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Zhao Y, Zhang F, Zhang S, Zhang X, Gao L, Ren Q, Han X, Ji L. Denosumab for Management of Hypercalcemia in Primary Hyperparathyroidism. Horm Metab Res 2024. [PMID: 39393416 DOI: 10.1055/a-2411-9426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2024]
Abstract
Denosumab is a completely human monoclonal high-affinity antibody that binds to the nuclear factor kappa-B ligand (RANKL) and is widely used to treat osteoporosis. Furthermore, it can potentially lower serum calcium levels by inhibiting osteoclast activation and preventing bone calcium from being released into the blood. This review aimed to provide evidence of the efficacy and safety of denosumab in treating hypercalcemia in primary hyperparathyroidism (PHPT). PubMed and the Cochrane Library were searched for published studies that described denosumab for hypercalcemia management in PHPT. Data were extracted by two independent investigators and analyzed using SPSS 23. The risk of bias was assessed by NIH Quality Assessment Tool. In total, 161 patients with PHPT from 18 studies were included in this review. The average age was 61 (47-72) years and the highest serum calcium was 3.76 (3.11-4.20) mmol/l. We found that denosumab can effectively reduce the serum calcium level by a median reduction of 0.5 mmol/l within 3 days. Significant reduction was maintained for 14 days. The serum calcium-lowering effect weakened after one month. In conclusion, denosumab has a potential clinical value in treating hypercalcemia in patients with PHPT.
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Affiliation(s)
- Yihan Zhao
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Fang Zhang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Simin Zhang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Xiaona Zhang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Leili Gao
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Qian Ren
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Xueyao Han
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
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Fuleihan GEH, Drake MT. Commentary on the endocrine society clinical practice guideline on the "treatment of hypercalcemia of malignancy in adults". Metabolism 2023; 143:155553. [PMID: 37028591 DOI: 10.1016/j.metabol.2023.155553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Matthew T Drake
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55902, USA
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Sapuppo G, Giusti MA, Aricò D, Masucci R, Tavarelli M, Russo M, Pellegriti G. Recurrent parathyromatosis in a patient with concomitant MEN1 and CASR gene alterations: Clinical management of a case report and literature review. Front Endocrinol (Lausanne) 2023; 14:1108278. [PMID: 36998475 PMCID: PMC10044612 DOI: 10.3389/fendo.2023.1108278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/02/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction Parathyromatosis is a rare cause of primitive hyperparathyroidism characterized by the presence of numerous parathyroid tissue foci in the neck/mediastinum, due to hyperplasia of parathyroid embryologic residues (primary-form) or to local parathyroid tissue implantation (secondary-form). 63 cases have been described in the literature. In our patient parathyromatosis was due to a combination of two mutations. Case report A 36-years-old woman was diagnosed with osteoporosis secondary to primary hyperparathyroidism. Subsequent right parathyroidectomy showed a parathyroid adenoma. The follow-up was negative but after 10 years she had a relapse. The genetic screening showed a rare intronic mutation of the MEN1 gene and a heterozygous mutation never described in exon 8 of the CASR gene, coding for the calcium receptor. Calcemia and PTH increased over the years with the onset of nephrocalcinosis and the worsening of osteoporosis despite the therapy with Cinacalcet, bisphosphonates and Vitamin D. She had therefore two additional surgical procedures (parathyroid tissue without malignancy). At follow-up she showed elevated levels of PTH (>1000 pg/ml) and calcium (11.2 mg/dl) and CT scans multiple subcentimetric nodules in the neck/upper mediastinum. Since the 68Ga-DOTATATE showed an increased uptake in the neck/mediastinum, lanreotide was added. After two months there was a significant biochemical response but, unfortunately, after six months, the patient showed a new worsening. Conclusions a rare case of parathyromatosis due to a combination of two genetic alterations never described. The main issues concern the diagnosis and the radical treatment. Somatostatin analogues may have a useful role in both diagnosis and therapy.
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Affiliation(s)
- Giulia Sapuppo
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Maria Ausilia Giusti
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Demetrio Aricò
- Department of Nuclear Medicine, Humanitas Oncological Centre of Catania, Catania, Italy
| | - Romilda Masucci
- Clinical and Diagnostic Center, Giovan Battista (G.B.) Morgagni, Catania, Italy
| | - Martina Tavarelli
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Marco Russo
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Gabriella Pellegriti
- Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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El-Hajj Fuleihan G, Clines GA, Hu MI, Marcocci C, Murad MH, Piggott T, Van Poznak C, Wu JY, Drake MT. Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2023; 108:507-528. [PMID: 36545746 DOI: 10.1210/clinem/dgac621] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypercalcemia of malignancy (HCM) is the most common metabolic complication of malignancies, but its incidence may be declining due to potent chemotherapeutic agents. The high mortality associated with HCM has declined markedly due to the introduction of increasingly effective chemotherapeutic drugs. Despite the widespread availability of efficacious medications to treat HCM, evidence-based recommendations to manage this debilitating condition are lacking. OBJECTIVE To develop guidelines for the treatment of adults with HCM. METHODS A multidisciplinary panel of clinical experts, together with experts in systematic literature review, identified and prioritized 8 clinical questions related to the treatment of HCM in adult patients. The systematic reviews (SRs) queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations. An independent SR was conducted in parallel to assess patients' and physicians' values and preferences, costs, resources needed, acceptability, feasibility, equity, and other domains relevant to the Evidence-to-Decision framework as well as to enable judgements and recommendations. RESULTS The panel recommends (strong recommendation) in adults with HCM treatment with denosumab (Dmab) or an intravenous (IV) bisphosphonate (BP). The following recommendations were based on low certainty of the evidence. The panel suggests (conditional recommendation) (1) in adults with HCM, the use of Dmab rather than an IV BP; (2) in adults with severe HCM, a combination of calcitonin and an IV BP or Dmab therapy as initial treatment; and (3) in adults with refractory/recurrent HCM despite treatment with BP, the use of Dmab. The panel suggests (conditional recommendation) the addition of an IV BP or Dmab in adult patients with hypercalcemia due to tumors associated with high calcitriol levels who are already receiving glucocorticoid therapy but continue to have severe or symptomatic HCM. The panel suggests (conditional recommendation) in adult patients with hypercalcemia due to parathyroid carcinoma, treatment with either a calcimimetic or an antiresorptive (IV BP or Dmab). The panel judges the treatments as probably accessible and feasible for most recommendations but noted variability in costs, resources required, and their impact on equity. CONCLUSIONS The panel's recommendations are based on currently available evidence considering the most important outcomes in HCM to patients and key stakeholders. Treatment of the primary malignancy is instrumental for controlling hypercalcemia and preventing its recurrence. The recommendations provide a framework for the medical management of adults with HCM and incorporate important decisional and contextual factors. The guidelines underscore current knowledge gaps that can be used to establish future research agendas.
