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Carsote M, Ciobica ML, Sima OC, Valea A, Bondor CI, Geleriu A, Ticolea M, Nistor C, Rusu CC. Brown Tumors: The Hidden Face of Primary and Renal Hyperparathyroidism Amid Real-Life Settings. J Clin Med 2024; 13:3847. [PMID: 38999413 PMCID: PMC11242279 DOI: 10.3390/jcm13133847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Brown tumors, an exceptional bone complication of severe primary (PHP) or renal (secondary) hyperparathyroidism (RHP), are caused by long-standing, elevated parathormone (PTH)-induced osteoclast activation causing multinucleated giant cell conglomerates with hemosiderin deposits in addition to the local production of cytokines and growth factors. We aim to present an adult case series including two females displaying this complication as part of a multidisciplinary complex panel in high PTH-related ailments. The approach was different since they had distinct medical backgrounds and posed a wide area of challenges amid real-life settings, namely, a 38-year-old lady with PHP and long-term uncontrolled hypercalcemia (with a history of pregnancy-associated PHP, the removal of a cystic jaw tumor, as well as a family and personal positive diagnosis of polycystic kidney disease, probably a PHP-jaw tumor syndrome), as well as, a 26-year-old woman with congenital single kidney and chronic renal disease-associated RHP who was poorly controlled under dialysis and developed severe anemia and episodes of metabolic acidosis (including one presentation that required emergency hemodialysis and was complicated with convulsive seizures, followed by resuscitated respiratory arrest). Both subjects displayed a severe picture of PHP/RHP with PTH levels of >1000 pg/mL and >2000 pg/mL and elevated serum bone turnover markers. Additionally, they had multiple brown tumors at the level of the ribs and pelvis (asymptomatically) and the spine, skull, and pelvis (complicated with a spontaneous cervical fracture). As an endocrine approach, the control of the underlying parathyroid disease was provided via surgery in PHP (for the postparathyroidectomy hungry bone syndrome) via medical intervention (with vitamin D analogs) in RHP. Additionally, in this case, since the diagnosis was not clear, a multidisciplinary decision to perform a biopsy was taken (which proved inconclusive), and the resection of the skull tumor to confirm the histological traits. This series highlights the importance of addressing the entire multidisciplinary panel of co-morbidities for a better outcome in patients with PHP/RHP-related brown tumors. However, in the instance of real-life medicine, poor compliance and reduced adherence to recommendations might impair the overall health status. Thus, sometimes, a direct approach at the level of cystic lesion is taken into consideration; this stands for a narrow frame of decision, and it is a matter of personalized decision. As seen here, brown tumors represent the hidden face of PHP/RHP, primarily the complex and severe forms, and awareness is essential even in the modern era.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Internal Medicine I and Rheumatology, "Dr. Carol Davila" Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Oana-Claudia Sima
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
- PhD Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ana Valea
- Department of Endocrinology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Endocrinology, County Emergency Clinical Hospital, 400347 Cluj-Napoca, Romania
| | - Cosmina Ioana Bondor
- Department of Medical Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andreea Geleriu
- Department of Endocrinology, Sibiu Clinical County Hospital, 550245 Sibiu, Romania
| | - Madalina Ticolea
- Department of Pathophysiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Thoracic Surgery Department, "Dr. Carol Davila" Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Crina Claudia Rusu
- Department of Nephrology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- "Mihai Manasia" Nephrology and Dialysis Clinic, County Emergency Clinical Hospital Cluj, 400347 Cluj-Napoca, Romania
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Gheorghe AM, Sima OC, Florescu AF, Ciuche A, Nistor C, Sandru F, Carsote M. Insights into Hyperparathyroidism-Jaw Tumour Syndrome: From Endocrine Acumen to the Spectrum of CDC73 Gene and Parafibromin-Deficient Tumours. Int J Mol Sci 2024; 25:2301. [PMID: 38396977 PMCID: PMC10889221 DOI: 10.3390/ijms25042301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
