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Related Experiment Video

Updated: Dec 11, 2025

Procurement of Parathyroid Glands from Living Donor Pigs and Ex Vivo Identification
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Histologic hypercellularity in a biopsied normal parathyroid gland does not correlate with hyperfunction in primary

Kelly L McCoy1, Linwah Yip1, Mashaal Dhir2

  • 1Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA.

Surgery
|August 19, 2020
PubMed
Summary

Biopsied normal parathyroid glands during surgery for primary hyperparathyroidism showed hypercellularity in about 10% of patients, but this finding did not predict multiglandular disease or recurrence. Normal parathyroid glands with normal cellularity strongly predicted a durable cure.

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Area of Science:

  • Endocrinology
  • Surgical Pathology
  • Oncology

Background:

  • Primary hyperparathyroidism (PHPT) can involve multiglandular disease in 15% of cases.
  • During surgery for apparent single adenomas, normal parathyroid glands may be identified and biopsied.
  • The clinical significance of hypercellularity in these incidentally biopsied normal parathyroid glands is unclear.

Purpose of the Study:

  • To investigate the correlation between normal parathyroid hypercellularity and multiglandular disease or recurrence of PHPT.
  • To assess the predictive value of normal parathyroid histology for long-term biochemical cure after PHPT surgery.

Main Methods:

  • Retrospective review of 134 patients undergoing initial surgery for sporadic PHPT (2001-2015).
  • Included patients had single gland removal, routine normal parathyroid biopsy, intraoperative parathyroid hormone monitoring, and ≥3 years follow-up.
  • Recurrence defined by hypercalcemia post-cure; hypercellularity by standard histologic criteria.

Main Results:

  • 98.5% of patients achieved initial cure; 6.1% developed recurrence after a mean of 5.8 years.
  • Normal parathyroid hypercellularity was found in 10.6% of cured patients and did not differ significantly in those with recurrence (25%, P=.2).
  • Normal parathyroid normocellularity had a high negative predictive value (94.9%) for recurrence.

Conclusions:

  • Hypercellularity in incidentally biopsied normal parathyroid glands during PHPT surgery does not signify missed multiglandular disease or predict recurrence.
  • Normal parathyroid normocellularity is a strong predictor of durable cure, with a 95% predictive value.
  • Histologic assessment of normal parathyroid glands offers high predictive value for surgical success in PHPT.