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Affiliation(s)
| | - Gregory A Clines
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56100, Italy
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
- MacGRADE Centre, McMaster University, Hamilton, ON, L8S 4K1, Canada
- Department of Family Medicine, Queens University, Kingston, ON, K7L 3G2, Canada
- Peterborough Public Health, Peterborough, ON, K9J 2R8, Canada
| | - Catherine Van Poznak
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Joy Y Wu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Matthew T Drake
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Almuradova E, Cicin I. Cancer-related hypercalcemia and potential treatments. Front Endocrinol (Lausanne) 2023; 14:1039490. [PMID: 37033238 PMCID: PMC10073684 DOI: 10.3389/fendo.2023.1039490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Cancer-related hypercalcemia is a common finding typically seen in patients with advanced cancer and occurs in about 20 to 30 percent of cases. The most common cause of hypercalcemia in hospitalized patients is hypercalcemia due to malignancy.This clinical problem is seen in patients with both solid tumors and patients with hematologic malignancies. Hypercalcemia is associated with a poor prognosis in oncology patients. This pathologic condition can occur due to many different mechanisms but is usually caused by abnormal calcium use resulting from bone resorption, intestinal absorption, or renal excretion. Hypercalcemia may present with a wide range of symptoms ranging from gastrointestinal system symptoms to neurologic symptoms. Timely diagnosis and initiation of treatment by the physician significantly reduce the risk of complications. Treatment aims to decrease serum calcium by increasing calciuresis, decreasing bone resorption, and decreasing intestinal calcium absorption. The mainstays of treatment are IV hydration, bisphosphonates and calcitonin, denosumab, and in some patients, prednisone, and cinacalcet. Patients with underlying advanced kidney disease and refractory severe hypercalcemia should be evaluated for hemodialysis. Every physician dealing with oncology patients should know the fastest and most effective management of hypercalcemia. We aimed to contribute in this sense.
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Affiliation(s)
| | - Irfan Cicin
- Medical Oncology Department, Faculty of Medicine, Trakya University, Trakya, Türkiye
- *Correspondence: Irfan Cicin,
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Abstract
IMPORTANCE Hypercalcemia affects approximately 1% of the worldwide population. Mild hypercalcemia, defined as total calcium of less than 12 mg/dL (<3 mmol/L) or ionized calcium of 5.6 to 8.0 mg/dL (1.4-2 mmol/L), is usually asymptomatic but may be associated with constitutional symptoms such as fatigue and constipation in approximately 20% of people. Hypercalcemia that is severe, defined as total calcium of 14 mg/dL or greater (>3.5 mmol/L) or ionized calcium of 10 mg/dL or greater (≥2.5 mmol/L) or that develops rapidly over days to weeks, can cause nausea, vomiting, dehydration, confusion, somnolence, and coma. OBSERVATIONS Approximately 90% of people with hypercalcemia have primary hyperparathyroidism (PHPT) or malignancy. Additional causes of hypercalcemia include granulomatous disease such as sarcoidosis, endocrinopathies such as thyroid disease, immobilization, genetic disorders, and medications such as thiazide diuretics and supplements such as calcium, vitamin D, or vitamin A. Hypercalcemia has been associated with sodium-glucose cotransporter 2 protein inhibitors, immune checkpoint inhibitors, denosumab discontinuation, SARS-CoV-2, ketogenic diets, and extreme exercise, but these account for less than 1% of causes. Serum intact parathyroid hormone (PTH), the most important initial test to evaluate hypercalcemia, distinguishes PTH-dependent from PTH-independent causes. In a patient with hypercalcemia, an elevated or normal PTH concentration is consistent with PHPT, while a suppressed PTH level (<20 pg/mL depending on assay) indicates another cause. Mild hypercalcemia usually does not need acute intervention. If due to PHPT, parathyroidectomy may be considered depending on age, serum calcium level, and kidney or skeletal involvement. In patients older than 50 years with serum calcium levels less than 1 mg above the upper normal limit and no evidence of skeletal or kidney disease, observation may be appropriate. Initial therapy of symptomatic or severe hypercalcemia consists of hydration and intravenous bisphosphonates, such as zoledronic acid or pamidronate. In patients with kidney failure, denosumab and dialysis may be indicated. Glucocorticoids may be used as primary treatment when hypercalcemia is due to excessive intestinal calcium absorption (vitamin D intoxication, granulomatous disorders, some lymphomas). Treatment reduces serum calcium and improves symptoms, at least transiently. The underlying cause of hypercalcemia should be identified and treated. The prognosis for asymptomatic PHPT is excellent with either medical or surgical management. Hypercalcemia of malignancy is associated with poor survival. CONCLUSIONS AND RELEVANCE Mild hypercalcemia is typically asymptomatic, while severe hypercalcemia is associated with nausea, vomiting, dehydration, confusion, somnolence, and coma. Asymptomatic hypercalcemia due to primary hyperparathyroidism is managed with parathyroidectomy or observation with monitoring, while severe hypercalcemia is typically treated with hydration and intravenous bisphosphonates.
