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Erol Ç, Şahin Ö, Şen AE, Aydın Z. Bone and Parathyroid Scintigraphy Findings in Sagliker Syndrome. Mol Imaging Radionucl Ther 2024; 33:40-42. [PMID: 38390778 PMCID: PMC10899744 DOI: 10.4274/mirt.galenos.2023.24382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Sagliker syndrome (SS) is a rare, exaggerated form of chronic kidney disease (CKD)-mineral and bone disorder resulting from untreated secondary hyperparathyroidism due to CKD. Herein, we describe a 34-year-old male patient whose Tc-99m-methylene diphosphonate bone scintigraphy and Tc-99m-sestamibi parathyroid scintigraphy revealed hints of SS and exhibited its defining characteristics.
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Affiliation(s)
- Çağlagül Erol
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Nuclear Medicine, Konya, Türkiye
| | - Özlem Şahin
- Necmettin Erbakan University Meram Faculty of Medicine, Department of Nuclear Medicine, Konya, Türkiye
| | - Ahmet Eren Şen
- Kastamonu Training and Research Hospital, Clinic of Nuclear Medicine, Kastamonu, Türkiye
| | - Zeynep Aydın
- Konya City Hospital, Clinic of Nuclear Medicine, Konya, Türkiye
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Salimkhanov R, Bondarenko E, Eremkina A, Bibik E, Kim E, Begova K, Kim I, Kuznetsov S, Mokrysheva N. Case report: Sagliker syndrome in the patient with recurrent tertiary hyperparathyroidism due to intrathyroidal parathyroid carcinoma. Front Endocrinol (Lausanne) 2024; 14:1292993. [PMID: 38250739 PMCID: PMC10796468 DOI: 10.3389/fendo.2023.1292993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Sagliker syndrome (SS) is an extremely rare disorder that manifests in patients with advanced chronic kidney disease (CKD) undergoing programmed hemodialysis as a renal replacement therapy. Treatment of secondary hyperparathyroidism (SHPT) in these patients is still challenging. The main clinical manifestations of SS include craniofacial and fingertip deformities, dental anomalies, gingival hyperplasia, short stature, hearing loss, neurological and psychiatric impairment. The etiology and pathogenesis of SS in patients with SHPT require further clarification. However, mutations in the GNAS1, FGF23, and FGFR3 genes were described in some patients, suggesting a possible role of genetic predisposition to the syndrome. The preferred therapeutic approach for SS is surgery, but the volume of the operation is debated. The main surgical strategies include total, subtotal parathyroidectomy, or total parathyroidectomy with autotransplantation of the parathyroid gland (PG). Unfortunately, parathyroidectomy does not contribute to the regression of significant skeletal deformities. We present a unique clinical case of a patient with classical features of SS, recurrent tertiary hyperparathyroidism (THPT) after total parathyroidectomy due to intrathyroidal parathyroid carcinoma (PC).
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Affiliation(s)
- Rustam Salimkhanov
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Center, Moscow, Russia
| | | | - Anna Eremkina
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Center, Moscow, Russia
| | - Ekaterina Bibik
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Center, Moscow, Russia
| | - Ekaterina Kim
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Center, Moscow, Russia
| | - Kamila Begova
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Center, Moscow, Russia
| | - Ilya Kim
- Department of Endocrine Surgery, Endocrinology Research Center, Moscow, Russia
| | - Sergey Kuznetsov
- Department of Endocrine Surgery, Endocrinology Research Center, Moscow, Russia
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Sabanis N, Paschou E, Drylli A, Papanikolaou P, Zagkotsis G. Uremic Leontiasis Ossea: Theoretical Concepts and Practical Considerations. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:702-715. [PMID: 37955462 DOI: 10.4103/1319-2442.389430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Leontiasis ossea (LO) in chronic kidney disease patients, also known as Sagliker syndrome, is an exceptionally uncommon uremic complication of long-lasting and severe secondary hyperparathyroidism. The prominent features of uremic LO (ULO) encompass the characteristic clinical trial of massive thickening of maxillary and mandibular bones, widening of interdental spaces, and flattening of nasal bridges and nares. Moreover, during the transformation of craniofacial architecture, significant structural and functional consequences may appear, including upper airway patency, visual and hearing acuity, oral phase of swallowing as well as various neurological and psychiatric disorders. Only few cases of ULO have been reported in the literature until now, making challenging not only the traditional diagnostic procedures but also the optimal therapeutic approach. In this narrative review, we aim to explore the underlying pathophysiological mechanisms, summarize the evidence for adverse outcomes, and highlight the current therapeutic strategies for ULO prevention and treatment, given that precise genetic determinants remain elusive.
