The parathyroid in chronic renal failure—a light and electron microscopical study

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Abstract
The parathyroids from 10 consecutive cases of chronic renal failure coming to operation in a period of 7 yr were studied by light microscopy and EM. The clinical and biochemical data and the levels of immunoreactive parathormone (iPTH) were reviewed. For the sake of comparison adenomata from 2 cases of primary hyperparathyroidism were studied. In the cases of chronic renal failure there were 6 cases of tertiary hyperparathyroidism with adenoma formation, surrounded by dense fibrous tissue and compression of adjacent parathyroid cells amidst a background of hyperplasia. Two cases showed secondary parathyroid hyperplasia, and the remaining 2 cases were adenomata which clinically affected only 1 gland. Neither the biochemical data nor levels of iPTH allowed the cases with secondary hyperplasia to be separated from those with tertiary hyperparathyroidism. EM showed no distinct differences between the 2 groups of adenomata in cases of primary hyperparathyroidism. The diagnosis of tertiary hyperparathyroidism is made on a combination of clinical, biochemical and histological features, the histological features being most important. Apparently tertiary hyperparathyroidism is part of a histological spectrum in response to chronic renal failure, and autonomous glands are related to the mass of parathyroid tissue present.

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