterally to the superior thyroid poles. The glands had a rich vascular supply and were composed of sheets of chief cells, which varied in electron density and content of organelles. No water-clear, oxyphil, or intraglandular fat cells were found. Some mitochondria exhibited electron lucent areas, and separation and bulbous projections of the membranes. The cell membranes were straight or tortuous and possessed microvilli, occasionally with central filamentous structures. The intercellular spaces were usually narrow. It is supposed that the variants of chief cells are interchangeable and that the differences in their morphological appearance are related to differences in functional state.

Animals↗

PubMed1975

A biologically active hormonal fragment isolated from bovine parathyroid glands (BPTH 1-65).

Fresh frozen bovine parathyroid glands were defatted in acetone, when extracted with phenol. Following trichloroacetic acid precipitation, the resultant peptides were chromatographed on Sephadex G-100. Parathyroid hormone (BPTH) characteristically elutes in the fourth peak. However, we also observed significant hormonal activity, both biological and immunological, in the fifth elution peak. The peak V material had potent hypercalcemic activity in the rat and chick, and stimulated adenylate cyclase activity in the rat renal cortex bioassay. This material was further purified by ion exchange chromatography on carboxymethylcellulose in 8 M urea. The biological activity of the purified peptide (3700 MRC units/mg) was equivalent to that of the native hormone on a molar basis. Amino acid analysis, carboxypeptidase digestion, and partial Edman sequence analysis identified this material as BPTH 1-65, a hormonal fragment lacking the C-terminal 19 residues of the 84 residue hormone molecule. Several immunoassays using different anti-PTH antisera had variable reactivity toward the BPTH 1-65 fragment, showing that it may be useful for further characterizing antibody recognition sites. The presence of a lysine residue at position 65 suggests a tryptic-like cleavage may be responsible for the genesis of this hormonal fragment. Further investigation will be necessary to determine if this peptide has physiological significance.

Amino Acid Sequence↗

PubMed2003

Differential regulation of PHEX expression in bone and parathyroid gland by chronic renal insufficiency and 1,25-dihydroxyvitamin D3.

Mutations in the PHEX gene are responsible for X-linked hypophosphatemia, a renal phosphate-wasting disorder associated with defective skeletal mineralization. PHEX is predominantly expressed in bones and teeth and in the parathyroid gland of patients with chronic renal failure and tertiary hyperparathyroidism. The purpose of the present study was to examine the effects of renal insufficiency and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] on the regulation of PHEX expression in rat tibia and parathyroid gland. In rats fed a high-phosphate (Pi) diet, nephrectomy elicited a significant increase in the serum parathyroid hormone (PTH) concentration that was associated with a significant increase in the abundance of PHEX mRNA and protein in the tibia and a significant increase in PHEX mRNA in the parathyroid gland. In contrast, 1,25(OH)2D3 administration to intact rats fed a control diet elicited a significant decrease in the serum PTH concentration that was accompanied by a significant decrease in PHEX mRNA and protein abundance in the tibia and a significant decrease in PHEX mRNA in the parathyroid gland. In addition, the increases in serum PTH levels and PHEX mRNA in the tibia and parathyroid gland in nephrectomized rats fed a high-Pi diet were blunted by 1,25(OH)2D3. Serum PTH concentration was positively and significantly correlated with tibial PHEX mRNA and protein abundance. In summary, we demonstrate that PHEX expression in the tibia and parathyroid gland is increased by chronic renal insufficiency and decreased by 1,25(OH)2D3 administration and suggest that PTH status may play an important role in mediating these changes in PHEX expression.

Animals↗

PubMed2001

Morphological identification of the lipid-storing cells in golden hamster parathyroid glands after vitamin A treatment.

We investigated hamster parathyroid glands of different ages using electron microscopy and found a new cell type in young, adult and senile hamsters. Theses special cells were located in interstitial tissues and invariably contained several lipid droplets within the cytoplasm. The cells showed an elongated spindle with some cell processes. The cells contained small Golgi complexes and moderate cisternae of the granular endoplasmic reticulum. The morphological characteristics of these cells were mostly the same as those of lipid-storing cells in other organs (Yamada and Hirosawa, 1976). After vitamin A administration, the lipid droplets in these cells markedly increased in number and also in volume density. The other morphological features of these cells resembled those of the control animals. We called these cells parathyroid lipid-storing cells. They may incorporate and store vitamin A within the lipid droplets. They can be classified as one of the cellular components in hamster parathyroid gland.

Age Factors↗

PubMed2005

Best practice no 183. Examination of parathyroid gland specimens.

The pathological examination of parathyroid glands is an essential component of the evaluation of hyperparathyroidism. Traditionally, this has involved intraoperative frozen sections during bilateral surgical exploration of the neck, to confirm removal of parathyroid tissue. With recent developments in imaging, some diseased glands can be localised preoperatively, enabling removal by minimally invasive, targetted surgery, with or without additional non-histological intraoperative procedures to confirm the removal of all hyperfunctioning parathyroid tissue. This article reviews these developments and describes the ideal approach to reporting parathyroid specimens.