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Affiliation(s)
- Nikolaos Sabanis
- Department of Nephrology, General Hospital of Livadia, Livadia, Greece
| | - Eleni Paschou
- Department of General Practice and Family Medicine, Medical Unit of St George, Livadia, Greece
| | - Aikaterini Drylli
- Department of Otorhinolaryngology, National and Kapodistrian University of Athens, Athens, Greece
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Guimarães LM, Valeriano AT, Rebelo Pontes HA, Gomez RS, Gomes CC. Manifestations of hyperparathyroidism in the jaws: Concepts, mechanisms, and clinical aspects. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 133:547-555. [PMID: 35181256 DOI: 10.1016/j.oooo.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/07/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022]
Abstract
Hyperparathyroidism is one of the most common endocrine disorders worldwide. In countries where routine biochemical screening is not common, symptomatic hyperparathyroidism predominates. Its manifestations include skeletal alterations, calcification of soft tissues, kidney stones, and functional alterations in other systems. Notably, jaw alterations can be the first clinical sign of hyperparathyroidism, including brown tumor, renal osteodystrophy, osteitis fibrosa, and leontiasis ossea, and knowing such conditions is of core importance for the multidisciplinary diagnosis and management of hyperparathyroidism. We aimed to perform a concise review, systematizing the concepts and mechanisms underlying hyperparathyroidism and associated gnathic alterations. In addition, a detailed description of the clinical aspects of the jaw manifestations is presented.
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Affiliation(s)
- Letícia Martins Guimarães
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alline Teixeira Valeriano
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Hélder Antônio Rebelo Pontes
- Service of Oral Pathology, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carolina Cavalieri Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Mi JP, He P, Shi K, Feng SY, Chen XZ, He QQ, Zhao MY, Ge PJ, Fan YP. Cephalometric craniofacial features of patients with Sagliker syndrome: a primary analysis of our experience. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:963. [PMID: 34277763 PMCID: PMC8267326 DOI: 10.21037/atm-21-1544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022]
Abstract
Background Sagliker syndrome (SS) is characterized by a severe uglifying facial appearance resulting from untreated or inadequately treated secondary hyperparathyroidism (SHPT). To date, the craniofacial morphology of patients with SS has yet to be analyzed. The present research sought to cephalometrically evaluate the craniofacial features of patients with SS and to perform an in-depth analysis of their serum biochemical parameters, with the aim of furthering the theoretical basis for the early diagnosis and prevention of SS. Methods A retrospective chart review of 9 patients who fulfilled the diagnostic criteria for SS were included in this study, and their serum biochemical parameters were collected. After subjecting standard lateral cephalometric radiographic images to correction for distortions caused by magnification followed by digitization, we conducted a cephalometric analysis. Student's two-tailed t tests or Mann-Whitney U tests were used to analyze the data. Thirty-three patients with patients with SHPT alone were also included as controls. Results The lower anterior facial height (ANS-ME) and total anterior facial height (N-Me) measurements of patients with SS were significantly increased compared to those of the controls. The angles between the Frankfort horizontal, palatal, and occlusal planes and the mandibular plane, were greater in the SS group than in the control group, as was the gonial angle. Patients with SS also exhibited a significantly larger maxillary protrusion angle and relative position of the maxilla to the mandible. Most patients with SS had class II malocclusion, whereas most of the controls exhibited normal occlusion. Soft tissue largely followed the same pattern as craniofacial changes. Our investigation also showed that among patients with SHPT, female sex, longer duration of dialysis, and higher serum levels of alkaline phosphatase and intact parathyroid hormone were associated with development to SS. Conclusions Patients with SS show facial and biochemical differences compared to patients with SHPT. Female sex, long dialysis duration, and high serum levels of intact parathyroid hormone and alkaline phosphatase may be potential risk factors for SS.
