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Query: UMLS:C0001430 (adenoma)
 21,222 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A series of 46 patients had a tissue diagnosis of primary hyperparthyrodism. Forty (88%) had a single adenoma, one had multiple adenomas; four exhibited parathyroid hyperplasia and one had carcinoma of the parathyroid. The incidence establishing the diagnosis has increased in recent years because of routine multichemistry screening for calcium. The most reliable "diagnostic" laboratory finding was an elevated serum calcium: 96 per cent of our patients had serum calcium above the upper limit of normal. Forty-one patients had lesions removed; parathyroid carcinoma (1), hyperplasia (3), and adenomas (37). Only two patients have presistent disease postoperatively: one with hyperplasia who apparently had an inadequate resection of her involved glands and one who had biopsy of an adenoma without further surgical management.
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PMID:Primary hyperparathyroidism in a referral hospital. 111 55

A radioimmunoassay for parathyroid hormone (PTH) using a double antibody system is described. Because of the immunolgoical heterogeneity of the hormone in human serum, the standard used has been serum from a patient with parathyroid carcinoma. With the use of the synthetic 34 amino acid N-terminal fragment of PTH, the anti-PTH antiserum was determined to react primarily with the N-terminal end of the molecule. PTH was detectable in the sera of 25% of normal subjects and elevated in 18 of 19 patients with parathyroid adenoma and carcinoma. Serum PTH levels were elevated in 3 of 5 patients with parathyroid hyperplasia.
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PMID:Serum parathyroid hormone: a double antibody radioimmunoassay. 122 75

Primary hyperparathyroidism (PHP) might be characterized by either prevailing bone or renal stone patterns with different metabolic features. To explore the possibility of different hormonal patterns we studied 129 patients with PHP: 95 stone formers (SF) and 34 nonstone formers (NSF). Females prevailed over males in both groups. Severe and specific bone lesions were more evident in NSF than SF. Parathyroid gland histology displayed a prevalence of adenoma in NSF, whereas isolated hyperplasia prevailed in SF. SF had lower levels of serum Ca, urinary Ca, ALP and serum PTH than NSF. As expected serum 1,25-dihydroxyvitamin D [1,25(OH)2 D] levels were greater in both groups of patients than in controls but we found no difference between the two groups. 25-Hydroxyvitamin D was neither increased with respect to controls nor different between groups. We conclude that patients with PHP may represent well separated metabolic and clinical entities, but we cannot confirm that serum 1,25(OH)2D levels play a key role in discriminating the different clinical features. In addition, the findings of predominant parathyroid hyperplasia in SF and the clinical evidence of recurrent hyperparathyroidism only in these patients suggest the possibility that the endocrine disorder might be the consequence over time rather than the cause of nephrolithiasis.
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PMID:Hyperparathyroidism: cause or consequence of recurrent calcium nephrolithiasis? 129 57

Vitamin D metabolites in serum and calcitriol receptor concentration in parathyroid tissue were examined in 52 patients operated on for primary hyperparathyroidism. The calcitriol receptor levels were not different in parathyroid adenomas (mean 224 fmol/mg of protein, range 29-509, N = 43), normal parathyroid tissue (mean 245, range 31-690, N = 20), and primary parathyroid hyperplasia (mean 172, range 46-477, N = 9). Preoperative serum levels of calcitriol concentration correlated inversely to the calcitriol receptor in normal parathyroid tissue in patients with adenoma (r = -0.57, N = 17, p = 0.017), but no such correlation was found in the corresponding adenomas (r = 0.14, p = 0.59). In 31 patients in whom both pre- and postoperative vitamin D metabolite analyses were carried out, 23 had lower calcitriol postoperative concentrations compared to preoperative values (p = 0.012, sign test). No change was found in the other vitamin D metabolites postoperatively. By multiple regression analysis calcitriol concentration in serum was inversely correlated to the serum concentration of urea and phosphate (p = 0.003). We conclude that calcitriol may influence calcitriol receptor expression in normal parathyroid tissue, but not in adenomatous parathyroid gland. Furthermore, serum calcitriol was correlated to the renal function, and phosphate level, and in most patients the calcitriol concentration was lower after the operation.
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PMID:Serum vitamin D metabolites and calcitriol receptor concentration in parathyroid tissue in primary hyperparathyroidism. 133

In addition to the common presentations of the multiple endocrine neoplasia (MEN) syndromes, unusual organ involvement as rare manifestations of a single disease may occur. Among our patients we have identified four cases in which unusual features of MEN were present. In the first patient, bilateral adrenal cortical adenoma, parathyroid adenoma, multiple pancreatic tumors, and follicular thyroid carcinoma were observed. The second patient suffered from thymic carcinoid, parathyroid hyperplasia, gastrinoma, and pituitary adenoma. Additionally, one family was discovered in which medullary thyroid carcinoma (MTC), Hirschsprung's disease, and pheochromocytoma occurred and another family had MTC and ovarian cancer. Based on these observations, we stress the importance of screening for MEN syndromes in all patients with pathologic findings in any endocrine organ.
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PMID:Unusual features of multiple endocrine neoplasia. 136 16

