Parathyroid gland

Parathyroid glands
Endocrine system. (Parathyroid gland not pictured, but are present on surface of thyroid gland, as shown below.)
Thyroid and parathyroid.
Latin	glandula parathyroidea inferior, glandula parathyroidea superior
Gray's	subject #273 1271
Artery	superior thyroid artery, inferior thyroid artery,
Vein	superior thyroid vein, middle thyroid vein, inferior thyroid vein,
Nerve	middle cervical ganglion, inferior cervical ganglion
Precursor	neural crest mesenchyme and third and fourth pharyngeal pouch endoderm

The parathyroid glands are small endocrine glands in the neck that produce parathyroid hormone. Humans have four parathyroid glands, which are usually located behind the thyroid gland, and, in rare cases, within the thyroid gland or in the chest. Parathyroid glands control the amount of calcium in the blood and within the bones.

Anatomy

Micrograph of a parathyroid gland. H&E stain.

The parathyroid glands are four or more small glands, about the size of a grain or rice, located on the posterior surface (back side) of the thyroid gland. The parathyroid glands are named for their proximity to the thyroid but serve a completely different role than the thyroid gland. They are quite easily recognizable from the thyroid as they have densely packed cells, in contrast with the follicle structure of the thyroid. ^[1] However, at surgery, they are harder to differentiate from the thyroid or fat.

In the histological sense, they distinguish themselves from the thyroid gland, as they contain two types of cells:^[2]

History

The parathyroid glands were first discovered in the Indian Rhinoceros by Richard Owen in 1850.^[4] The glands were first discovered in humans by Ivar Viktor Sandström (1852-1889), a Swedish medical student, in 1880.^[5] It was the last major organ to be recognized in humans.

Physiology

The major function of the parathyroid glands is to maintain the body's calcium level within a very narrow range, so that the nervous and muscular systems can function properly.

When blood calcium levels drop below a certain point, calcium-sensing receptors in the parathyroid gland are activated to release hormone into the blood.

Parathyroid hormone (PTH, also known as parathormone) is a small protein that takes part in the control of calcium and phosphate homeostasis, as well as bone physiology. Parathyroid hormone has effects antagonistic to those of calcitonin. PTH increases blood calcium levels by stimulating osteoclasts to break down bone and release calcium. PTH also increases gastrointestinal calcium absorption by activating vitamin D, and promotes calcium conservation (reabsorption) by the kidneys. PTH affects the perception of well being and absence of PTH can be associated with feeling of fatigue and anxiety.

Role in disease

Many conditions are associated with disorders of parathyroid function. These can be divided into those causing hyperparathyroidism, and those causing hypoparathyroidism.

Embryology and evolution

The parathyroid glands originate from the interaction of neural crest mesenchyme and third and fourth branchial pouch endoderm.

Eya-1 (transcripitonal co-activator), Six-1 (a homeobox transcription factor), and Gcm-2 (a transcription factor) have been associated with the development of the parathyroid gland, and alterations in these genes alters parathyroid gland development.

The superior parathyroids arise from the fourth pharyngeal pouch, and the inferior parathyroids arise from the third pharyngeal pouch. They are vertically transposed during embryogenesis. This is significant in function-preserving parathyroidectomy, because both the superior and the inferior parathyroids are supplied by the inferior thyroid artery. If the surgeon is to leave a single functional parathyroid for the patient, he/she must preserve the appropriate blood supply.

In other animals

Parathyroid glands are found in all adult tetrapods, although they vary in their number, and in their exact position. Mammals typically have four parathyroids, while other groups typically have six.

Fish do not possess parathyroid glands, although the ultimobranchial glands, which are found close to the oesophagus, may have a similar function and could even be homologous with the tetrapod parathyroids. Even these glands are absent in the most primitive vertebrates, the jawless fish, but as these species have no bone in their skeletons, only cartilage, it may be that they have less need to regulate calcium metabolism.

The conserved homology of genes and calcium-sensing receptors in fish gills with those in the parathryroid glands of birds and mammals is recognized by evolutionary developmental biology as evolution-using genes and gene networks in novel ways to generate new structures with some similar functions and novel functions.

Additional images

High magnification micrograph of a parathyroid gland. H&E stain.	Intermediate magnification micrograph of a parathyroid gland. H&E stain.	Low magnification micrograph of a parathyroid gland and parathyroid adenoma (bottom left). H&E stain.	Scheme showing development of branchial epithelial bodies. I, II, III, IV. Branchial pouches.
Human parathyroid glands

References

1. ↑ Histology at BU 15001ooa
2. ↑ Histology at BU 15002loa
3. ↑ Histology at OU 40_06
4. ↑ Cave, A.J.E. (1953). "Richard Owen and the discovery of the parathyroid glands". In E. Ashworth Underwood. Science, Medicine and History. Essays on the Evolution of Scientific Thought and Medical Practice. 2. Oxford University Press. pp. 217–222. http://www.rhinoresourcecenter.com/ref_files/1216989886.pdf. Retrieved 2009-07-20. 
5. ↑ Eknoyan G (November 1995). "A history of the parathyroid glands". Am. J. Kidney Dis. 26 (5): 801–7. doi:10.1016/0272-6386(95)90447-6. PMID 7485136. http://linkinghub.elsevier.com/retrieve/pii/0272638695904476. 

External links

• Parathyroid disease and treatments discussed in layman's terms at Parathyroid.com
• Parathyroid Surgery and minimal access parathyroid surgery by a UK surgeon
• Minimally Invasive Advanced Parathyroid Surgery at the New York Center for Advanced Parathyroid Surgery
• Endocrine Web at endocrineweb.com
• The origin of the parathyroid gland at pnas.org
• Parathyroid+gland at eMedicine Dictionary
• Virtual Slidebox at Univ. Iowa Slide 149