title: Histology and immunohistochemistry of the parathyroid glands in renal secondary hyperparathyroidism refractory to vitamin D or cinacalcet therapy.
abstract: BACKGROUND
  Cinacalcet is a new effective treatment of secondary hyperparathyroidism (SHPT) in hemodialysis patients (HP), but the alterations of parathyroid gland (PTG) hyperplasia determined by cinacalcet and vitamin D have not been extensively investigated in humans.
  
  
  METHODS
  We performed histological analyses of 94 PTGs removed from 25 HP who underwent parathyroidectomy (PTx) because of SHPT refractory to therapy with vitamin D alone (group A=13 HP and 46 PTGs) or associated with cinacalcet (group B=12 HP and 48 PTGs). The number, weight, the macroscopic cystic/hemorrhagic changes, and type of hyperplasia of PTG (nodular=NH, diffuse=DH) were assessed. In randomly selected HP of group A (4 HP and 14 PTGs) and group B (4 HP and 15 PTGs), the labeling index of cells positive to Ki-67 and TUNEL and the semiquantitative score of immunohistochemistry staining of vitamin D receptor, calcium-sensing receptor, and vascular endothelial growth factor-α (VEGF-α) were measured in the entire PTGs and in the areas with DH or NH.
  
  
  RESULTS
  The number and weight of single and total PTG of each HP were similar in the two groups as well as the number of PTG with macroscopic cystic/hemorrhagic areas. TUNEL, Ki-67, and VEGF-α scores were higher in NH than in DH areas.
  
  
  CONCLUSIONS
  This observational study of a highly selected population of HP, submitted to PTx because SHPT refractory to therapy, shows that the macroscopic, microscopic, and immunochemistry characteristics of PTG in HP who received or did not receive cinacalcet before PTx did not differ significantly.
authors.affiliation: Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Rome 00168, Italy. c.vulpio@alice.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Vulpio
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bossola
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Stasio
authors.forename: Luigi
authors.initials: L
authors.lastname: Tazza
authors.forename: Patrizia
authors.initials: P
authors.lastname: Silvestri
authors.forename: Guido
authors.initials: G
authors.lastname: Fadda
mesh_terms: D000328:Adult; D000368:Aged; D000069449:Cinacalcet; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology*; D007150:Immunohistochemistry; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use*; D010280:Parathyroid Glands / Q000378:metabolism*; D006435:Renal Dialysis; D012189:Retrospective Studies; D014807:Vitamin D / Q000627:therapeutic use*
chemical_list: D009281:Naphthalenes; D014807:Vitamin D; D000069449:Cinacalcet