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At least 19 recordsLinked to original sources

Autoimmune diseases of the adrenal glands, parathyroid glands, gonads, and hypothalamic-pituitary axis.

Autoimmunity directed against the adrenal glands, parathyroid glands, gonads, and hypothalamic-pituitary axis can arise in isolation or as part of a polyglandular autoimmune syndrome. Affected patients can be asymptomatic, but they may also suffer significant morbidity or even mortality. Currently, treatment is restricted largely to hormone replacement when end-organ destruction is almost complete. As our understanding of the pathogenesis of autoimmune endocrinopathies improves, it is probable that early patient detection will become practical and trials of protective immunotherapies entertained.

Addison Disease↗

Immunohistochemical demonstration of keratins in the cysts of thyroid glands, parathyroid glands, and C-cell complexes of the dog.

Cyst structures were often detected in and around thyroid glands of the dog. The present study revealed the frequency of occurrence, the light microscopic features, and the immunoperoxidase reactions to anti-keratin and anti-19S-thyroglobulin antisera of each cyst located in parathyroid III, parathyroid IV, thymus IV, C-cell complexes, and thyroid parenchyma from 112 dogs. In each location, cysts showed characteristic features. In parathyroid III, the cysts were covered with single or pseudostratified epithelium composed of ciliated cells; whereas in parathyroid IV they were covered with keratinizing stratified squamous epithelium. In C-cell complexes, small cysts lined with small packed cells were predominant, and large cysts lined with single cuboidal cells or stratified squamous cells were also present. In thymus IV located in the close vicinity of parathyroid IV, cyst epithelium consisted of several types of cells showing variable features. In thyroid parenchyma, there were several types of cysts: some were covered with ciliated columnar cells, and others were covered with two or multilayers of small packed cells or cuboidal cells. In spite of these differences in appearance of the cysts located in different tissues, all their epithelia were immunoreactive to the keratin antisera, except for small cysts in C-cell complexes, which were regarded as immature structures. Thus, the presence of keratin filaments in epithelial cells seems to be a characteristic feature of all cysts. The lumens of each cyst contained variable amounts of amorphous materials, which showed colloid-like, flocculent, foamy, and granular features and were periodic acid-Schiff-positive in variable degrees, from weak to intense. Although the lumenal contents of the cysts in parathyroid III revealed no immunoreactivity for 19S-thyroglobulin, those in thyroid parenchyma, C-cell complexes, parathyroid IV, and thymus IV reacted strongly with the 19S-thyroglobulin antiserum.

Animals↗

Multiple ectopic parathyroid glands.

Parathyroid surgery to correct primary hyperparathyroidism is successful in 80 to 97 per cent of initial explorations. Failures are often linked to inability to locate ectopic parathyroid glands. Although ectopic parathyroid glands are relatively common (15%) multiple ectopic glands are rarely reported. We describe a case of multiple ectopic parathyroid glands and the intraoperative approach to their localization and review the anatomy and embryology of ectopic parathyroid glands. A 39-year-old woman presented with fatigue, lethargy, and depression. On biochemical evaluation she was noted to be hypercalcemic and hyperparathyroid. Preoperative parathyroid localization failed to identify abnormal parathyroid glands. At exploration three of four parathyroid glands, including an adenoma, were located in ectopic positions by a meticulous and systematic dissection. A careful exploration coupled with a thorough knowledge of parathyroid anatomy and embryology will produce successful surgical correction of primary hyperparathyroidism in greater than 95 per cent of patients even in the few patients with multiple ectopic parathyroid glands.

Adult↗

Case of a parathyroidectomized patient observed longitudinally by ultrasonography. Relationship between the growth rates and 1,25-dihydroxyvitamin D3 receptor contents in the parathyroid glands.