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Affiliation(s)
- Jiao-Ping Mi
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Peng He
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Kai Shi
- Department of Stomatology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Shao-Yan Feng
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xian-Zhen Chen
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Qing-Qing He
- Department of Otolaryngology Head and Neck Surgery, Zhuhai Maternal and Child Health Hospital, Zhuhai, China
| | - Ming-Yue Zhao
- The Graduate School of Zunyi Medical University, Zunyi, China
| | - Ping-Jiang Ge
- Department of Otolaryngology Head and Neck Surgery, Guangdong Provincial General Hospital, Guangzhou, China
| | - Yun-Ping Fan
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Department of Otolaryngology Head and Neck Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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Abstract
In this report, we present a case of a patient with a history of complex airway anatomy secondary to Sagliker syndrome (SS) who presented with acute exacerbation of chronic respiratory failure. The patient's difficult airway, complicated medical comorbidities, and poor psychosocial status posed a unique challenge for providing safe care during an emergency. The perioperative anesthesia service (PAS), led by critical care anesthesiologists, coordinated a multidisciplinary airway management plan. The PAS team also assisted this medically complex patient with her decision-making process. A 37-year-old female with SS, which is characterized by irreversible disfiguring of head and neck anatomy secondary to end-stage renal disease (ESRD) and poorly controlled hyperparathyroidism, presented with acute exacerbation of chronic respiratory failure due to hypervolemia. The patient's respiratory status rapidly deteriorated despite aggressive hemodialysis, requiring transfer to the ICU. Given the challenging anatomy and poor respiratory reserve in this patient, the PAS team helped coordinate a comprehensive airway plan that involved transnasal fiberoptic intubation, and in case of emergency, extracorporeal membrane oxygenation (ECMO) as a bridge to a surgical airway. During the decision-making process, the patient was found to be in psychological distress and had limited insights into her condition. The PAS team helped facilitated multidisciplinary goals-of-care discussions for the patient and her family. Fortunately, the patient's oxygenation improved with noninvasive oxygen support and aggressive hemodialysis without the need for intubation. She was discharged with outpatient follow-up appointments arranged to discuss long-term management. This is the first reported case of SS in the United States. The early involvement by the PAS team helped coordinate a multidisciplinary care plan for this patient with a difficult airway and complex comorbidities. This report highlights an innovative airway algorithm for a potentially "cannot-intubate, cannot ventilate" complex airway, and the PAS team's role in providing support for the patient's physical and psychological needs, suggesting that a comprehensive perioperative service can improve the quality and safety of care, not only for surgical patients but also for medically complex patients as well.
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Affiliation(s)
- QiLiang Chen
- Department of Anesthesiology, Stanford University, Stanford, USA
| | - Javier Lorenzo
- Department of Anesthesiology, Stanford University, Stanford, USA
| | - Amy Lu
- Department of Anesthesiology, Stanford University, Stanford, USA
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Yu Y, Zhu CF, Fu X, Xu H. Sagliker syndrome: A case report of a rare manifestation of uncontrolled secondary hyperparathyroidism in chronic renal failure. World J Clin Cases 2019; 7:3792-3799. [PMID: 31799306 PMCID: PMC6887613 DOI: 10.12998/wjcc.v7.i22.3792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/03/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sagliker syndrome (SS) resulting from uncontrolled secondary hyperparathyroidism (SHPT) in chronic renal failure (CRF) is seldom reported.
CASE SUMMARY A 24-year-old woman presented with asymmetric facial deformity and stature shortening. She was diagnosed with SS, SHPT, CRF, and thyroid cancer. The patient underwent a total parathyroidectomy and thyroidectomy with central lymph node dissection. The patient’s condition was stable and was discharged from the hospital.
CONCLUSION Undergoing dialysis vintage, presenting high serum phosphate levels, and female gender may be risk factors for SS. Intramembranous ossification in the craniomaxillofacial region is possibly activated in this special pathophysiological condition. What’s more, the choice of surgery mainly depends on the treatment goal and the experience of the individual surgeon.