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Affiliation(s)
- Marcella Donovan Walker
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
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Tsai WH, Zeng YH, Lee CC, Tsai MC. Mortality factors in recurrent parathyroid cancer: a pooled analysis. J Bone Miner Metab 2022; 40:508-517. [PMID: 35184206 DOI: 10.1007/s00774-021-01305-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Parathyroid cancer is a rare disease with high recurrence rate. The prognostic factors for recurrent parathyroid cancer are yet to be ascertained. We aimed to establish the association between recurrent parathyroid cancer and previously reported prognostic factors. MATERIALS AND METHODS We conducted a PubMed search using the keywords 'parathyroid cancer', 'parathyroid neoplasm', and 'hypercalcemia' during 1966-2019 and included 3272 articles. We focused on 73 patients with recurrent parathyroid cancer from 55 studies. We conducted a survival analysis using the Cox proportional hazards model with 95% confidence interval. RESULTS For the 73 patients included in the analysis, the mean age (± standard deviation) was 44 ± 13.2 years, wherein 36 patients were women (49.3%). During the 5236 person-months at risk (mean follow-up 71.7 months, range 3-264), 38 patients died. The incidence of local recurrence, lymph-node metastasis, lung metastasis, and bone metastasis were 60.3, 12.3, 56.2, and 24.7, respectively. Bone metastasis, disease-free interval < 1 year, and total surgeries < 3 were significant prognostic factors in univariate analysis (log-rank test P = 0.0063, P = 0.0006, and P = 0.0056, respectively). In the multivariate-adjusted analysis, the mortality risk was significantly increased in patients with bone metastasis with a hazard ratio (HR) of 4.83 (95% CI 1.16-20.2; P = 0.03), disease-free interval <=1 year of 5.92 (95% CI 1.85-18.99; P = 0.003), and total surgeries <3 of 11.29 (95% CI 2.82-45.22; P = 0.001), considering these as possible predictive prognostic factors. CONCLUSION Bone metastasis, duration of disease-free interval, and total number of surgeries predict survival in recurrent parathyroid cancer.
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Affiliation(s)
- Wen-Hsuan Tsai
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC)
| | - Yi-Hong Zeng
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC)
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (ROC)
| | - Chun-Chuan Lee
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC)
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (ROC)
| | - Ming-Chieh Tsai
- Division of Endocrinology and Metabolism, Department of Endocrinology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 104, Taiwan (ROC).
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan (ROC).
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Tzotzas T, Goropoulos A, Karras S, Terzaki A, Siolos A, Doumas A, Zaramboukas T, Tigas S. Effective long-term management of parathyromatosis-related refractory hypercalcemia with a combination of denosumab and cinacalcet treatment. Hormones (Athens) 2022; 21:171-176. [PMID: 34993886 DOI: 10.1007/s42000-021-00343-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
Abstract
Parathyromatosis is a rare cause of persistent or recurrent primary hyperparathyroidism and hypercalcemia due to the presence of hyperfunctioning foci of parathyroid tissue in the neck and/or mediastinum. We describe the case of a male patient who presented with severe hypercalcemia and a left-sided palpable parathyroid mass. Over the course of the next 18 years, the patient underwent neck exploration surgery on multiple occasions due to recurrent primary hyperparathyroidism and refractory hypercalcemia, complicated by nephrolithiasis and impairment of renal function, while bone mineral density was preserved. Histological findings and the natural course of the disease were consistent with parathyromatosis. Medical interventions with oral bisphosphonates or high-dose cinacalcet failed to control the patient's hypercalcemia. The combination of monthly denosumab and cinacalcet was, however, successful in maintaining the patient's serum calcium in the normal/upper-normal range over a 36-month period with no significant side effects. This is the first report of off-label denosumab use in combination with cinacalcet in the long-term management of parathyromatosis-related refractory hypercalcemia.
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Affiliation(s)
| | | | - Spyridon Karras
- Postdoctoral Researcher-National Scholarship Foundation, Thessaloniki, Greece
| | - Alexandra Terzaki
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - Athanasios Siolos
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - Argyrios Doumas
- Nuclear Medicine Department, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Stelios Tigas
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
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Wang Q, Wang J, Xin Y, He Z, Zhou X, Liu X, Zhao T, He L, Shen H, Jin M, Wei B. Hsa_circ_0005729 enhances accuracy in diagnosing parathyroid carcinoma. Endocr Connect 2022; 11:EC-21-0605.R1. [PMID: 35029546 PMCID: PMC8859958 DOI: 10.1530/ec-21-0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/14/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Parathyroid carcinoma (PC), often misdiagnosed as a parathyroid adenoma (PA), is prone to local relapse due to the initial surgery being restricted to parathyroid lesions instead of en bloc resection of parathyroid lesions with negative incision margins. However, it is very challenging to distinguish PC from PA preoperatively; hence, this study investigated an effective biomarker for increasing accuracy in PC diagnosis. METHOD First, the differentially expressed circular RNAs between three PC tissues and three PA tissues were screened by high-throughput circular RNA sequencing, and the expression of hsa_circ_0005729 was verified by qRT-PCR in 14 patients with PC and 40 patients with PA. Secondly, the receiver operating characteristic curve and the area under the curve (AUC) were used to analyze the diagnostic efficiency of hsa_circ_0005729 in PC by combining with laboratory data. Thirdly, RNF138mRNA, the corresponding linear transcript of hsa_circ_0005729, was measured, and the relationship between hsa_circ_0005729 and RNF138 mRNA was analyzed in patients with PA and patients with PC. RESULTS Hsa_circ_0005729 expression was significantly higher in patients with PC than in patients with PA. Serum calcium (P = 0.045), alkaline phosphatase (ALP) (P = 0.048), and creatinine levels (P = 0.036) were significantly higher in patients with PC than in patients with PA. The AUC increased to 0.86 when hsa_circ_0005729 combined with serum calcium, creatinine, and ALP. In addition, hsa_circ_0005729 was positively correlated with RNF138 mRNA in patients with PA but not in patients with PC. CONCLUSION The novel circular RNA hsa_circ_0005729 was found to have a higher expression in patients with PC, indicating its usefulness for distinguishing PC from PA.
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Affiliation(s)
- Qian Wang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiacheng Wang
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yunhui Xin
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ziyang He
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiang Zhou
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xing Liu
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Teng Zhao
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lihan He
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong Shen
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mulan Jin
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bojun Wei
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Correspondence should be addressed to B Wei:
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Su C, Zhang J, Yang H, Xu Y, Lu X. Diagnosis and treatment of liver metastases of parathyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:982972. [PMID: 36303876 PMCID: PMC9592764 DOI: 10.3389/fendo.2022.982972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Parathyroid carcinoma (PC) is a very rare endocrine malignancy occurring in less than 1% of all cases of primary hyperparathyroidism (pHPT). The liver is the second most common target organ for distant metastases of PC, but no guidelines are available for the diagnosis and treatment of liver metastases. In this study, we attempted to summarize the characteristics of the diagnosis and treatment of liver metastases based on our patients and other cases reported in the literature. MATERIALS AND METHODS The files of all patients diagnosed with PC with liver metastases summarized at our center between 2000 and 2022 were reviewed, and three datasets from Medline, Web of Science, and Embase were systematically searched to identify relevant articles. RESULTS Three patients with liver metastases from our center and 11 patients from the literature were included in the study. All patients had pHPT with borderline remission of hypercalcemia after each operation. A total of 71.4% of the patients' liver lesions were found by abdominal CT scans, while 35.7% were found by MRI, PET-CT, and fine-needle aspiration biopsy (FNAB), which were also helpful for diagnosis. Eight of nine patients (88.9%) who underwent surgery, radiofrequency ablation (RFA), or transcatheter arterial embolization (TAE) were alive, and only one postoperative patient died after a follow-up of 60 months. CONCLUSIONS PC is a rare malignant tumor prone to recurrence and metastasis, and postoperative reviews should be carried out routinely. Abnormally elevated parathyroid hormone (PTH) and serum calcium can indicate recurrence or metastasis. Enhanced CT and MRI can provide valuable support for the diagnosis of liver metastases, but whether [18F]FDG-PET-CT, [18F]FCH-PET-CT, or [11C]choline-PET-CT can be used as a diagnostic basis requires further study. Resection of liver metastases, segmental hepatectomy, or RFA can significantly improve patients' symptoms.
