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

Survey

We would appreciate your feedback on this module. Click on the button below to complete a brief survey. Your responses and comments will be shared with the module’s author, the LSI EdTech team, and LSI curriculum leaders. We will use your feedback to improve future versions of the module.

The survey is both optional and anonymous and should take less than 5 minutes to complete.

Survey