Parathyroid

Abstract

In their studies of anatomy, early pathologists failed to immediately recognize the distinct entities of the parathyroid glands. It was not until 1850 that the organ was first described during the necropsy of an Indian rhinoceros at the London Zoo.1 Seventy-five years later, the first surgery for hyperparathyroidism was performed in Vienna by Dr. Felix Mandl on a trolley-car operator with severe osteitis fibrosa cystica known as Albert J.2-4 One enlarged gland was removed, and Albert had symptomatic improvement for about 6 years until his bone disease recurred. In 1926, a second parathyroid surgery was performed without any prior knowledge of Albert's case. This time, surgeons at the Massachusetts General Hospital explored the neck of Captain Charles Martell, a merchant marine who suffered severe back and leg pain, fractures of his arms and legs, kyphoscoliosis, urinary calculi, hypercalcemia, and hypophosphatemia.5,6 The initial exploration and five subsequent operations revealed only normal parathyroid glands. Only during a seventh surgery was a large parathyroid adenoma identified in Captain Martell's mediastinum. Ninety percent of this enlarged gland was resected while a small remnant was intentionally left behind. © 2008 Springer New York.