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Affiliation(s)
- Chaoyun Su
- Department of General Surgery, Beijing Aerospace General Hospital, Beijing, China
| | - Junwei Zhang
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huayu Yang
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yiyao Xu
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yiyao Xu, ; Xin Lu,
| | - Xin Lu
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- *Correspondence: Yiyao Xu, ; Xin Lu,
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11
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Kuchay MS, Mathew A, Kaur P, Mishra SK. Denosumab can be used successfully as a bridge to surgery in patients with severe hypercalcemia due to primary hyperparathyroidism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:669-673. [PMID: 34591412 PMCID: PMC10528581 DOI: 10.20945/2359-3997000000408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022]
Abstract
Severe hypercalcemia is a medical emergency that requires immediate and aggressive management. Primary hyperparathyroidism (PHPT) often causes severe hypercalcemia. Volume resuscitation, parenteral salmon calcitonin, and administration of intravenous bisphosphonates are common measures used to stabilize patients. However, the use of these measures is inadequate in several patients and may even be contraindicated in individuals with renal insufficiency or severe systemic illness. This study demonstrated the efficacy and safety of denosumab in patients with severe hypercalcemia due to PHPT, when immediate surgery was not feasible. We present four patients with severe hypercalcemia due to PHPT. Immediate surgery was not feasible because the patients had severe systemic illness, such as seizures and altered sensorium (case 1); acute severe pancreatitis (cases 2 and 3); or coronavirus disease 2019 pneumonia (case 4). Intravenous normal saline and parenteral salmon calcitonin were inadequate for controlling hypercalcemia. Intravenous bisphosphonates were avoided because of severe systemic illness in all cases and impaired renal function in three cases. Denosumab was administered to control hypercalcemia and allow the stabilization of patients for definitive surgical management. Following denosumab administration, serum calcium levels normalized, and general condition improved in all patients. Three patients underwent parathyroidectomy after two weeks and another patient after eight weeks. The use of denosumab for the management of severe hypercalcemia due to PHPT is efficacious and safe in patients when immediate surgical management is not feasible due to severe systemic illness.
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Affiliation(s)
- Mohammad Shafi Kuchay
- Division of Endocrinology and Diabetes, Medanta - The Medicity Hospital, Gurugram, Haryana, India,
| | - Anu Mathew
- Division of Endocrinology and Diabetes, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Parjeet Kaur
- Division of Endocrinology and Diabetes, Medanta - The Medicity Hospital, Gurugram, Haryana, India
| | - Sunil Kumar Mishra
- Division of Endocrinology and Diabetes, Medanta - The Medicity Hospital, Gurugram, Haryana, India
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Mamedova E, Kolodkina A, Vasilyev EV, Petrov V, Belaya Z, Tiulpakov A. Successful Use of Denosumab for Life-Threatening Hypercalcemia in a Pediatric Patient with Primary Hyperparathyroidism. Horm Res Paediatr 2021; 93:272-278. [PMID: 32998142 DOI: 10.1159/000510625] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is rare and usually symptomatic in children. There is no approved medication to lower serum calcium levels in this patient group. Denosumab is used in adult patients with osteoporosis and hyperparathyroidism. To our knowledge, only 1 case of denosumab treatment in a child with severe PHPT has been reported to date. CASE PRESENTATION A 16-year-old female was referred to our clinic with symptoms including pathologic fractures, nausea, emesis, and progressive weight loss. At admission, her serum total calcium was 4.17 mmol/L (reference range 2.15-2.55), parathyroid hormone 2,151 pg/mL (15-65), and phosphate 1.07 mmol/L (1.45-1.78). Due to potentially life-threatening hypercalcemia, denosumab 60 mg subcutaneously was administered after obtaining informed consent. Serum calcium levels were reduced within 12 h of injection and the patient's condition rapidly improved, which allowed genetic testing to be done prior to surgery. A heterozygous mutation in the CDC73 gene was revealed, and a parathyroidectomy was performed on day 22 after denosumab administration. Morphological examination revealed solitary parathyroid adenoma. After surgery, hypocalcemia developed requiring high doses of alfacalcidol and calcium supplements. CONCLUSION Our case supports the previous observations in adults that denosumab can be safely and effectively used as a preoperative treatment in patients with PHPT and severe hypercalcemia and shows that it may be used in pediatric patients.