A total of 1 out of 10 patients with primary hyperparathyroidism (PHP) presents an underlying genetic form, such as multiple endocrine neoplasia types 1, 2A, etc., as well as hyperparathyroidism-jaw tumour syndrome (HJT). We aimed to summarise the recent data, thus raising more awareness regarding HJT, from the clinical perspective of PHP in association with the challenges and pitfalls of CDC73 genetic testing and parafibromin staining. This narrative review included a sample-focused analysis from the past decade according to a PubMed search. We identified 17 original human studies (≥4 patients per article). The mean age at disease onset was between 20.8 and 39.5 years, while the largest study found that 71% of patients had HJT recognised before the age of 30. Males and females seemed to be equally affected, in contrast with sporadic PHP. PHP represented the central manifestation of HJT, occurring as the first manifestation in up to 85% of HJT cases. A biochemistry panel found a mean serum calcium level above the level of 12 mg/dL in PHP. PTH was elevated in HJT as well, with average values of at least 236.6 pg/mL. The most frequent pathological type in PHP was a parathyroid adenoma, but the incidence of a parathyroid carcinoma was much higher than in non-HJT cases (15% of all parathyroid tumours), with the diagnosis being established between the age of 15 and 37.5. In some families up to 85% of carriers suffered from a parathyroid carcinoma thus indicating that certain CDC73 pathogenic variants may harbour a higher risk. An important issue in HJT was represented by the parafibromin profile in the parathyroid tumours since in HJT both parathyroid adenomas and carcinomas might display a deficient immunoreactivity. Another frequent manifestation in HJT was ossifying fibromas of the jaw (affecting 5.4% to 50% of patients; the largest study found a prevalence of 15.4%). HJT was associated with a wide variety of kidney lesion (mostly: kidney cysts, with a prevalence of up to 75%, and renal tumours involved in 19% of patients). The risk of uterine lesions seemed increased in HJT, especially with concern to leiomyomas, adenofibromas, and adenomyosis. The underlying pathogenic mechanisms and the involvement of CDC73 pathogenic variants and parafibromin expression are yet to be explored. Currently, the heterogeneous expression of parafibromin status and, the wide spectrum of CDC73 mutations including the variety of clinical presentations in HJT, make it difficult to predict the phenotype based on the genotype. The central role of HJT-PHP is, however, the main clinical element, while the elevated risk of parathyroid carcinoma requires a special awareness.
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Affiliation(s)
- Ana-Maria Gheorghe
- PhD Doctoral School of “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.-M.G.); (O.-C.S.)
| | - Oana-Claudia Sima
- PhD Doctoral School of “Carol Davila”, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.-M.G.); (O.-C.S.)
| | - Alexandru Florin Florescu
- Endocrinology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania;
- Endocrinology Department, “Sf. Spiridon” Emergency County Clinical Hospital, 700111 Iasi, Romania
| | - Adrian Ciuche
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Claudiu Nistor
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Thoracic Surgery Department, “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatovenerology, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 020021 Bucharest, Romania
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Mirfarsi S, Seleem D, Sathananthan A. Mandibular Jaw Lesion Excisional Biopsy on a Patient with Hyperparathyroidism (Primary). Dent Clin North Am 2023; 67:597-600. [PMID: 37714603 DOI: 10.1016/j.cden.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Most of the primary hyperparathyroidism is due to adenomas in the parathyroid glands. Hypercalcemia is more common in primary hyperparathyroidism. Hyperparathyroidism may be asymptomatic and detected incidentally as part of a routine serological evaluation. Oral health care providers should recognize distinct changes in the jawbone associated with primary and secondary hyperparathyroidism.
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Affiliation(s)
- Sahar Mirfarsi
- Western University of Health Sciences, College of Dental Medicine, 309 East Second Street, Pomona, CA 91766-1854, USA.
