Ultrastructural morphometry was performed on human parathyroid tissue from adenomas in chronic and acute (pernicious) hyperparathyroidism (HPT) including contralateral atrophic glands with the aim to compare the observed alterations with the corresponding clinico-functional findings. Quantitative assessment of various cell organelles, nucleus and cell perimeter revealed that significant correlations between ultrastructural features and laboratory parameters were only calculable by regarding extreme ranges of functional stages, i.e. adenomas of acute HPT (hyperparathyroid crisis) and contralateral atrophic glands. In chief cells of chronic HPT there was an inhomogeneity of measurements due to the disparate composition of the adenomatous tissue. Our results show that large complex lipid bodies and extensive accumulations of glycogen are valuable indicators of a functionally suppressed chief cell in atrophic parathyroid glands. An increased number of coated pits and vesicles is amongst other features (increase in size or number of Golgi apparatus, rough endoplasmic reticulum, mitochondria, nucleus and nucleolus as well as extension of the plasma membrane) characteristic of an endocrine stimulation.