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Affiliation(s)
- Elizaveta Mamedova
- Department of Neuroendocrinology and Bone Diseases, Endocrinology Research Centre, Moscow, Russian Federation
| | - Anna Kolodkina
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation
| | - Evgeny V Vasilyev
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation
| | - Vasiliy Petrov
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation
| | - Zhanna Belaya
- Department of Neuroendocrinology and Bone Diseases, Endocrinology Research Centre, Moscow, Russian Federation
| | - Anatoly Tiulpakov
- Department and Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre, Moscow, Russian Federation,
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Roukain A, Alwan H, Bongiovanni M, Sykiotis GP, Kopp PA. Denosumab for the Treatment of Hypercalcemia in a Patient With Parathyroid Carcinoma: A Case Report. Front Endocrinol (Lausanne) 2021; 12:794988. [PMID: 35173680 PMCID: PMC8842631 DOI: 10.3389/fendo.2021.794988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/30/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Refractory hypercalcemia is one of the major complications of parathyroid carcinoma. CASE REPORT An 84-year old female patient presented with an acute confusional state due to hypercalcemia. This led to the diagnosis of primary hyperparathyroidism for which she underwent surgery. The initial histological diagnosis was interpreted as atypical parathyroid adenoma; the resection was microscopically incomplete. One year later, the patient presented with elevated calcium levels up to 3.89 mmol/l. Recurrent severe hypercalcemia required multiple hospitalizations. Review of the histology slides revealed that the initially resected lesion was in fact a parathyroid carcinoma. Treatment with the calcimimetic drug cinacalcet was poorly tolerated. Repeated administration of zoledronic acid only had transient effects on calcium levels, and bisphosphonate treatment was ultimately discontinued because of chronic renal failure. The patient then received denosumab (60 or 120 mg) when needed (nine doses over twenty months), the last dose in November 2020, which led to a reduction and control of here calcium levels. Currently, at three years after initial surgery, calcium levels are stable between 2.7-2.8 mmol/l and the patient has not required hospitalization for hypercalcemia for 10 months. DISCUSSION In case of parathyroid carcinoma, en-bloc resection is the first treatment. Denosumab has proven its efficiency in treating hypercalcemia in malignancy. Several case reports studied denosumab in hypercalcemia due to parathyroid carcinoma, and the treatment were efficient to decrease levels of calcium when repeated as needed or monthly. We report another case of refractory hypercalcemia treated with several doses of denosumab in a patient with parathyroid carcinoma.
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Affiliation(s)
- Abdallah Roukain
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- *Correspondence: Abdallah Roukain,
| | - Heba Alwan
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | | | - Gerasimos P. Sykiotis
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Peter A. Kopp
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
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Eremkina A, Krupinova J, Dobreva E, Gorbacheva A, Bibik E, Samsonova M, Ajnetdinova A, Mokrysheva N. Denosumab for management of severe hypercalcemia in primary hyperparathyroidism. Endocr Connect 2020; 9:1019-1027. [PMID: 33112830 PMCID: PMC7707828 DOI: 10.1530/ec-20-0380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/01/2020] [Indexed: 11/08/2022]
Abstract
Hypercalcemic crisis is a severe but rare complication of primary hyperparathyroidism (PHPT), and data on denosumab treatment of patients with this disease is still very limited. The aim of this paper is to investigate the hypocalcemic effect of denosumab in PHPT patients with severe hypercalcemia when surgery should be delayed or is impossible for some reasons. We performed a retrospective study of 10 patients. The analysis included the use of biochemical markers of calcium-phosphorus metabolism, which were followed after the administration of 60 mg of denosumab. The trend to calcium reduction was already determined on the 3rd day after denosumab administration. In most cases the decrease in serum calcium level to the range of 2.8 mmol/L on average or lower was observed on the 7th day (P = 0.002). In addition to a significant increase in calcium levels we confirmed a significant increase in the estimated glomerular filtration rate on 7th day (P = 0.012). After that, seven patients underwent successful parathyroidectomy and achieved eucalcemia or hypocalcemia, one patient developed the recurrence of parathyroid cancer after initial surgery, while two patients with severe cardiovascular pathology refused surgery. Our study shows that denosumab is a useful tool in PHPT-associated hypercalcemia before surgery or if surgery is contraindicated.
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Affiliation(s)
- Anna Eremkina
- Endocrinology Research Center, Russian Federation, Moscow, Russia
- Correspondence should be addressed to A Eremkina:
| | - Julia Krupinova
- Endocrinology Research Center, Russian Federation, Moscow, Russia
| | | | - Anna Gorbacheva
- Endocrinology Research Center, Russian Federation, Moscow, Russia
| | - Ekaterina Bibik
- Endocrinology Research Center, Russian Federation, Moscow, Russia
| | - Margarita Samsonova
- Faculty of Fundamental Medicine, ederal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University, Moscow, Russia
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Pereira CA, Garrido S, Amaral C, Lima O, Cardoso H. Severe symptomatic hyperparathyroidism-Is it carcinoma?-Case report and literature review. Clin Case Rep 2020; 8:1476-1482. [PMID: 32884778 PMCID: PMC7455427 DOI: 10.1002/ccr3.2886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/28/2020] [Accepted: 04/02/2020] [Indexed: 12/05/2022] Open
Abstract
Parathyroid carcinoma is a rare disease, difficult to diagnose and associated with a poor prognosis. It must be suspected preoperatively, based on clinical and imaging grounds, in order to perform the best surgical option and avoid compromising patient's prognosis.
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Affiliation(s)
- Catarina A. Pereira
- Endocrinology DepartmentCentro Hospitalar e Universitário do PortoPortoPortugal
| | - Susana Garrido
- Endocrinology DepartmentCentro Hospitalar e Universitário do PortoPortoPortugal
| | - Cláudia Amaral
- Endocrinology DepartmentCentro Hospitalar e Universitário do PortoPortoPortugal
| | - Olinda Lima
- Anatomopathology DepartmentCentro Hospitalar e Universitário do PortoPortoPortugal
| | - Helena Cardoso
- Endocrinology DepartmentCentro Hospitalar e Universitário do PortoPortoPortugal
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16
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Omi Y, Yamamoto T, Nagashima Y, Abe K, Karasawa K, Tanaka Y, Okamoto T. Parathyroid carcinoma in a 13-year-old girl with a long-term survival. Surg Case Rep 2020; 6:145. [PMID: 32572650 PMCID: PMC7310022 DOI: 10.1186/s40792-020-00914-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background Parathyroid carcinoma as a cause of primary hyperparathyroidism in children is extremely rare. We report a case of parathyroid carcinoma which occurred in a 13-year-old girl who survived for more than 45 years after the first operation. Case presentation A woman was admitted to our hospital for the treatment of recurrent parathyroid carcinoma in the neck. She had been diagnosed with primary hyperparathyroidism from a fibula fracture and underwent parathyroidectomy at 13 years old. She had no family history of multiple endocrine neoplasia or jaw tumor syndrome. Genetic testing was not performed, and the histopathological diagnosis of the tumor had been parathyroid adenoma at the time. At 22 years old, she showed hypercalcemia after a femur fracture. Pulmonary metastases of parathyroid carcinoma in the bilateral lungs were found and surgically removed. Regarding the clinical course, her diagnosis was corrected from parathyroid adenoma to parathyroid carcinoma. At 33 years old, re-resection of the lung metastases was performed. For 10 years, her serum calcium level stayed within the normal range. However, her serum calcium level and intact parathyroid hormone eventually began to increase. Two masses suspected of being parathyroid carcinoma recurrence were found in the neck when she was 57 years old. En bloc resection was performed. Pathologically, the tumors were diagnosed as parathyroid adenoma. The serum calcium level and intact parathyroid hormone did not decrease after the operation. A 99mTc-methoxy-isobutyl-isonitrile- and 18F-fluorodeoxyglucose-negative, 11C-methionine-positive tumor was detected at the right side of the trachea in the neck. The tumor was removed, along with the thyroid, muscle, and trachea that were involved. The pathological diagnosis was parathyroid carcinoma recurrence. The serum calcium level and intact parathyroid hormone decreased temporarily but had increased again 8 months later. Methionine-positive tumors were found at the right side of the trachea and suspected of being a recurrence. Denosumab reduced her serum calcium level, and radiation successfully suppressed the growth of the recurrent tumors. Conclusion We have reported a rare case of parathyroid carcinoma in a child who has survived for over 40 years. Positron emission tomography of 11C-methionine was useful for detecting local recurrence. This patient’s long-term survival has been attributed to multimodality treatment including repeated surgery, medication, and radiation.