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Affiliation(s)
- Yu Yu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Chen-Fang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Xiao Fu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Hua Xu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
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Panezai MA, Ahmed S, Colbert GB. Sagliker syndrome in a patient with end-stage renal disease with secondary hyperparathyroidism. Proc (Bayl Univ Med Cent) 2019; 32:624-626. [PMID: 31656444 DOI: 10.1080/08998280.2019.1624092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022] Open
Abstract
Sagliker syndrome (SS), also known as an "uglifying human face syndrome," is one of the severe manifestations of chronic kidney disease in patients with uncontrolled secondary hyperparathyroidism. Patients with SS develop short stature, maxillary and mandibular bone overgrowth, nasal bone and cartilage destruction, widely spaced teeth with anterior positioning, soft tissue tumors in the oral cavity, auditory loss, and neurological and psychological features. SS can possibly be prevented with proper treatment of secondary hyperparathyroidism using disease-modifying medication and surgical therapies. We report a case of SS in a patient in the USA with end-stage renal disease achieving adequate hemodialysis.
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Affiliation(s)
| | - Sana Ahmed
- Division of Nephrology, Department of Internal Medicine, Baylor University Medical Center at DallasDallasTexas
| | - Gates B Colbert
- Division of Nephrology, Department of Internal Medicine, Baylor University Medical Center at DallasDallasTexas
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Pereira TDSF, Gomes CC, Brennan PA, Fonseca FP, Gomez RS. Fibrous dysplasia of the jaws: Integrating molecular pathogenesis with clinical, radiological, and histopathological features. J Oral Pathol Med 2018; 48:3-9. [PMID: 30376190 DOI: 10.1111/jop.12797] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fibrous dysplasia is a non-neoplastic developmental process that affects the craniofacial bones, characterized by painless enlargement as a result of bone substitution by abnormal fibrous tissue. Postzygotic somatic activating mutations in the GNAS1 gene cause fibrous dysplasia and have been extensively investigated, as well as being helpful in the differential diagnosis of the disease. Fibrous dysplasia may involve one (monostotic) or multiple bones (polyostotic), sporadically or in association with McCune-Albright syndrome, Jeffe-Lichenstein syndrome, or Mazabreud syndrome. This review summarizes the current knowledge on fibrous dysplasia, emphasizing the value of integrating the understanding of its molecular pathogenesis with the clinical, radiological, and histopathological features. In addition, we address important aspects related to the differential diagnosis and patient management.
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Affiliation(s)
- Thaís Dos Santos Fontes Pereira
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Cavalieri Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Systematic review of oral manifestations related to hyperparathyroidism. Clin Oral Investig 2017; 22:1-27. [DOI: 10.1007/s00784-017-2124-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 05/10/2017] [Indexed: 12/29/2022]
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Tunç E, Demirhan O, Sağliker Y, Yildiz İ, Paylar N, Güzel Aİ. Chromosomal findings and sequence analysis of target exons of calcium-sensingreceptor (CaSR) gene in patients with Sagliker syndrome. Turk J Med Sci 2017; 47:13-21. [PMID: 28263480 DOI: 10.3906/sag-1507-102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/28/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/AIM Sagliker syndrome (SS) develops as a continuation of chronic kidney disease and secondary hyperparathyroidism conditions. It was thought that there are some genetic predisposition factors leading to SS. The calcium-sensing receptor (CaSR) is essential for calcium homeostasis in the body. We aimed to examine SS patients for chromosome aberrations (CAs) and CaSR gene abnormalities in exons 2 and 3. MATERIALS AND METHODS Twenty-three patients and 23 control subjects were admitted to Balcalı Hospital of the Medical Faculty of Çukurova University in Turkey between 2009 and 2011. Chromosomal analysis was performed according to standard cytogenetic methods. Full sequencing of exons 2 and 3 of the CaSR gene was done. RESULTS We found base alterations and deletions in exons 2 and 3 of the CaSR gene. We also found a statistically significant increase in the rate of CAs in patients compared to controls. In total we evaluated 639 metaphase plaques in 23 patients and found 241 CAs, of which 88% were structural and 12% were numerical abnormalities. CONCLUSION There is no relation between the etiology of SS and nucleotide alterations that we could find in exons 2 and 3 of the CaSR gene. Our data suggest that there may be a correlation between CAs and the progression of SS.