Parathyroid glands enlarge gradually with the progression of secondary hyperparathyroidism. The significance of down-regulation of the 1,25-dihydroxyvitamin D receptor (VDR) in parathyroid glands has been emphasized. Here we report a case in whom the relationship between the growth rates of the parathyroid glands and their VDR content was examined. A 36-year-old man, who had been hemodialyzed for 8.8 years because of chronic renal failure due to chronic glomerulonephritis, developed severe secondary hyperparathyroidism. The first ultrasonographic examination of the parathyroid glands, performed 10 months before parathyroidectomy, revealed that the sizes of the right upper (RU) and left upper (LU) glands were 10 x 8 x 5 and 14 x 10 x 9 mm3, respectively, although the right lower (RL) and left lower (LL) glands were not detected. The second ultrasonographic examination performed 5 days before PTX revealed that the RU gland had enlarged up to 24 x 12 x 10 mm3, while the LU gland remained unchanged at 16 x 9 x 8 mm3. At this time, the sizes of the RL and LL glands were determined only in the longitudinal section to be 10 x 5 and 4 x 3 mm2, respectively. In the excised specimens, the sizes and weights of the RU and RL glands were 25 x 10 x 9 mm3 and 1,950 mg and 17 x 10 x 8 mm3 and 1,160 mg, respectively, while those of the LU and LL glands were 16 x 10 x 7 mm3 and 850 mg and 9 x 8 x 7 mm3 and 350 mg, respectively. Histopathologic study demonstrated that the RU and RL glands exhibited nodular hyperplasia, while the LU and LL glands exhibited diffuse hyperplasia. Using a ligand binding assay, the VDR content of the rapidly growing RU and RL glands were significantly reduced to 32.6 +/- 9.6 and 32.7 +/- 5.2 fmol/mg protein, respectively, as compared to that of the LU gland with no significant proliferating activity (111.8 +/- 0.8 fmol/mg protein). It is of great interest that the smallest LL gland, which showed some proliferating potential in spite of a histologic pattern of diffuse hyperplasia, has a VDR content of 41.0 +/- 2.6 fmol/mg protein. In summary, it was implied from this case that the VDR content in the parathyroid gland might reduce as the growth rate of the parathyroid gland increases and, furthermore, that the VDR content seems to depend to some degree on the histopathologic pattern rather than on gland weight.

Adult↗

[Structure and age-related changes of the microcirculatory routes of human parathyroid glands].

Parathyroid glands (648), obtained from 170 cadavers of men and women of different age (from neonatal to the age of 90 years) were examined. Impregnation methods after V. V. Kupriyanov, Gros-Bilshovsky modified by Campos, and general histological methods were used to study the microcirculation tracts. In neonates these tracts are characterized by homogenous structure, immature "accomodations" for the circulation control; the gland capsule displays regional vascular complexes. Formation of the microcirculation tracts of the parathyroid gland courses up to the first period of mature age; later the volume of the venous link of the microcirculation tracts increases due to an elevated number of the convoluted, lacune-like dilated venules, venulo-venular anastomoses. Convoluted arterioles and arteriolo-arteriolar anastomoses appear in old age, and the number of arteriolo-venular anastomoses becomes greater.

Adolescent↗

[Thyroid gland and parathyroid gland changes in ultrasound (real time B image)].

Using a high-resolution real-time B-imager, examinations of the thyroid and parathyroid glands of 112 patients revealed small focal lesions (more than 3 mm diameter: thyroid gland, parathyroid gland) as well as diffuse alterations (thyroid gland). The following focal lesions were found: Adenomas of the parathyroid gland (n = 9), haemangiomas of thyroid gland (n = 3), adenomas of thyroid gland (n = 2), metastases into the thyroid gland (n = 7), primary cancer of the thyroid gland or its recurrence (n = 3) and metastases of different cancers in soft tissue of the neck regions (n = 8). A struma nodosa was diagnosed in 15 patients. With regard to diffuse alterations of the thyroid gland, atrophies (n = 6), aplasieas of 1 lobe (n = 2), thyreoiditides (n = 3), and struma diffuse (n = 5). In 49 of 52 cases morphological alterations of the thyroid gland could be excluded, while for the other 3 patients, who had been operated on in the region of the neck, no final evaluation was possible. On comparing these findings with the results of computed tomography and scintigraphy, ultrasound as a screening method showed the highest sensitivity while its specificity could be enlarged by considering the results of scintigraphy. Decision by ultrasound only as to whether a focal lesion was benign or malignant was only possible under certain circumstances. However, a histological diagnosis could not be made by ultrasound.

Adenoma↗

Release of calcium from bone in vitro by homogenates of embryonic chick parathyroid glands.

Parathyroid glands were removed from chick embryos of 12 to 20 days of development and tested for their ability to stimulate calcium release from calcium-45-labeled embryonic chick bone in organ culture. All glands stimulated calcium-45 release to approximately the same degree, although the glands of 16- and 20-day embryos had a somewhat enhanced calcium-mobilizing ability. It appears that parathyroid hormone is present in the embryonic chick coincidental with the time of early development of the skeleton and is present in similar quantities throughout the remainder of embryogenesis.

