[Parathyroidectomy and autotransplantation in renal hyperparathyroidism. II. Functional in vitro studies for tissue...

The PTH secretion was studied in fragments of 83 (reactive) hyperplastic parathyroids (type 1 a: n = 24; type 1 b: n = 20, type 2: n = 39) simulating hypo- (0.3 mmol Ca++ = maximal PTH secretion), normo- (0.9 and 1.2 mmol Ca++) and hypercalcemia (3.0 mmol Ca++ = basic PTH secretion, maximal suppressibility) in vitro. 56 out of 83 glands (67%) were suppressible (PTH secretion decreased under 50% of maximal secretion) with no significant difference in suppressibility of diffuse and nodular hyperplasia (50% and 74%, respectively). Differentiating diffuse hyperplastic glands in those with (type 1 a) and without (type 1 b) stroma fat cells, 92% of type 1 a glands and only 25% of type 1 b glands were suppressible (Fischer's test: p less than 0.001). Separated (oxyphilic and/or chief cell) nodules, type 1 b- and type 1 a-like areas (both localized between nodules) of types 2 glands were suppressible in 18%, 17% and 91%, respectively (Fischer's test: p less than 0.001). Thus fragments of type 1 a regions should be autotransplanted for preference. Type 1 b regions or nodules should not be used for grafting.