38-year-old female suffers from renal insufficiency due to chronic glomerulonephritis. In adddition, she is at times confused. Serum calcium concentration is normal to increased. Secondary hyperparathyroidism necessitates surgical intervention (surgical resection specimen).
- Increase in the number of the epithelial cells of the parathyroid glands, with simultaneous loss of adipose tissue (below 50%). Focally, adipose tissue may be absent altogether. Net result is an increased volume of the glands (weight of this specimen 3g; normal weight 30-35mg for each gland, diameter 4-5mm).
- Main cell type is the chief cell (faintly eosinophilic cytoplasm with centrally placed nucleus). Some chief cells with lesser degree of eosinophilia (clear cells). In addition, oxyphilic cells are observed (granular eosinophilic appearance because of a high content of mitochondria)
chronic renal disease leads to elevation of serum phosphorous levels with a compensatory decrease of calcium. Maintenance of the concentration of ionized serum calcium requires mobilization of calcium from the bone. The latter is achieved by increasing the secretion of parathormone. In long standing cases, osteitis fibrosa cystica may develop.