Age Factors↗

Intermediate-filament proteins in parathyroid glands and parathyroid adenomas.

The intermediate-filament proteins of normal, hyperplastic, and adenomatous parathyroid glands were analyzed immunohistochemically and by immunoblotting with monospecific antibodies. In both normal and adenomatous parathyroid glands, we found keratins with molecular weights of 52, 45, and 40 kilodaltons (Nos. 8, 18, and 19, respectively). Vimentin proteins could be identified only in stromal cells, while glial fibrillary acidic protein was not found. In normal parathyroid glands, neurofilament positivity was seen only in nerve axons. In five of 15 parathyroid gland adenomas some keratin-positive cells expressed neurofilamentlike immunoreactivity also. In cytoskeletal extracts of one adenoma, the 200-kilodalton neurofilament protein was identified by immunoblotting. Thus it appears that some parathyroid gland adenoma cells may acquire neurofilament proteins and coexpress cytokeratin and neurofilament polypeptide in a way comparable with that reported in certain neuroendocrine tumors.

Adenoma↗

Nitric Oxide Synthase in Human Parathyroid Glands and Parathyroid Adenomas.

Nitric oxide (NO) is a novel gaseous intercellular transmitter thought to play important physiological roles in the regulation of blood flow and hormone secretion in, for example, the pituitary, the thyroid, and the endocrine pancreas. Whether nitric oxide synthase (NOS) is present in the human parathyroid glands has not yet been demonstrated. In the present study, histologically normal, but functionally suppressed human parathyroid glands and parathyroid adenomas from patients with primary hyperparathyroidism were investigated by immunocytochemistry with antibodies against neuronal NOS and by reduced nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase histochemistry. We also used H&E to identify the NOS-immunoreactive cells. Immunocytochemistry demonstrated the presence of neuronal-type NOS in a subpopulation of glandular cells, identified as oxyphilic cells, in both normal parathyroid glands and adenomas. NADPH-diaphorase staining visualized NOS in the endothelium of blood vessels and in glandular cells, corresponding to those containing immunoreactive NOS. In addition, we found NADPIH-diaphorase staining in many chief cells. Our results indicate that both glandular cells and vascular endothelium in human parathyroid glands and adenomas express NOS. There is thus a morphological substrate for locally produced NO that may be involved in the regulation of parathyroid blood flow and hormone secretion.

Journal Article↗

Occurrence of oxyphil cells in suppressed parathyroid glands.

Parathyroid glands from Mongolian gerbils cultured for 7 days at a high calcium concentration and examined by electron microscopy, were found to contain suppressed chief cells containing numerous mitochondria, and some oxyphil cells containing an abundance of medium-sized or large mitochondria with calcium-containing precipitates. It is suggested that parathyroid chief cells may be transformed into oxyphil cells, under certain conditions, and that the associated increase in the number and size of the mitochondria may be related to an intracellular accumulation of calcium.

Animals↗

Role of the fetal parathyroid glands and parathyroid hormone-related protein in the regulation of placental transport of calcium, magnesium and inorganic phosphate.

The plasma Ca concentration of the fetus is maintained higher than maternal levels by active placental transport. Ca, Mg and PO4 accumulation by the fetus is mainly associated with skeletal growth. The fetal parathyroid glands are essential for maintenance of elevated plasma Ca, which is necessary for the stimulation of fetal osteoblasts and mineralization of cartilage and osteoid. Fetal thyroparathyroidectomy (TxPTx) results in a decreased activity of the placental Ca pump. The presence of a parathyroid hormone-related protein (PTHrP) has been demonstrated in fetal parathyroid glands and placental tissue. Extracts of fetal parathyroid glands and purified PTHrP, as well as recombinant PTHrP (1-84, 1-108 and 1-141), stimulate Ca and Mg but not PO4 transport across the placenta of TxPTx-ized fetuses perfused with autologous blood in the absence of the fetus. Parathyroid hormone (PTH) and the N-terminal region of PTHrP do not stimulate placental Ca and Mg transport. It is concluded that a mid-molecule region of this novel hormone may be required to stimulate placental Ca transfer and contribute to the regulation of fetal Ca homeostasis.

Animals↗

PHEX expression in parathyroid gland and parathyroid hormone dysregulation in X-linked hypophosphatemia.

