克氏外科学19版chapter 39.pdfVIP

CHAPTER 39 THE PARATHYROID GLANDS Julie Ann Sosa and Robert Udelsman history calcium physiology anatomy diagnosis and clinical features hypercalcemic crisis hypoparathyroidism hyperparathyroidism inherited parathyroid disease parathyroid carcinoma The clinical features, diagnosis, and treatment of parathyroid disease have changed radically over the past 25 years as a result of technologic advances in the fields of laboratory medicine, radiology, medicine, and surgery. In particular, there have been many technical advances in the surgical management of primary hyperparathyroidism (HPT). HISTORY Advances in parathyroid surgery have been colorful and international. Although the Swedish medical student Ivar Sandstrom is credited with first describing the “glandularae parathyrtreoidae” in 1880,1 Sir Richard Owen made the original description in 1850.2 Understanding of parathyroid function predated appreciation of the glands themselves; tetany was described in 1879 in a patient who underwent thyroidectomy (and incidental parathyroidectomy), and the connection between the parathyroids and tetany was identified in 1891.3 Famous patients with HPT include Albert Gahne, a Viennese tram car conductor who underwent two separate parathyroid resections in the 1920s by Felix Mandl for what was most likely parathyroid carcinoma,4 and Captain Charles Martell, a Merchant Marine captain who underwent seven operations and was eventually found to have a mediastinal parathyroid adenoma.5 Both men succumbed to their disease and the consequences of its treatment. The relationship between chronic renal disease and HPT was first suggested by Albright and colleagues in 1934.6 Castleman and Mallory7 described the pathologic finding of parathyroid hyperplasia of chief cells with marked gland enlargement. Stanbury and associates8 described renal rickets, azotemic osteomalacia, and azotemic HPT and also performed the first subtotal parathyroidectomy as definitive therapy for renal osteitis fibrosa