Adenoma↗

PubMedDate not supplied

Magnetic resonance imaging (MRI) and technetium-99m-methoxyisonitrile (MIBI) scintigraphy to evaluate the abnormal parathyroid gland and PEIT efficacy for secondary hyperparathyroidism.

PURPOSE: Percutaneous ethanol injection therapy (PEIT) of the abnormal parathyroid gland is an effective treatment in patients with chronic renal failure with dialysis that tends to be unresponsive to medication. To evaluate the efficacy of PEIT, we investigated the correlation between serum intact PTH (iPTH), and the findings of MR imaging and 99mTc-MIBI scintigraphy. MATERIALS AND METHODS: PEIT was performed 32 times in 24 patients with secondary hyperparathyroidism. Both MR imaging and MIBI scintigraphy were performed before and after PEIT. The detectability of parathyroid lesions was evaluated by MRI and MIBI scintigraphy with reference to ultrasound (B-mode) findings (as a standard) and the comparison of each treatment was done between imaging changes and serum iPTH levels. RESULTS: In the small parathyroid glands (< 0.5 ml with US), MR images detected abnormal glands in 74.0% (20/27), and MIBI accumulation was observed in 40.7% of the cases. Whereas, MR images and MIBI showed similar detectability (95.0% vs. 90.0%) to large parathyroid glands (> or = 0.5 ml with US). After PEIT, glands in which ethanol was successfully injected showed decreased signal intensity on T2-weighted images and decreased accumulation of MIBI. MR imaging and MIBI scintigraphy showed almost equivalent high sensitivity in evaluating therapeutic changes (73.3% vs. 76.4%) according to our evaluation category of more than 30% reduction of iPTH as effective. However, the specificity of MR imaging was much higher (100%) than that of MIBI scintigraphy in evaluating therapeutic effects. CONCLUSION: In conclusion, MRI provided better detectability of abnormal parathyroid glands than 99mTc-MIBI scintigraphy. The reduction of high signal intensity area after PEIT on T2-weighted MR images is considered an useful therapeutic evaluation guideline than the reduction of MIBI accumulation on scintigraphy.

Adult↗

PubMed2002

Effects of 1,25-dihydroxy-22-oxavitamin D(3) on parathyroid gland function in haemodialysis patients with secondary hyperparathyroidism.

Secondary hyperparathyroidism (2HPT) is characterized by an abnormal threshold for suppression of parathyroid hormone (PTH) secretion by serum ionized Ca (ICa). It is therefore critical to examine the threshold of PTH secretion in chronic renal failure patients in relation to the physiopathological conditions and the severity of 2HPT. The effect of 1,25-dihidroxy-22-oxavitamin D(3) (22-oxacalcitriol, OCT) on parathyroid gland function was investigated in six haemodialysis patients with 2HPT. OCT was administered three times a week for 26 consecutive weeks. The maximum serum PTH (PTHmax), the minimum serum PTH (PTHmin), and ICa concentration required to inhibit 50% of PTHmax were estimated based on the model formula of the sigmoid curve describing the relationship between ICa and intact-PTH levels. The sigmoid ICa-PTH curves displayed a downward shift at 12 and 26 weeks of OCT treatment. Parathyroid gland function, as reflected by both PTHmax and PTHmin, decreased over time. A steep slope was found at 12 and 26 weeks, compared with that at the start of OCT treatment. There were no marked changes in the set point of calcium. Hypercalcaemia and elevated creatine phosphokinase, probably due to OCT therapy, were observed during the study period. In view of the findings that the sigmoid ICa-PTH curve displayed a downward shift, that both PTHmax and PTHmin decreased, and that functional mass of the parathyroid gland was reduced, OCT appears to be useful in ameliorating parathyroid gland function, contributing to the management of 2HPT.

Adult↗

PubMed2001

Relation between technetium 99m-methoxyisobutylisonitrile accumulation and multidrug resistance protein in the parathyroid glands.