| | - Dalia Seleem
- Western University of Health Sciences, College of Dental Medicine, 309 East Second Street, Pomona, CA 91766-1854, USA
| | - Airani Sathananthan
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Department of Internal Medicine, 309 East Second Street, Pomona, CA 91766-1854, USA
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Mohamed FF, de Oliveira FA, Kinoshita Y, Yalamanchili RR, Eltilib LA, Andras NL, Narisawa S, Tani T, Chu EY, Millán JL, Foster BL. Dentoalveolar Alterations in an Adenine-Induced Chronic Kidney Disease Mouse Model. J Bone Miner Res 2023; 38:1192-1207. [PMID: 37191192 PMCID: PMC10524958 DOI: 10.1002/jbmr.4829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
Chronic kidney disease (CKD) is characterized by kidney damage and loss of renal function. CKD mineral and bone disorder (CKD-MBD) describes the dysregulation of mineral homeostasis, including hyperphosphatemia and elevated parathyroid hormone (PTH) secretion, skeletal abnormalities, and vascular calcification. CKD-MBD impacts the oral cavity, with effects including salivary gland dysfunction, enamel hypoplasia and damage, increased dentin formation, decreased pulp volume, pulp calcifications, and altered jaw bones, contributing to clinical manifestations of periodontal disease and tooth loss. Underlying mechanisms are not fully understood, and CKD mouse models commonly require invasive procedures with high rates of infection and mortality. We aimed to characterize the dentoalveolar effects of an adenine diet (AD)-induced CKD (AD-CKD) mouse model. Eight-week-old C57BL/6J mice were provided either a normal phosphorus diet control (CTR) or adenine and high-phosphorus diet CKD to induce kidney failure. Mice were euthanized at 15 weeks old, and mandibles were collected for micro-computed tomography and histology. CKD mice exhibited kidney failure, hyperphosphatemia, and hyperparathyroidism in association with porous cortical bone in femurs. CKD mice showed a 30% decrease in molar enamel volume compared to CTR mice. Enamel wear was associated with reduced ductal components, ectopic calcifications, and altered osteopontin (OPN) deposition in submandibular salivary glands of CKD mice. Molar cusps in CKD mice were flattened, exposing dentin. Molar dentin/cementum volume increased 7% in CKD mice and pulp volume decreased. Histology revealed excessive reactionary dentin and altered pulp-dentin extracellular matrix proteins, including increased OPN. Mandibular bone volume fraction decreased 12% and bone mineral density decreased 9% in CKD versus CTR mice. Alveolar bone in CKD mice exhibited increased tissue-nonspecific alkaline phosphatase localization, OPN deposition, and greater osteoclast numbers. AD-CKD recapitulated key aspects reported in CKD patients and revealed new insights into CKD-associated oral defects. This model has potential for studying mechanisms of dentoalveolar defects or therapeutic interventions. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Fatma F. Mohamed
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Flavia Amadeu de Oliveira
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Yuka Kinoshita
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Riti R. Yalamanchili
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Leena A. Eltilib
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Natalie L. Andras
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Sonoko Narisawa
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Takashi Tani
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Emily Y. Chu
- Department of General Dentistry, Operative Division, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - José Luis Millán
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Brian L. Foster
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
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Miguita L, de Souza JC, Bastos VC, Pereira NB, de Freitas RAB, Guimarães LM, de Avelar GF, Andrade LO, Dutra WO, Nunes FD, Castro WH, de Lacerda JCT, Reis AMS, Bernardes VF, Diniz MG, Gomez RS, Gomes CC. Central giant cell granulomas of the jaws stromal cells harbour mutations and have osteogenic differentiation capacity,
in vivo
and
in vitro. J Oral Pathol Med 2022; 51:206-216. [DOI: 10.1111/jop.13274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/07/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Lucyene Miguita
- Department of Pathology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | - Juliana Cristina de Souza
- Department of Pathology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | - Victor Coutinho Bastos
- Department of Pathology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | - Nubia Braga Pereira
- Department of Pathology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | - Raphaela Alvarenga Braga de Freitas
- Department of Oral Surgery and Pathology School of Dentistry Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | - Leticia Martins Guimarães
- Department of Pathology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | - Gleide Fernandes de Avelar
- Department of Morphology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Brazil 31270‐901
| | - Luciana Oliveira Andrade
- Department of Morphology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Brazil 31270‐901
| | - Walderez Ornelas Dutra
- Department of Morphology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Brazil 31270‐901
| | - Fábio Daumas Nunes
- Department of Stomatology School of Dentistry Universidade de São Paulo (USP) São Paulo Brazil 05508‐000
| | - Wagner Henriques Castro
- Department of Oral Surgery and Pathology School of Dentistry Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | | | - Amanda Maria Sena Reis
- Department of Pathology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | - Vanessa Fátima Bernardes
- Department of Pathology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | - Marina Gonçalves Diniz
- Department of Pathology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology School of Dentistry Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
| | - Carolina Cavalieri Gomes
- Department of Pathology Biological Science Institute Universidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil 31270‐901
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