A STUDY OF PARATHYROID HYPERPLASIA IN CHRONIC-RENAL-FAILURE

Specimens removed at parathyroidectomy from 41 patients with chronic r enal failure, 12 patients with parathyroid adenomas and parathyroid gl ands from 24 autopsies were studied by light microscopy, immunohistoch emistry and electron micro copy. The morphological abnormalities were correlated with clinical data obtained from patients' medical records. Glandular enlargement in chronic renal failure, primarily due to pare nchymal cell hyperplasia, was as much as 20 times the normal in contra st to 40 times the normal cases of adenomas. Glandular hyperplasia was mostly due to an increase in the number of chief cells and to a lesse r extent increase in the number of oxyphil cells, transitional oxyphil cells and water-clear cells. There was a corresponding reduction in f at and intracellular lipid content. There were differences in the over all morphology of normal, hyperplastic and adenomatous glands. The cle ar histological distinction between hyperplastic and adenomatous gland s was at times difficult. There was no correlation between the extent of hyperplasia, the cause of renal failure, duration of chronic renal :: failure, levels of serum calcium, phosphate or parathyroid hormone. Immunohistochemical studies showed that all 3 types of cells containe d parathyroid hormone but in hyperplastic and adenomatous glands there was a reduction in parathyroid hormone and chromogranin A staining. T here were no specific ultrastructural abnormalities which would distin guish between hyperplastic and adenomatous glands.