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Affiliation(s)
- Yoko Omi
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
| | - Tomoko Yamamoto
- Department of Diagnostic Pathology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yoji Nagashima
- Department of Diagnostic Pathology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Koichiro Abe
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Kumiko Karasawa
- Department of Radiation Oncology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yukichi Tanaka
- Department of Diagnostic Pathology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Japan
| | - Takahiro Okamoto
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
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17
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Li Y, Fan CY, Manni A, Simonds WF. Pitfalls of using denosumab preoperatively to treat refractory severe hypercalcaemia. BMJ Case Rep 2020; 13:13/4/e233665. [PMID: 32350052 DOI: 10.1136/bcr-2019-233665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 40-year-old man, with a history of metastatic parathyroid carcinoma, status post primary tumour resection and lung metastasectomy, was hospitalised for persistent severe hypercalcaemia and elevated parathyroid hormone levels despite conventional management and escalating doses of cinacalcet. A single dose (120 mg) of denosumab was given and his calcium level plummeted from 14.8 mg/dL to 5.5 mg/dL. After second lung metastasectomy, he developed prolonged hypocalcaemia that required calcium and vitamin D supplements for more than 3 years. In patients with severe hypercalcaemia refractory to conventional therapies, denosumab has been used off-label with some success. A known side effect of denosumab is hypocalcaemia, which is often short-lived. The risk of prolonged hypocalcaemia should be fully evaluated before using denosumab preoperatively, especially in patients with renal insufficiency, prolonged hyperparathyroidism or anticipated tumour debulking surgery.
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Affiliation(s)
- Yulong Li
- Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Chris Y Fan
- Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Andrea Manni
- Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - William F Simonds
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
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18
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Pratt RM, West ML, Tennankore KK. Use of denosumab to treat refractory hypercalcemia in a peritoneal dialysis patient with immobilization and tertiary hyperparathyroidism. Perit Dial Int 2020; 40:103-106. [DOI: 10.1177/0896860819880095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hypercalcemia due to excess parathyroid hormone (PTH) production is a common condition among patients with end-stage renal disease (ESRD), often referred to as tertiary hyperparathyroidism. There are limited effective medical treatment options currently available for such patients. Denosumab is a monoclonal antibody that inhibits osteoclast activation, thereby reducing calcium release from bones. Denosumab has been used to treat medically-refractory hypercalcemia in non-ESRD patients with hyperparathyroidism. Denosumab has also been used to treat non-PTH-mediated hypercalcemia in patients with advanced chronic kidney disease and ESRD. In this case report, we describe the use of denosumab to successfully treat a case of medically refractory hypercalcemia due to immobilization in a patient on peritoneal dialysis with severe underlying tertiary hyperparathyroidism. In spite of persistently elevated PTH, hypercalcemia quickly resolved after a single dose of denosumab. The patient subsequently developed temporary hypocalcemia requiring medical intervention. Our case report, which is the first described use of denosumab for treatment of hypercalcemia in the setting of tertiary hyperparathyroidism in a peritoneal dialysis patient, adds to the body of literature suggesting denosumab is a useful therapeutic agent in patients with ESRD. Issues with post-treatment electrolyte management and other therapeutic considerations are also discussed.
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Affiliation(s)
- Ryan M Pratt
- Division of Nephrology, Department of Medicine, Dalhousie University, Nova Scotia, Canada
- Queen Elizabeth II Health Sciences Center, Nova Scotia, Canada
| | - Michael L West
- Division of Nephrology, Department of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Karthik K Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University, Nova Scotia, Canada
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Pramanik S, Ray S, Bhattacharjee R, Chowdhury S. Parathyroid Carcinoma and Persistent Hypercalcemia: A Case Report and Review of Therapeutic Options. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 6:115-118. [PMID: 30787833 PMCID: PMC6196698 DOI: 10.4103/sjmms.sjmms_104_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Parathyroid carcinomas are very uncommon, accounting for 0.1% to 5% of all causes of primary hyperparathyroidism. Parathyroid–jaw tumor syndrome, with a mutation in HRPT2 that encodes parafibromin, is the most common genetic association. Unique features include aggressive clinical course and a lack of preoperative definitive diagnostic criteria. The authors report a case of a 33-year-old male with bilateral nephrocalcinosis, a left-sided neck mass, high calcium, very high parathormone level and a history of parathyroid adenectomy. Computed tomography and 99m-technetium methoxyisobutylisonitrile scan revealed a localized tumor in the left inferior parathyroid region. The patient underwent radical surgery, and histopathology revealed characteristic features of parathyroid carcinoma. Preoperative identification with clinical clues is very important to plan a more radical surgical approach, as both radiotherapy and chemotherapy are ineffective. Recurrence is common and mostly occurs within 2–3 years after surgery. Patient's age, histology and tumor DNA aneuploidy are predictors of survival. Hypercalcemia is controlled with calcimimetics, bisphosphonates and denosumab in inoperable cases. Furthermore, biologic therapy with parafibromin and telomerase inhibitors is under development.
