Overview
Parathyroid hyperplasia refers to the enlargement of one or more parathyroid glands, often leading to hyperparathyroidism characterized by excessive parathyroid hormone (PTH) secretion, which can result in mineral imbalances and various systemic manifestations 12.Diagnosis
Comprehensive clinical evaluation including history of symptoms (e.g., bone pain, renal stones, fatigue) 2.
Laboratory tests: Elevated serum calcium, low serum phosphorus, and elevated PTH levels 2.
Imaging studies: Sestamibi scan or ultrasound to localize abnormal parathyroid tissue 1.
Immunohistochemistry: Utilize markers like chromogranin-A, synaptophysin, keratin, and parafibromin to differentiate between benign adenomas and more aggressive lesions 3.Management
Primary Hyperparathyroidism:
- Surgery (parathyroidectomy) is the definitive treatment with high cure rates 2.
- Post-surgery monitoring of calcium and PTH levels 2.
Hypoparathyroidism:
- High-calcium diet and vitamin D supplementation (e.g., calcitriol) 2.
- Monitoring for complications like tetany and myopathies 4.Special Populations
Pregnancy:
- Hyperparathyroidism managed surgically if severe, with careful monitoring of maternal and fetal outcomes 2.
- Hypoparathyroidism requires vigilant management of vitamin D deficiency to prevent perinatal morbidity 2.
Comorbidities:
- Patients with musculoskeletal issues may require specific management for bone disease, pseudogout, or myopathies 4.Key Recommendations
Definitive treatment for primary hyperparathyroidism is surgical intervention, particularly parathyroidectomy, which offers excellent outcomes (Evidence: Strong 2).
Post-surgical follow-up should include monitoring of serum calcium and PTH levels to ensure normalization and detect recurrence (Evidence: Moderate 2).
Hypoparathyroidism necessitates high-calcium diets and vitamin D supplementation to manage symptoms and prevent complications (Evidence: Moderate 2).
Pathologists should receive comprehensive clinical and paraclinical data to accurately characterize parathyroid lesions through histological and molecular assessments (Evidence: Expert opinion 1).References
1 Dupeux M, Aubert S. Chapter 13: Changes in 2022 WHO classification of parathyroid tumors. Annales d'endocrinologie 2025. link
2 Sullivan SA. Parathyroid Diseases. Clinical obstetrics and gynecology 2019. link
3 Erickson LA, Mete O. Immunohistochemistry in Diagnostic Parathyroid Pathology. Endocrine pathology 2018. link
4 Wen HY, Schumacher HR, Zhang LY. Parathyroid disease. Rheumatic diseases clinics of North America 2010. link
5 Hackett DA, Kauffman GL. Historical perspective of parathyroid disease. Otolaryngologic clinics of North America 2004. link