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Affiliation(s)
- Erdal Tunç
- Department of Medical Biology and Genetics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Osman Demirhan
- Department of Medical Biology and Genetics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Yahya Sağliker
- Department of Internal Medicine, Faculty of Medicine, Çukurova University, Adana, Turkey
| | | | - Nuray Paylar
- Department of Internal Medicine, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ali İrfan Güzel
- Department of Medical Biology and Genetics, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
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Demirhan O, Arslan A, Sagliker Y, Akbal E, Ergun S, Bayraktar R, Sagliker HS, Dogan E, Gunesacar R, Ozkaynak PS. Gene mutations in chronic kidney disease patients with secondary hyperparathyroidism and Sagliker syndrome. J Ren Nutr 2015; 25:176-86. [PMID: 25701941 DOI: 10.1053/j.jrn.2014.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/22/2014] [Accepted: 12/22/2014] [Indexed: 12/26/2022] Open
Abstract
Sagliker syndrome (SS) develops particularly before puberty while chronic kidney disease (CKD) reaches stage 3 with overt secondary hyperparathyroidism. We conducted screening for mutations in all the 13 exons of GNAS1 gene, all 3 exons of FGF23, and all 18 exons in FGFR3 genes in 23 patients. In 73.9% (17 of 23) patients, 17 genetic abnormalities in GNAS1 were detected. Seven (58.3%) of 12 nucleotide alterations comprised novel missense mutations and 3 nonsense. Mismutations were in different manner. There were also 6 heterozygous transversion polymorphisms in exons. Six were introngenic mutations (introns 65626, 70387, 70817). We found 10 mutations with different manner in FGF23 gene. Two were defined previously but remaining 8 were novel mutations. Three were in intronic region near exon 2. We sequenced all exons and intronic regions near exon-exon junction regions of FGFR3 gene. We found 22 mutations with different manner. Six were defined previously and remaining 16 were novel mutations. Eight of them were in intronic region near exon 11 and the last 2 were in noncoding exonic region of exons. One was in the exon-exon junction region between exon 11 and 12, therefore this mutation might be preventing splicing of this intron. Because the incidence of CKD late stage 3 is around 8% but the incidence of SS is around 0.5% in CKD, these gene mismutations might be responsible for bone deformities such as McCune-Albright syndrome and achondroplasias. Although our patients were not resembling any of them, they could be in between, and SS might be a combination-compulsion of bone dysplasias-hereditary osteodystrophies and CKD.
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Affiliation(s)
| | | | - Yahya Sagliker
- Sagliker Hypertension and Nephrology Unit, Adana, Turkey.
| | | | | | | | | | - Ekrem Dogan
- Sutcu Imam University, Kahramanmaras, Turkey
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Mejía Pineda A, Aguilera ML, Meléndez HJ, Lemus JA, Peñalonzo MA. Sagliker syndrome in patients with secondary hyperparathyroidism and chronic renal failure: Case report. Int J Surg Case Rep 2015; 8C:127-30. [PMID: 25661637 PMCID: PMC4353958 DOI: 10.1016/j.ijscr.2015.01.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 12/28/2022] Open
Abstract
Sagliker syndrome is assumed to result from insufficient treatment of secondary hyperparathyroidism in early stages of chronic renal failure. Sagliker syndrome should be added to current surgical indications for parathyroidectomy.
Introduction Sagliker described craniofacial, skeletal, neurologic and soft tissue abnormalities in patients with secondary hyperparathyroidism with end-stage chronic renal disease. This unique entity has been attributed to delay in treatment of renal insufficiency. As of 2012 sixty cases have been reported. The aim of the study is to report this entity in five patients and to propose this condition as an indication for parathyroidectomy. Methods We report five patients. All patients had chronic renal failure (CRF) and secondary hyperparathyroidism that fulfilled the criteria for Sagliker syndrome and underwent parathyroid surgery. We collected detailed information, including clinical history, laboratory data, and old/current photographs for comparison. Results The five patients, four women and one man mean age 21 years, had severe secondary hyperparathyroidism (mean serum preoperative PTH = 3779.6 pg/ml, mean preoperative Ca2+ = 8.83 mg/dl and P3– = 5.66 mg/dl); maxillary and mandibular bone changes; teeth/dental abnormalities; and soft and benign tumors in the mouth. Three had severe uglifying facial appearance. All patients underwent total parathyroidectomy without postoperative complications. After surgery mean serum PTH was 17.16 pg/ml (p = 0.006), P3− = 3.38 mg/dl (p = 0.0068) and Ca2+ = 6.97 mg/dl (p = 0.345). At surgery, average height was 149.8 cm, a mean of 6 cm (p = 0.003) less than at the beginning of CRF. Preoperative Beck Depression Inventory test mean score was 37 (severe depression); 6 months after surgery mean score was 15.8 (mild mood disturbance)(p = 0.0001). Clinical follow-up was satisfactory with a mean follow up time of 14 months. Conclusion We consider that Sagliker syndrome should be added to current surgical indications for parathyroidectomy.