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Affiliation(s)
- Subhodip Pramanik
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sayantan Ray
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Rana Bhattacharjee
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Refractory hypercalcemia due to hyperparathyroidism in a patient with metastatic parathyroid carcinoma. JOURNAL OF CANCER RESEARCH AND PRACTICE 2018. [DOI: 10.1016/j.jcrpr.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Li Y, Simonds WF. Recent advances in the management of endocrine malignancies associated with hereditary hyperparathyroidism syndromes. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2017. [DOI: 10.2217/ije-2016-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hereditary hyperparathyroidism syndromes, such as multiple endocrine neoplasm type 1, type 2A and the hyperparathyroidism-jaw tumor syndrome, are associated with an increased incidence of malignancies involving the neuroendocrine tissue of the pancreas and thymus, parathyroid and thyroid glands. The natural history of these endocrine tumors can differ from nonhereditary malignancies. The surgical approach, the only potentially curative treatment option for these endocrine malignancies, has evolved considerably in recent years. Newer targeted therapies, such as small molecule kinase inhibitors, somatostatin analogs and peptide receptor radionuclide therapy, are being developed. We provide here a comprehensive review of the current standards of treatment and emerging novel therapies for the endocrine malignancies commonly associated with hereditary hyperparathyroidism syndromes.
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Affiliation(s)
- Yulong Li
- Metabolic Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, MD 20892, USA
| | - William F Simonds
- Metabolic Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, MD 20892, USA
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de Almeida Vital JM, de Farias TP, Vaisman F, Fernandes J, Moraes ARL, José de Cavalcanti Siebra P, da Paixão JGM. Two case reports of parathyroid carcinoma and review of the literature. JOURNAL OF ONCOLOGICAL SCIENCES 2017. [DOI: 10.1016/j.jons.2016.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Manandhar S, Selk KL, Sobel SI. Denosumab Use For Severe Hypercalcemia In A Man With End-Stage Renal Disease On Hemodialysis. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161270.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Verdelli C, Corbetta S. MECHANISMS IN ENDOCRINOLOGY: Kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects. Eur J Endocrinol 2017; 176:R39-R52. [PMID: 27601015 DOI: 10.1530/eje-16-0430] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/12/2016] [Accepted: 09/02/2016] [Indexed: 12/27/2022]
Abstract
Primary hyperparathyroidism (PHPT) is the third most common endocrine disease. Kidney is a target of both chronic elevated PTH and calcium in PHPT. The classic PHPT complications of symptomatic kidney stones and nephrocalcinosis have become rare and the PHPT current presentation is asymptomatic with uncertain and long-lasting progression. Nonetheless, the routine use of imaging and of biochemical determinations have revealed the frequent occurrence of asymptomatic kidney stones, hypercalciuria and reduced kidney function in asymptomatic PHPT patients. Though the pathogenesis is far from being elucidated, PHPT is associated with reduced renal function, in terms of estimated glomerular filtration rate, and related increased morbidity and mortality. In the last decade, the effort of the Kidney Disease: Improving Global Outcomes (KDIGO) panel of experts highlighted that even mild reduction of kidney function is associated with increased risk of cardiovascular disease. These considerations provided the basis for the Fourth Workshop recommendations of a more extensive diagnostic workout about kidney features and of wider criteria for parathyroid surgery including asymptomatic kidney disease. Moreover, kidney involvement in PHPT is likely to be affected by variants of genes coding the key molecules regulating the calcium and ions renal handling; these features might have clinical relevance and should be considered both during diagnostic workout and follow-up. Finally, the effects of parathyroid surgery and of medical treatment on kidney involvement of PHPT are reviewed.
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Affiliation(s)
- C Verdelli
- Laboratory of Experimental EndocrinologyIRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - S Corbetta
- Laboratory of Experimental EndocrinologyIRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Endocrinology ServiceDepartment of Biomedical Sciences for Health, University of Milan, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Tong CV, Hussein Z. Response to "Is denosumab a long-term option for the treatment of parathyroid carcinoma?". QJM 2016; 109:289. [PMID: 26803152 DOI: 10.1093/qjmed/hcw019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C V Tong
- From the Endocrine Unit, Department of Medicine, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Presint 7, Putrajaya 62250, Malaysia
| | - Z Hussein
- From the Endocrine Unit, Department of Medicine, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Presint 7, Putrajaya 62250, Malaysia
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Abstract
CONTEXT Parathyroid carcinoma is exceedingly rare in children. We describe a case of parathyroid cancer in a young female who was originally classified as benign and managed surgically. Upon her diagnosis with malignancy, concurrent with metastatic lung involvement, she was referred for medical and surgical palliation to control her symptomatic hypercalcemia. We briefly review published childhood cases, consider the challenges in differentiating malignant from benign hyperparathyroidism in this age group, and discuss the association of CDC73 mutations with parathyroid carcinoma. CASE PRESENTATION A 13-year-old African American girl with a history of parathyroid adenoma, diagnosed at 8 years of age with multiple recurrences, presented with hypercalcemia and elevated parathyroid hormone when her disease had been reclassified as malignant. Germline gene analysis revealed a heterozygous partial deletion of CDC73. The patient underwent palliative surgery for disease metastatic to her lungs. She continues with medical management of her hypercalcemia. CONCLUSIONS A case of pediatric parathyroid carcinoma associated with haploinsufficiency of CDC73 is discussed. We review all published cases of pediatric parathyroid carcinoma and offer diagnostic considerations for a parathyroid mass in a child.
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Jumpertz von Schwartzenberg R, Elbelt U, Ventz M, Mai K, Kienitz T, Maurer L, Rose T, Rückert JC, Strasburger CJ, Spranger J. Palliative treatment of uncontrollable hypercalcemia due to parathyrotoxicosis: denosumab as rescue therapy. Endocrinol Diabetes Metab Case Rep 2015; 2015:150082. [PMID: 26605043 PMCID: PMC4653612 DOI: 10.1530/edm-15-0082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/29/2015] [Indexed: 11/08/2022] Open
Abstract
Parathyroid carcinoma is a rare disease leading to severe hypercalcemia due to hyperparathyroidism. Surgery is the primary treatment option. A more progressive form of the disease is characterized by parathyrotoxicosis, and subsequent hypercalcemia is the most common cause of death. We report a case presenting with severe hypercalcemia due to parathyrotoxicosis from parathyroid carcinoma treated for the first time using the monoclonal antibody denosumab as a rescue therapy and present long-term follow-up data. The 71-year-old patient presented with severe hypercalcemia due to metastatic parathyroid carcinoma. Despite undergoing treatment with bisphosphonates, cinacalcet hydrochloride, and forced diuresis, the patient`s condition deteriorated rapidly due to resistant hypercalcemia. Surgery performed because of spinal metastasis and forced diuresis lowered calcium levels, albeit they remained in the hypercalcemic range and significantly increased when forced diuresis was stopped. Considering a palliative situation to overcome hypercalcemia, we decided to administer denosumab, a monoclonal antibody that binds to the receptor activator of nuclear factor-kappa B ligand. After a single subcutaneous administration of 60 mg denosumab, calcium levels normalized within one day. Subsequent denosumab injections led to permanent control of serum calcium for more than 2 years despite rising parathyroid hormone levels and repeated surgeries. Together with recent cases in the literature supporting our observation, we believe that denosumab is relevant for future trials and represents an effective tool to control hypercalcemia in patients with advanced stages of parathyroid cancer.