Technetium 99m ((99m)Tc)-methoxyisobutylisonitrile (MIBI) scintigraphy has been reported to be a useful method for visualizing the parathyroid glands for the diagnosis of hyperparathyroidism. Some drug metabolism transporters, such as p-glycoprotein (P-GP) or multidrug resistance-associated protein (MRP), are believed to be involved with one mechanism of (99m)Tc-MIBI accumulation in the parathyroid glands. We analyzed the expression of P-GP and MRP in 40 parathyroid glands from eight patients with primary hyperparathyroidism and six patients with secondary hyperparathyroidism using an immunohistochemical procedure. These patients underwent (99m)Tc-MIBI scintigraphy and thallium 201 ((201)Tl)/(99m)Tc subtraction scintigraphy preoperatively. We investigated the relation between the scintigraphic images and the expression of P-GP and MRP. The positive findings of (99m)Tc-MIBI accumulation in the hyperfunctioning parathyroids were increased significantly. There was a significant difference between the expression of P-GP and the (99m)Tc-MIBI scintigraphy findings. High expression of P-GP in parathyroid cells resulted in the negative image of (99m)Tc-MIBI, and low or no expression of P-GP made the image positive. There was no significant difference between the expression of MRP and the (99m)Tc-MIBI scintigraphic imaging. The (99m)Tc-MIBI image was also related to the weight of the parathyroid glands but not to the type of the parathyroid cells. Based on these clinical findings, we can hypothesize that P-GP functions as a drug transporter not only for chemotherapeutic agents but also for (99m)Tc-MIBI.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed1978

[Histogenesis of adenomas of the parathyroid gland].

The similarity of adenomas of the parathyroid gland with other tumours of the APUD-system elements was investigated. The structure of 10 adenomas was studied. The ultrastructural characteristics were compared with the histological structure of the tumour. Various histological variants of the neoplasias were shown to have similar ultrastructure. The tumour tissue was represented by clear transitional and dark cells. In their cytoplasm, osmiophilic granules of the secrete, villae, laminar structures resembling Nissl bodies, fine granular and fine fibrous substances, and lipid inclusions were found. The structural similarity of adenomas with other endocrine-active tumours developing from cells of the neuroectodermal origin (carcinoids, paragangliomas, etc.) was noted. It is suggested that parathyroid glands belong to the APUD-system.

Adenoma↗

PubMed2000

Weight characteristics of the parathyroid glands in renal hyperparathyroidism.

BACKGROUND: Although the mean weight of normal parathyroid glands is known, reports concerning the weight of hyperplastic glands in renal hyperparathyroidism are rare. The aim was to collect data about the weight of such glands and also to study the intraindividual distribution. METHODS: Statistical results are presented about the weight of 60 parathyroid glands that were removed in 20 patients with renal hyperparathyroidism (the fourth gland was subtotally removed and therefore not included in the study). RESULTS: The median weight was 1.005 g, with a range from 0.10 to 7.15 g. All removed glands were enlarged, but the most salient finding was the wide distribution of weights. Also, the intra-individual variation was great. The largest gland of each patient weighed, on average, three to four times more than the smallest gland of the same subject. CONCLUSION: The weight of the superior glands tended to be somewhat greater in comparison with the inferior glands.

Adult↗

PubMed2002

Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m)technetium sestamibi scintigraphy.

OBJECTIVE: To determine the utility of ultrasonography for the preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism, and to compare this method with (99m)technetium sestamibi scintigraphy. DESIGN: The results of ultrasonography for localization of enlarged parathyroid glands were determined in 120 consecutive patients with primary hyperparathyroidism and compared with findings at surgery (n = 86) and with the results of (99m)technetium sestamibi scintigraphy (n = 99). PATIENTS: All patients had biochemically documented primary hyperparathyroidism based on elevated serum calcium and 'intact' parathyroid hormone measured by immunoassay. Patients with prior parathyroid surgery or secondary hyperparathyroidism were excluded. MEASUREMENTS: High-resolution ultrasonography was performed by a single observer. (99m)Technetium sestamibi scintigraphy was performed using early and delayed (2-h) views, and correlated with simultaneous thyroidal 123I uptake in most patients. RESULTS: Ultrasonography detected putative enlarged parathyroid glands in 92 of 120 unselected patients (77%). It correctly predicted surgical findings in 64 of 86 patients undergoing surgery (74%), including 61 of 72 patients with solitary eutopic parathyroid adenomas (84%), but only two of eight patients with solitary ectopic adenomas, and only one of six patients with multigland parathyroid disease. Sestamibi scintigraphy was positive in 87 of 99 unselected patients (88%), a higher proportion than ultrasonography (P < 0.05), reflecting superior sensitivity for the detection of ectopic parathyroid adenomas. For 74 patients undergoing parathyroid surgery who underwent both imaging tests there was no statistically significant difference between ultrasonography and sestamibi scintigraphy in ability to correctly predict surgical findings (74%vs. 82%, respectively) or in positive predictive value (93%vs. 90%, respectively). However, sestamibi scintigraphy was clearly more sensitive for ectopic parathyroid adenomas, providing correct localization in 8/8 cases. When one test was negative, testing with the second method was usually positive, improving the likelihood of a positive result to 98% when both tests were employed. CONCLUSIONS: Ultrasonography can be a sensitive and accurate method for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism, comparable in overall utility to sestamibi scintigraphy. These results suggest that a strategy of initial testing with one or the other method, followed by the alternate imaging test if the first test is negative, would provide correct parathyroid imaging in most patients without prior parathyroid surgery.

Adenoma↗