Morphologic and functional studies to prevent graft-dependent recurrence in renal osteodystrophy.

The cross sections of hyperplastic glands removed during total parathyroidectomy in patients with renal osteodystrophy were classified on the basis of macroscopic and functional criteria. Diffuse (type 1) and nodular (type 2) glands could be distinguished macroscopically. Functional in vitro studies showed no significant difference in suppressibility and basal parathyroid hormone (PTH) secretion (61% and 74%, respectively). In both types of glands A, B, C, and D regions could be distinguished with use of a stereo magnifier (magnification, x10 to x16). In diffuse A regions containing stroma fat cells, PTH secretion could be suppressed optimally (more than 50% of maximum secretion) in more than 90% of all specimens in vitro. In diffuse B regions containing no fat cells, hormonal secretion could be suppressed in only 17% and 25%, respectively. Confined (oxyphilic or chief cell) nodules (C regions), only found in type 2 glands, could be suppressed in 18%. Nodules of "degenerating" oxyphilic cells (D regions), only found in type 2 glands, were suppressible, but the low PTH secretion indicated degenerative processes. Thus only fragments from A regions should be selected for autotransplantation.