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Parathyroid Glands: Anatomy

The parathyroid glands are 2 pairs of small endocrine glands Endocrine glands Ductless glands that secrete hormones directly into the blood circulation. These hormones influence the metabolism and other functions of cells in the body. Glandular Epithelium: Histology found in close proximity to the thyroid gland Thyroid gland The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy. The superior parathyroid glands are lodged within the parenchyma of the upper poles of the right and left thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy lobes; the inferior parathyroid glands are close to the inferior tips TIPS A type of surgical portasystemic shunt to reduce portal hypertension with associated complications of esophageal varices and ascites. It is performed percutaneously through the jugular vein and involves the creation of an intrahepatic shunt between the hepatic vein and portal vein. The channel is maintained by a metallic stent. The procedure can be performed in patients who have failed sclerotherapy and is an additional option to the surgical techniques of portocaval, mesocaval, and splenorenal shunts. It takes one to three hours to perform. Cirrhosis or poles of the lobes. The glands secrete parathyroid hormone, which plays a key role in regulating calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes levels.

Last updated: 7 Apr, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Development

The parathyroid glands are derived from pharyngeal pouches Pharyngeal pouches Branchial Apparatus and Aortic Arches, which originate in the mesoderm Mesoderm The middle germ layer of an embryo derived from three paired mesenchymal aggregates along the neural tube. Gastrulation and Neurulation.

  • The parathyroid glands develop by the 7th week of gestation.
  • The 3rd pharyngeal pouch gives rise to inferior parathyroid glands.
  • The 4th pharyngeal pouch gives rise to superior parathyroid glands.

Gross Anatomy and Neurovasculature

Gross anatomy

Structure:

  • Total of 4 parathyroid glands
  • Left and right superior parathyroid glands
  • Left and right inferior parathyroid glands

Relations: posterior aspect of the lateral lobes of the thyroid gland Thyroid gland The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy

Parathyroid glands anatomy

Posterior view of the thyroid gland Thyroid gland The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy showcasing the parathyroid glands

Image by Lecturio.

Neurovasculature

  • Arterial supply: primary from the inferior thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries: Histology
  • Venous drainage: parathyroid veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins: Histology thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy plexus of veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins: Histology
  • Innervation: thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy branches of the cervical ganglia
Arterial supply of parathyroid glands

Arterial supply of parathyroid glands

Image by Lecturio.

Microscopic Anatomy and Function

Microscopic anatomy

  • Chief cells Chief cells Epithelial cells that line the basal half of the gastric glands. Chief cells synthesize and export an inactive enzyme pepsinogen which is converted into the highly proteolytic enzyme pepsin in the acid environment of the stomach. Stomach: Anatomy ( principal cells Principal cells Tubular System): 
    • Polygonal cells with round nuclei
    • Appear purple due to the granules within the cytoplasm
  • Oxyphil cells: 
    • Large cells with abundant cytoplasm
    • Pinker cytoplasm than chief cells Chief cells Epithelial cells that line the basal half of the gastric glands. Chief cells synthesize and export an inactive enzyme pepsinogen which is converted into the highly proteolytic enzyme pepsin in the acid environment of the stomach. Stomach: Anatomy
Parathyroid oxyphil and chief cells

High magnification micrograph with hematoxylin and eosin (H&E) stain:
The small, dark cells are chief cells Chief cells Epithelial cells that line the basal half of the gastric glands. Chief cells synthesize and export an inactive enzyme pepsinogen which is converted into the highly proteolytic enzyme pepsin in the acid environment of the stomach. Stomach: Anatomy, which are responsible for secreting parathyroid hormone (PTH). The cells with the orange-/pink-stained cytoplasm are oxyphil cells.

