Parathyroid Gland Histopathology M-2 P.E. Wakely, Jr., M.D. Department of Pathology Wexner Medical...

Parathyroid Gland Histopathology M-2

P.E. Wakely, Jr., M.D.Department of Pathology

Wexner Medical Center

Parathyroid Gland - Objectives

Describe

• the embryology & histology of the parathyroid glands.

Define

• the etiology and clinical features of hyper- and hypo-parathyroidism.

Recognize

• the distinction between parathyroid hyperplasia and parathyroid adenoma.

Parathyroid Glands

Derived from pharyngeal pouches

Inferior glands from 3rd pouch

Superior glands from 4th pouch

Typically 4 glands – 2 on each side

Cell Types: • Chief cells: pale or clear

cytoplasm• Oxyphil cells:

eosinophilic cytoplasm• 30-40 mg. each

Two major diseases: • hyper- and hypo- PTH

Ivar Sandström, MD1852-1889

26 y/o medical student Uppsala Hospital Discoverer of

parathyroid glands Suicide, age 37 yrs.

Normal parathyroid

Primary HyperParathyroidism

serum PTH level

Mobilized Ca++ serum Ca++, serum P

Etiology: adenoma – 80%• hyperplasia – 15-20%• carcinoma – <1 %

Clinical Manifestations• F:M = 4:1; 50-75 yrs. • renal calculi / weakness/fatigue / osteoporosis / bone resorption

[osteitis fibrosa cystica]• mental status change, seizures

Fig. 10-44. Parathyroid hyperplasia. All four glands are enlarged, albeit not to the same extent.

Parathyroid hyperplasia

Capt C. Martell

1926 the first parathyroidectomy performed in the USA.

Over several yrs. had 6 operations in neck for hyperparathyroidism

7th operation: found tumor in mediastinum.

Cured hyperPTH

Died 6 weeks later from hypocalcemic-induced hypoparathyroidism.

PTH Adenoma

Parathyroid adenoma

PTH Adenoma

PTH Adenoma, Oxyphilic Type

PTH Adenoma

PTH Adenoma, Clear Cell Type

h13

85-90%

5-15%

HypoParathyroidism

serum Ca++

Etiology• inadvertent surgical removal, congenital absence,

idiopathic atrophy

Clinical manifestations• tetany [neuromuscular irritability numbness

laryngospasm, seizures] • mental status changes, • cardiac conduction disturbances: prolongation QT

interval

Thank you for completing this module. QUESTIONS?

Please direct questions to: Paul.Wakely@osumc.edu

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