Physiopathology and Diagnosis of Hyperparathyroidism

Abstract

The following points of interest are discussed: the frequency, classification, pathological patterns, clinical aspects and the role of hyperparathyroidism (HPT) in the genesis of calcium lithiasis. The steps of the diagnostic screening adopted at the Urological Clinic of the University of Genova are described. The problems of pathogenesis and classification of HPT are however far from a uniform, definitive and satisfactory solution. We still distinguish, for the sake of simplicity, between primary and secondary HPT. The latter form may become autonomous (tertiary HPT) and unable to respond to correction of the basic defect. From a histopathological standpoint, the distinction between adenoma and hyperplasia on the one part and between mild hyperplasia and normal glands on the other, is still fraught with difficulties. On clinical grounds, the work-up for screening, diagnosis of nature and location and, closely related, indications for surgery, suffers from these drawbacks. Fortunately, however, diagnostic methods today are sufficiently reliable to lead to a correct diagnosis in most cases.

A brief survey of personal experience is presented, consisting of over 200 evaluable patients. Surgery was performed in 38, including 24 orthotopic adenomas, 4 ectopic adenomas, and 10 diffuse hyperplasias. Six of the latter cases were treated with total parathyroidectomy and autotransplantation in the forearm.

Follow-up of operated patients ranges between a few months and 8 years. No recurrent HPT and no recurrence of urolithiasis have been observed in our series.