Image: “Parathyroid oxyphil and chief cells Chief cells Epithelial cells that line the basal half of the gastric glands. Chief cells synthesize and export an inactive enzyme pepsinogen which is converted into the highly proteolytic enzyme pepsin in the acid environment of the stomach. Stomach: Anatomy – annotated” by Mikael Häggström. License: CC0 1.0

Function

Effects of the parathyroid glands are exerted through chief cells Chief cells Epithelial cells that line the basal half of the gastric glands. Chief cells synthesize and export an inactive enzyme pepsinogen which is converted into the highly proteolytic enzyme pepsin in the acid environment of the stomach. Stomach: Anatomy, which produce and secrete parathyroid hormone (PTH):

  • Regulate calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes levels in the blood
  • Calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes-sensing receptors Receptors Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors (CaSRs) within chief cells Chief cells Epithelial cells that line the basal half of the gastric glands. Chief cells synthesize and export an inactive enzyme pepsinogen which is converted into the highly proteolytic enzyme pepsin in the acid environment of the stomach. Stomach: Anatomy monitor calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes blood levels and moderate PTH secretion Secretion Coagulation Studies.
  • ↓ Blood calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes levels → ↑ secretion Secretion Coagulation Studies of PTH → ↑ serum calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes
  • PTH effects: 
    • Stimulation of calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes reabsorption and phosphate Phosphate Inorganic salts of phosphoric acid. Electrolytes excretion in the distal tubule of the kidney
    • Increases renal activation of vitamin D Vitamin D A vitamin that includes both cholecalciferols and ergocalciferols, which have the common effect of preventing or curing rickets in animals. It can also be viewed as a hormone since it can be formed in skin by action of ultraviolet rays upon the precursors, 7-dehydrocholesterol and ergosterol, and acts on vitamin D receptors to regulate calcium in opposition to parathyroid hormone. Fat-soluble Vitamins and their Deficiencies:
      • Calcitriol (1,25-dihydroxyvitamin D) is the active form.
      • Increases intestinal reabsorption of calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes
    • Stimulation of calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes and phosphate Phosphate Inorganic salts of phosphoric acid. Electrolytes release Release Release of a virus from the host cell following virus assembly and maturation. Egress can occur by host cell lysis, exocytosis, or budding through the plasma membrane. Virology from the bones through osteoclast activation
  • PTH secretion Secretion Coagulation Studies regulation: 
    • Stimulated by:
      • Decreases in serum calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes
      • Low levels of calcitriol
      • Hyperphosphatemia Hyperphosphatemia A condition of abnormally high level of phosphates in the blood, usually significantly above the normal range of 0. 84-1. 58 mmol per liter of serum. Hypocalcemia
      • Mild hypomagnesemia Hypomagnesemia A nutritional condition produced by a deficiency of magnesium in the diet, characterized by anorexia, nausea, vomiting, lethargy, and weakness. Symptoms are paresthesias, muscle cramps, irritability, decreased attention span, and mental confusion, possibly requiring months to appear. Deficiency of body magnesium can exist even when serum values are normal. In addition, magnesium deficiency may be organ-selective, since certain tissues become deficient before others. Electrolytes
    • Inhibited by high levels of serum calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes
Diagram showcasing the role of pth in the regulation of calcium levels

Diagram showcasing the role of parathyroid hormone (PTH) in the regulation of calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes levels

Image by Lecturio.