X-linked hypophosphatemia (XLH), a renal phosphate (Pi) wasting disorder with defective bone mineralization, is caused by mutations in the PHEX gene (a Pi-regulating gene with homology to endopeptidases on the X chromosome). Parathyroid hormone (PTH) status in XLH has been controversial, with the prevailing belief that hyperparathyroidism develops in response to Pi therapy. We report a 5-year-old girl with XLH (patient 1) who had significant hyperparathyroidism at presentation, prior to initiation of therapy. We examined her response to a single oral Pi dose, in combination with calcitriol, and demonstrated a rise in serum concentration of intact PTH, which peaked at 4 h and paralleled the rise in serum Pi concentration. We also present two other patients whose parathyroid glands were analyzed for PHEX mRNA expression following parathyroidectomy. Patient 2 had autonomous hyperparathyroidism associated with chronic renal insufficiency, and patient 3, with XLH, developed autonomous hyperparathyroidism after 8 years of therapy with Pi and calcitriol. Following parathyroidectomy, patient 3 exhibited an increase in both serum Pi concentration and renal Pi reabsorption. The abundance of PHEX mRNA, relative to beta-actin mRNA, in parathyroid glands from patients 2 and 3 was several-fold greater than that in human fetal calvaria, as estimated by ribonuclease protection assay. In summary, we have shown that hyperparathyroidism can be a primary manifestation of XLH and that PHEX is abundantly expressed in the parathyroid gland. Given that PHEX has homology to endopeptidases, we propose that PHEX may have a role in the normal regulation of PTH.

Adolescent↗

Hypotensive actions of snake parathyroid glands.

Parathyroid gland extracts from four different snake species, Ptyas korros, Ptyas mucosa, Elaphe radiata, and Naja naja, were prepared and their hypotensive actions were assayed in anesthetized P. korros. All extracts were hypotensive and the responses, except that of N. naja, were dose related. Their potencies were, however, different in different species. These data suggest that the hypotensive property of the parathyroid hormone is probably widely distributed in submammalian vertebrates.

Animals↗

[Comparative analysis of the technics of preoperative localization of the parathyroid glands].

Parathyroid surgery needs an appropriate diagnosis and a preoperative localization. We conducted a prospective study to compare the efficacy of 4 different imaging modalities in 17 patients: thallium-technetium subtraction scintigraphy, ultrasonography, computed tomography and arteriography. The sensitivity was: scintigraphy 58%, echotomography 86%, Tc 92% and arteriography only 33%. Neck exploration confirmed the imaging results. We found 15 cases of adenomas (2 cases of double adenoma) and 1 case of hyperplasia; in 1 patient, no lesions were found. We conclude that the association of such techniques appears to be the optimal strategy in about 100% of the patients.

Adenoma↗

Structural analysis of parathormone fragments elaborated by cells cultured from a hyperplastic human parathyroid gland.

Parathyroid cells were obtained by collagenase digestion of 2 g of human parathyroid tissue obtained at surgery from a patient with end stage renal failure and hypercalcemia. Cells were placed into monolayer culture in supplemented Waymouth's MB752/1. Secretion of parathyroid hormone (PTH) from monolayer cultures was inhibited for 3 weeks by 2.5 mM compared to 0.5 mM calcium. The inhibition was 50% on day 3 of culture, and decreased to 19% by day 21. When cultures were incubated with [3H]leucine, radioactive PTH and COOH-terminal PTH fragments were secreted. Sequence analyses were performed on material in radioactive and immunoreactive peaks following gel filtration and high performance liquid chromatography of media. The results indicated that cleavage of PTH or fragments thereof occurred at the 23-24, 27-28, and 33-34 peptide bonds. NH2-terminal fragments of PTH were not detected in media.

Cells, Cultured↗

Aspiration of enlarged parathyroid glands for parathyroid hormone assay.

Enlarged parathyroid glands were percutaneously aspirated under computed tomographic (CT) control in 7 patients, and levels of parathyroid hormone (PTH) and human thyroglobulin (HTg) were measured. All 7 patients had high levels of PTH in at least 1 specimen. It is concluded that the measurement of high concentrations of PTH in the aspirate from a cervical or mediastinal mass, with CT documentation of needle position, provides absolute localization of parathyroid masses.

Adenoma↗

Localization of parathyroid glands.

Parathyroid localization tests are helpful for all patients with primary hyperparathyroidism before parathyroid exploration, and they are essential for patients who have had previous parathyroid or thyroid operations. The selection of specific localization tests depends on whether the patient is undergoing an initial or a reoperative procedure, as well as on the availability of the specialized equipment and expertise of the physicians and technicians performing and interpreting these studies.

Diagnostic Imaging↗