Primary hyperplasia of the parathyroids.

Eight cases of primary hyperplasia of the parathyroid are reported among 322 cases of primary hyperparathyroidism. Preoperatively, all had high serum calcium. Six cases were water-clear, one chief cell, and one mixed hyperplasia. The case of chief cell hyperplasia was misdiagnosed primarily as adenoma. Its exact nature was recognised retrospectively. Identification and biopsy with frozen section of all the parathyroid glands is stressed. This is essential to rule out the presence of multiple adenoma or adenomatous formation in hyperplasia. When hyperplasia was proved, total parathyroidectomy and autotransplantation of parathyroid tissue equivalent to 1/2 or one normal-sized parathyroid gland was done in 7 cases. Although one patient had hyperplastic tissue in situ, the results of this management are considered to be satisfactory. On to six years postoperatively, all surviving patients are without symptoms of hyperparathyroidism and have normal serum calcium. Two patients required a small dose of Vit D-2 to sustain a normal calcium level. Total parathyroidectomy and autotransplantation of parathyroid tissue (PTA) is preferred to subtotal parathyroidectomy in cases of primary hyperplasia. There is a good primary result and reoperation can be easily done if there is recurrence of hyperparathyroidism.