Clinical Relevance

  • Hyperparathyroidism Hyperparathyroidism Hyperparathyroidism is a condition associated with elevated blood levels of parathyroid hormone (PTH). Depending on the pathogenesis of this condition, hyperparathyroidism can be defined as primary, secondary or tertiary. Hyperparathyroidism: demonstrated by pathologically elevated PTH levels. Depending on the pathogenesis, the presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor may be primary, secondary, or tertiary hyperparathyroidism Hyperparathyroidism Hyperparathyroidism is a condition associated with elevated blood levels of parathyroid hormone (PTH). Depending on the pathogenesis of this condition, hyperparathyroidism can be defined as primary, secondary or tertiary. Hyperparathyroidism. The most frequent cause is adenomas of the parathyroid gland Parathyroid gland Two pairs of small oval-shaped glands located in the front and the base of the neck and adjacent to the two lobes of thyroid gland. They secrete parathyroid hormone that regulates the balance of calcium; phosphorus; and magnesium in the body. Hormones: Overview and Types, which can be localized utilizing a Tc-99m sestamibi scan with SPECT SPECT An imaging technique using a device which combines tomography, emission-computed, single-photon and tomography, x-ray computed in the same session. Nuclear Imaging imaging for 3D localization. Hyperfunctioning adenomas are typically removed with surgery.
  • Hypoparathyroidism Hypoparathyroidism Hypoparathyroidism is defined as reduced parathyroid hormone (PTH) levels due to poor function of the parathyroid glands. The cause of hypoparathyroidism is most commonly iatrogenic following neck surgery, but it can also be associated with genetic or autoimmune disorders as well as infiltrative diseases causing destruction of the normal parathyroid tissue. Hypoparathyroidism: Parathyroid hormone deficiency results in low serum calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes levels and elevated phosphate Phosphate Inorganic salts of phosphoric acid. Electrolytes levels. The cause of hypoparathyroidism Hypoparathyroidism Hypoparathyroidism is defined as reduced parathyroid hormone (PTH) levels due to poor function of the parathyroid glands. The cause of hypoparathyroidism is most commonly iatrogenic following neck surgery, but it can also be associated with genetic or autoimmune disorders as well as infiltrative diseases causing destruction of the normal parathyroid tissue. Hypoparathyroidism is most commonly iatrogenic Iatrogenic Any adverse condition in a patient occurring as the result of treatment by a physician, surgeon, or other health professional, especially infections acquired by a patient during the course of treatment. Anterior Cord Syndrome following neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess surgery (e.g., thyroidectomy Thyroidectomy Surgical removal of the thyroid gland. Goiter). Treatment is calcium Calcium A basic element found in nearly all tissues. It is a member of the alkaline earth family of metals with the atomic symbol ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. Electrolytes replacement therapy with frequent lab monitoring to ensure appropriate physiological levels.
  • Parathyroid carcinoma Parathyroid Carcinoma Hyperparathyroidism: accounts for approximately 1% of all cases of hyperparathyroidism Hyperparathyroidism Hyperparathyroidism is a condition associated with elevated blood levels of parathyroid hormone (PTH). Depending on the pathogenesis of this condition, hyperparathyroidism can be defined as primary, secondary or tertiary. Hyperparathyroidism (hypersecretion of PTH accounts for approximately 90% of cancers). Neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess ultrasound and/or Tc-99m sestamibi scans are utilized for enlarged gland detection but lack the sensitivity Sensitivity Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Blotting Techniques or specificity Specificity Specificity is the probability of correctly determining the absence of a condition. Immunoassays to differentiate between benign Benign Fibroadenoma and malignant etiologies of hyperparathyroidism Hyperparathyroidism Hyperparathyroidism is a condition associated with elevated blood levels of parathyroid hormone (PTH). Depending on the pathogenesis of this condition, hyperparathyroidism can be defined as primary, secondary or tertiary. Hyperparathyroidism. Fine- needle aspiration Needle aspiration Using fine needles (finer than 22-gauge) to remove tissue or fluid specimens from the living body for examination in the pathology laboratory and for disease diagnosis. Peritonsillar Abscess biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma is not recommended due to the difficult task of differentiating benign Benign Fibroadenoma and malignant cells on cytopathology and the high risk of seeding Seeding The local implantation of tumor cells by contamination of instruments and surgical equipment during and after surgical resection, resulting in local growth of the cells and tumor formation. Grading, Staging, and Metastasis the parathyroid soft tissues. Both diagnosis and treatment are achieved with surgical resection.

References

  1. Wei, C.H., Harari, A. (2012). Parathyroid carcinoma: update and guidelines for management. Curr Treat Options Oncol. 13(1), 11–23. https://pubmed.ncbi.nlm.nih.gov/22327883/
  2. Fuleihan, G.E., Silverberg, S.J. (2020). Primary hyperparathyroidism: Diagnosis, differential diagnosis, and evaluation. UpToDate. Retrieved February 6, 2021, from https://www.uptodate.com/contents/primary-hyperparathyroidism-diagnosis-differential-diagnosis-and-evaluation
  3. Silverberg, S.J., Fuleihan, G.E. (2019). Primary hyperparathyroidism: Management. UpToDate. Retrieved February 6, 2021, from https://www.uptodate.com/contents/primary-hyperparathyroidism-management

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