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Acute hyperparathyroidism

Clinical, laboratory and ultrastructural findings in a variant of primary hyperparathyroidism

Der akute Hyperparathyreoidismus

Klinische, laborchemische und ultrastrukturelle Befunde einer Verlaufsvariante des primären Hyperparathyreoidismus

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Zusammenfassung

Bei 6 Kranken mit akutem Hyperparathyreoidismus werden klinische Befunde, Labordaten und Besonderheiten in der Ultrastruktur der Nebenschilddrüsen den Daten von 47 Kranken mit extrarenalen Hyperparathyreoidismus gegenübergestellt. Typische Unterschiede konnten aufgezeigt werden, die Übergänge sind aber fließend. Beim klinischen Verlauf waren neuromuskuläre Zeichen, psychiatrische und Störungen des Bewußtseins deutlicher in der ersten Gruppe. Beim Vergleich der Labordaten war radioimmunchemisches Parathormon höher in der akuten Gruppe und das Hämoglobin niedriger. Das Gewicht der Adenome und die lichtmikroskopischen Befunde waren nicht unterschiedlich in beiden Gruppen. Die elektronenmikroskopischen Studien des Adenomgewebes zeigten eine erhöhte Hormonausschüttung mit einer deutlichen Beschleunigung der Autodigestion von Membranmaterial. Diese Veränderungen entsprechen etwa denen, wie sie an Nebenschilddrüsengewebe in der Gewebekultur nach Stimulation durch Hypocalciämie gefunden werden.

Summary

In a series of 6 patients out of 47 cases with extrarenal hyperparathyroidism we investigated the clinical, laboratory and ultrastructural peculiarities of acute hyperparathyroidism. It was found that there are characteristic differences between both entities which, however, are fluid. Clinically more severe were neuromuscular psychiatric and mental signs. In the laboratory parameters PTH determined by radio-immunoassay and calcium were higher whereas hemoglobin was lower. The weights of the adenomas did not differ in both groups and this was also true for light microscopy findings. Electron microscopy revealed accelerated hormone extrusion and autodigestion of retrieved membrane material in the cases of acute hyperparathyroidism similar to characteristics of parathyroid cells stimulated by hypocalcemia in tissue culture.

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Authors and Affiliations

  1. Institute of Pathology, Germany

    J. Thiele

  2. Department of Abdominal Surgery and Transplantation Medical School Hannover, D-3000, Hannover 61

    G. Tidow

  3. Dept. of Internal Medicine, Div. of Clinical Endocrinology Medical School Hannover, Karl Wiechert-Allee 9, D-3000, Hannover 61, Germany

    R. Hehrmann &  R. D. Hesch

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  1. R. Hehrmann
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  2. J. Thiele
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  3. G. Tidow
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  4. R. D. Hesch
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The work of the Division of Clinical Endocrinology is supported by the Deutsche Forschungsgemeinschaft (He 593/11)

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Hehrmann, R., Thiele, J., Tidow, G. et al. Acute hyperparathyroidism. Klin Wochenschr 58, 501–510 (1980). https://doi.org/10.1007/BF01477067

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