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Affiliation(s)
- Ana Mejía Pineda
- Fellow Endocrine Surgery, Universidad Francisco Marroquín, Guatemala.
| | | | | | - José A Lemus
- Medical Doctor, Universidad Francisco Marroquín, Guatemala.
| | - Marco A Peñalonzo
- Director Endocrine Surgery Fellowship, Universidad, Francisco Marroquín, Guatemala.
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Yang G, Zhang B, Zha XM, Wang NN, Xing CY. Total parathyroidectomy with autotransplantation for a rare disease derived from uremic secondary hyperparathyroidism, the uremic leontiasis ossea. Osteoporos Int 2014; 25:1115-21. [PMID: 23989901 DOI: 10.1007/s00198-013-2488-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/02/2013] [Indexed: 12/21/2022]
Abstract
SUMMARY We described six uremic leontiasis ossea (ULO) patients who underwent total parathyroidectomy with autotransplantation. ULO demonstrated more a systemic disease than a simple craniofacial deformation. The surgery seemed an effective treatment to alleviate secondary hyperparathyroidism and to improve patients' quality of life. ULO may have a high postoperative recurrence tendency. INTRODUCTION ULO is a rare disease derived from uremic secondary hyperparathyroidism (SHPT). Previous studies mostly focused on the craniofacial deformations. This study aims to investigate the systemic features of the disease and the surgical outcomes. METHODS The present study retrospectively assessed six ULO patients who underwent total parathyroidectomy (TPTX) with autotransplantation (AT). Follow-up data were recorded. The follow-up status was considered as "effectiveness" if serum intact parathyroid hormone (iPTH) levels were <150 pg/mL in the first 3 days after surgery, or as "recurrence" if serum iPTH gradually increased >300 pg/mL during follow-up in patients whose status was initially considered as "effectiveness". RESULTS Craniofacial deformations, short stature, thoracocyllosis, spine malformations, osteodynia, and muscle weakness were observed in all patients. Abnormal pulmonary functions were observed in five patients. After surgery, one patient died from respiratory failure. Surgery was effective in the remaining five patients with relieved osteodynia and stopped craniofacial deformation. A mean follow-up of 7.6 (4 to 12) months was available. Three patients suffered from recurrence of hyperparathyroidism originating from autografts. CONCLUSIONS Our data suggests that ULO is not only a simple disease with craniofacial malformations but is a severe systemic disease leading to increased surgical risks. TPTX with AT seems an effective treatment to relieve SHPT and to improve quality of life. ULO may have a high postoperative recurrence tendency.
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Affiliation(s)
- G Yang
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, Jiangsu, 210029, China
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Chen XH, Shen B, Zou J, Ding X, Liu Z, Lv W, Cao X, Nie Y. Clinical status of Sagliker syndrome: a case report and literature review. Ren Fail 2014; 36:800-3. [PMID: 24575953 DOI: 10.3109/0886022x.2014.890110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In a 53-year-old woman, Sagliker syndrome developed during 22 years of treatment with intermittent hemodialysis as a result of severe secondary hyperparathyroidism (SHPT) complicating end-stage renal disease. She failed medical managements and lost her renal graft just after the kidney transplantation due to acute rejection. Although surgical parathyroidectomy was effective, the parathyroid hormone level became extremely high again due to recurrent hyperparathyroidism. It is possible that such patient could survive long-term with dialysis, but prevention of severe SHPT is the most important.
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Affiliation(s)
- Xiao Hong Chen
- Blood Purification Center, Zhongshan Hospital of Fudan University , Shanghai , P.R. China and
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