The term 'Multiple Endocrine Neoplasia' (MEN) denotes a genetically determined syndrome characterized by the independent appearance of benign or malignant changes of several endocrine organs as well as occasional changes of neural, muscular and connective tissue. Three different forms have been identified: MEN 1 (Werner's syndrome) includes parathyroid hyperplasia in combination with pancreatic islet cell and pituitary tumours; MEN 2a (Sipple's syndrome) includes medullary thyroid carcinoma in association with phaeochromocytoma and parathyroid hyperplasia; MEN 2b includes medullary thyroid carcinoma, phaeochromocytoma and mucosal neuromas. MEN syndrome is transmitted as an autosomal dominant trait with a high degree of penetrance. The changes in the individual glands appear to be causally and temporally independent of each other. A spectrum of pathological changes exist in the affected glands which range from hyperplasia to adenoma to carcinoma. The pathological process is almost always multicentric, often resulting in bilateral disease of organs. The appearance of an endocrine tumour known to be associated with MEN should alert the physician to the possibility of a MEN syndrome. When the possibility of such a syndrome exists, screening and long-term observation should be initiated to diagnose a carcinoma in its earliest stage, or before the development of clinical manifestations of hormone excess.
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PMID:Clinical features of multiple endocrine neoplasia type 1 and type 2. 136 14

The entity of preclinical hyperparathyroidism has never been clearly investigated. The authors believe that the incidence of pathologic abnormalities of the parathyroid glands before the development of any symptoms or hypercalcemia (serum calcium > 12.0 mg/dl) is more frequent than has been reported. Over a 14-year period, parathyroid glands were examined during thyroid operations in over 800 patients. Serum calcium and phosphorous levels were measured in all patients preoperatively. Thirty-six patients had additional parathyroid operations for a preclinical form of hyperparathyroidism, defined by abnormal appearing parathyroid glands at the time of thyroid surgery. None of the 36 patients had symptoms of hyperparathyroidism preoperatively. Nine patients had borderline hypercalcemia (serum calcium 10.6 to 12.0 mg/dl), and the remainder were considered normocalcemic. The average age was 53 (range 21 to 75) with a male to female ratio of 1:3. Nine of the 36 patients had thyroid cancer. There were eight patients with parathyroid adenoma and 28 patients with parathyroid hyperplasia. Of 13 patients who had a history of neck irradiation, five had parathyroid adenoma and eight had parathyroid hyperplasia. Only two patients with parathyroid hyperplasia remain on calcium medication. Since preoperative normocalcemia does not preclude the presence of parathyroid pathology, the authors urge careful identification and examination of the parathyroid glands during thyroid operations. It adds little time to the procedure. Excision of parathyroid disease along with the thyroid gland can be performed safely and prevents the need for further operation with its associated morbidity.
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PMID:Incidental preclinical hyperparathyroidism identified during thyroid operations. 145 99

To discriminate benign from malignant parathyroid glands lesions is often difficult, because the morphologic features lack absolute diagnostic value. The differential diagnosis between chief cell hyperplasia and parathyroid adenoma is frequently based on physical features such as increased gland weight and number of enlarged glands. A carcinoma is identified by the evidence of local invasion, metastases or recurrence. Nevertheless the lesions classified as benign for lack of histologic features of aggressiveness can show nuclear atypia, increased mitotic figures and broad fibrous bands. Since DNA aneuploidy is present in a great number of human neoplasms and DNA aneuploidy has been suggest to be a marker of malignancy, flow cytometric assessment of ploidy appeared a possible method for rapid and objective distinction between benign and malignant lesions. Flow cytometric DNA content was evaluated on 113 parathyroid glands: the parathyroids were resected from 26 patients with hyperparathyroidism and from 17 patients with adenoma. The analysis was performed on paraffin-embedded specimens according to Hedley with minor modifications. Interpretable histograms were obtained for 103 parathyroids gland (mean CV = 5.3). Aneuploidy was detected in 22.5% of glands; in 12 instances of parathyroid hyperplasia the glands of the same patient showed different DNA Indexes. Cytometric results and morphological features do not correlate as far as aneuploidy and cellular atypia are involved. Although our results fail to show any correlation between morphology of parathyroid cells and DNA content, and abnormal DNA content suggests a careful follow up of these patients.
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PMID:[The use of flow cytometry in the study of parathyroid hyperplasia and adenomas]. 149 87

Controversy exists concerning indications for primary hyperparathyroidism surgery, tests to localize parathyroid tumors, pathologic criteria for adenoma and hyperplasia, and unilateral versus bilateral surgery for hyperparathyroidism. Seventy cases were reviewed. Results of localization tests, sites of aberrant tumors, symptoms, complications, and ratio of adenoma to hyperplasia will be presented. The foreseeable trends are continued improvement in localization techniques, earlier intervention in the disease spectrum, unilateral exploration for adenoma and bilateral surgery for hyperplasia, and acceptance of primary nodular hyperplasia and normal size with hypercellularity as pathologic entities in primary parathyroid hyperplasia.
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PMID:Trends in primary hyperparathyroidism surgery. 155 92

Plasma levels of intact parathyroid hormone (PTH) were measured intraoperatively before and after removal of one enlarged gland in 20 hyperparathyroid patients. In 13 patients with a single parathyroid adenoma, plasma levels of intact PTH-(1-84) had declined at 15 min after removal of the adenoma by 86.5 +/- 4.4% of baseline in the antecubital vein and by 85.6 +/- 4.2% in the ipsilateral internal jugular vein. In seven patients with parathyroid hyperplasia, the corresponding figures for decline at 15 min after removal of one enlarged parathyroid gland were only 26.6 +/- 6.4% and 7.8 +/- 29.4%. The fall in PTH levels was significantly less in hyperplasia than in adenoma (p less than 0.001). Thus 15 min after removal of one enlarged parathyroid gland, the decline in plasma level of intact PTH may distinguish between single adenoma and multiglandular disease as the cause of hyperparathyroidism.
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PMID:Intraoperative fall in plasma levels of intact parathyroid hormone after removal of one enlarged parathyroid gland in hyperparathyroid patients. 167 1


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