702 LEWELLYS F. BARKER 



III. Hyperplasia of the Parathyroid Glands in 

 Chronic Renal Disease 



As early as 1904, W. G. MacCallum (a) had reported a case of "tumor" 

 of the parathyroid in a young person with renal disease, and suggested that 

 the renal disease might possibly be the cause of the enlargement of the 

 parathyroid. Cameron and Fletschner some years ago associated juvenile 

 osteomalacia and infantilism with primary nephritis. 



Enlargement of the parathyroid glands, apparently due to hyper- 

 plasia, has been described in ten cases of serious renal disease by H. Berg- 

 strand. Bergstrand concluded that the hyperplastic tissue in the para- 

 thyroids in renal disease consists almost entirely of chief cells free from 

 fat (or poor in fat) and devoid of colloid. In some of his cases of en- 

 largement of the parathyroids in Bright's disease there was a circum- 

 scribed growth surrounded by apparently unchanged parathyroid tissue 

 instead of a general hyperplasia. 



Bergstrand states that no parallelism between the degree of the uremic 

 symptoms and the enlargement of the parathyroids could be recognized, and 

 in none of his cases could osteoporosis or osteomalacia be made out. In 

 several instances there was a good deal of lime deposit, however, in the 

 kidneys. 



Certain other observations bearing upon the relations of renal disease 

 and parathyroid function have been reported. Thus Larsson of Stockholm 

 found an increased galvanic excitability of the motor nerves in acute 

 nephritis. And Harbitz has reported a case of adenoma or struma of 

 the parathyroids associated with nephritis and with a deposit of lime in 

 the kidneys. lie was uncertain whether the renal disease or the deposit 

 of lime was primary. 



During the present year (1921), Thomas and Wentworth of Clifton 

 Springs have shown me x-rays and autopsy material from a remarkable 

 case that illustrates well the relationship of hyperplasia of the parathyroid 

 glands to chronic renal disease. The patient, a young man of 21, suf- 

 fered from a severe nephritis at the age of 11. He died at the age of 21. 

 Some months before death, large lime deposits appeared in the tendon 

 sheaths and burstu in various parts of the body, and an extensive arterio- 

 sclerosis with chronic arterial hypertension developed. The most ex- 

 tensive calcification of all the smaller peripheral arteries occurred. Dur- 

 ing life, x-rays revealed these calcifications of the arteries in the ex- 

 tremities, and especially in the voluntary muscles. At autopsy, rontgeno- 

 ii-rains were made of the tongue, of the heart and of the various internal 

 organs and these revealed the most extensive calcification of all the smaller 

 arteries. A certain decalcification of the bones similar to that seen in 

 osteitis fibrosa was demonstrable in the x-ray plates and at autopsy the 



