562 OSKAR KLOTZ 



It is of interest that where the parathyroids are present in insufficient 

 number those^ remaining show more or less compensatory hypertrophy. 

 Such hypertrophy may simulate in one of these glands the so-called ade- 

 noma of parathyroid. This has also been observed in human cases follow- 

 ing hemorrhage into one or more of the parathyroids, as well as in animals 

 after partial parathyroidectomy (Alquier). 



Inflammatory and Fibrotic Reactions in the Parathyroids 



Acute Inflammations. Acute inflammatory reaction within the para- 

 thyroids is very unusual, and very few observers have found sufficient evi- 

 dence of this process to comment upon its occurrence and significance to 

 these glandules. The tissues of the parathyroids do not appear to offer fa- 

 vorable conditions for bacterial localization, so that microorganisms, which 

 are the main causative factor for exudative reactions elsewhere, do not find 

 a satisfactory nidus in them. This does not exclude the possibility of the 

 effect of bacterial toxins acting upon the parenchyma of the parathyroids, 

 but such action does not induce true inflammation, but more commonly 

 leads to degenerative changes with possible late alteration in the stroma. 

 Guizzctti (a.) claims to have observed a marked infiltration by mononuclear 

 cells in two cases of tetanus. In two other cases he failed to find the 

 reaction. Thompson studied five cases of the same disease, and was 

 unable to determine any change. Gamier found normal parathyroids in a 

 case of experimental tetanus. 



Inflammation by Extension. Occasionally, inflammatory reactions in 

 neighboring tissues may involve one of the parathyroids. Under these 

 conditions, clinical manifestations of altered function do not make their 

 appearance, and the finding is accidental. The not uncommon lymphocytic 

 infiltration of the thyroid occurring in its periphery, and involving the 

 capsule, transgresses its boundaries and may extend to the border of the 

 parathyroid. In consequence, the main change resulting in the parathy- 

 roid is a thickening of its capsule and stroma along with a slight lympho- 

 cytic infiltration. Similar inflammatory processes may advance upon one 

 or more of the parathyroids* from a cellulitis of the neighboring tissues of 

 the neck. 



Fibrosis in the Parathyroids. Fibroses, to a greater or less extent, are 

 found more commonly than can be accounted for as the outcome of acute 

 or subacnte parathyroiditis. In infants, the capsule and stroma of the 

 parathyroids are very delicate, forming only a fine reticulum supporting 

 the blood vessels and parenchymatous structures. With advancing age, 

 there is a relative increase in the connective tissue stroma, as well as the 

 adipose tissue which, however, does not normally proceed to a true fibrosis. 

 In many adults, even in advanced age, the connective tissue structures 



