Enlarged parathyroid glands found at autopsy in a 69-year-old-old man
with chronic renal failure and hyperparathyroidism were examined and c
ompared with his parathyroidectomy specimens from 5 years previously.
Histology, immunohistochemistry, and DNA analysis did not discriminate
conclusively between nodular hyperplasia and adenoma. Although transf
ormation of parathyroid hyperplasia to adenoma remains an attractive h
ypothesis, conclusive distinction between dependent secondary hyperpar
athyroidism and autonomous tertiary hyperparathyroidism cannot be made
at present on the basis of morphology.