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Affiliation(s)
| | - Ulf Elbelt
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Manfred Ventz
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Knut Mai
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Tina Kienitz
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Lukas Maurer
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Thomas Rose
- Division of Rheumatology and Clinical Immunology, Medical Department, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Jens C Rückert
- Department of General Visceral Vascular and Thoracic Surgery, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Christian J Strasburger
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
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Thosani S, Hu MI. Denosumab: a new agent in the management of hypercalcemia of malignancy. Future Oncol 2015; 11:2865-71. [PMID: 26403973 DOI: 10.2217/fon.15.232] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hypercalcemia of malignancy is an oncologic emergency due to tumoral factors that stimulate osteoclast-mediated bone resorption. It requires a combination of recommended treatments (i.e., hydration, bisphosphonate and calcitonin), which may be deleterious in patients with compromised cardiac or renal function or may not control serum calcium levels long term. Recurrent or refractory hypercalcemia may preclude the use of chemotherapeutic agents needed to effectively treat the underlying cancer, which is the cause of hypercalcemia. Denosumab, a fully human monoclonal antibody against RANKL, inhibits the maturation, function and survival of osteoclasts. An open-label, single-arm study of denosumab in patients with hypercalcemia of malignancy despite recent bisphosphonate treatment revealed positive results. Thus, the US FDA recently approved denosumab for the indication of hypercalcemia of malignancy, increasing the options available for patients with this debilitating and life-threatening condition.
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Affiliation(s)
- Sonali Thosani
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Duan K, Gomez Hernandez K, Mete O. Clinicopathological correlates of hyperparathyroidism. J Clin Pathol 2015; 68:771-87. [PMID: 26163537 DOI: 10.1136/jclinpath-2015-203186] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 12/21/2022]
Abstract
Hyperparathyroidism is a common endocrine disorder with potential complications on the skeletal, renal, neurocognitive and cardiovascular systems. While most cases (95%) occur sporadically, about 5% are associated with a hereditary syndrome: multiple endocrine neoplasia syndromes (MEN-1, MEN-2A, MEN-4), hyperparathyroidism-jaw tumour syndrome (HPT-JT), familial hypocalciuric hypercalcaemia (FHH-1, FHH-2, FHH-3), familial hypercalciuric hypercalcaemia, neonatal severe hyperparathyroidism and isolated familial hyperparathyroidism. Recently, molecular mechanisms underlying possible tumour suppressor genes (MEN1, CDC73/HRPT2, CDKIs, APC, SFRPs, GSK3β, RASSF1A, HIC1, RIZ1, WT1, CaSR, GNA11, AP2S1) and proto-oncogenes (CCND1/PRAD1, RET, ZFX, CTNNB1, EZH2) have been uncovered in the pathogenesis of hyperparathyroidism. While bi-allelic inactivation of CDC73/HRPT2 seems unique to parathyroid malignancy, aberrant activation of cyclin D1 and Wnt/β-catenin signalling has been reported in benign and malignant parathyroid tumours. Clinicopathological correlates of primary hyperparathyroidism include parathyroid adenoma (80-85%), hyperplasia (10-15%) and carcinoma (<1-5%). Secondary hyperparathyroidism generally presents with diffuse parathyroid hyperplasia, whereas tertiary hyperparathyroidism reflects the emergence of autonomous parathyroid hormone (PTH)-producing neoplasm(s) from secondary parathyroid hyperplasia. Surgical resection of abnormal parathyroid tissue remains the only curative treatment in primary hyperparathyroidism, and parathyroidectomy specimens are frequently encountered in this setting. Clinical and biochemical features, including intraoperative PTH levels, number, weight and size of the affected parathyroid gland(s), are crucial parameters to consider when rendering an accurate diagnosis of parathyroid proliferations. This review provides an update on the expanding knowledge of hyperparathyroidism and highlights the clinicopathological correlations of this prevalent disease.
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Affiliation(s)
- Kai Duan
- Department of Pathology, University Health Network, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Karen Gomez Hernandez
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, Ontario, Canada Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ozgur Mete
- Department of Pathology, University Health Network, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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30
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Parathyroid carcinoma: Challenges in diagnosis and treatment. ANNALES D'ENDOCRINOLOGIE 2015; 76:169-77. [DOI: 10.1016/j.ando.2015.03.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/05/2015] [Indexed: 01/09/2023]
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31
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Fountas A, Andrikoula M, Giotaki Z, Limniati C, Tsakiridou E, Tigas S, Tsatsoulis A. The emerging role of denosumab in the long-term management of parathyroid carcinoma-related refractory hypercalcemia. Endocr Pract 2015; 21:468-73. [PMID: 25667369 DOI: 10.4158/ep14410.or] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The main cause of death in patients with parathyroid carcinoma is parathyroid hormone (PTH)-induced hypercalcemia. To date, the management of hypercalcemia has been based on the use of bisphosphonates and calcimimetic agents. In recent reports, the use of denosumab has shown encouraging results in cases of refractory hypercalcemia of malignancy. Our objective is to present a case of successful management of resistant hypercalcemia due to parathyroid carcinoma with denosumab, to review similar cases from the literature, and to propose denosumab's use in the clinical management of PTH-induced refractory hypercalcemia. METHODS Presentation of a case report and review of the literature for cases of parathyroid carcinoma-mediated hypercalcemia successfully treated with denosumab. RESULTS A 71-year-old man with metastatic parathyroid carcinoma was referred to our department for uncontrolled hypercalcemia, resistant to treatment with bisphosphonates and cinacalcet. Treatment with denosumab (120 mg per month) in addition to cinacalcet (180 mg per day) resulted in normalization of calcium levels and maintenance within the normal range for an observation period of 11 months. Review of the literature revealed 4 case reports and a letter to the editor, all of which reported the successful treatment of resistant hypercalcemia associated with parathyroid carcinoma. CONCLUSION Based on the above findings of the effectiveness of denosumab in controlling refractory hypercalcemia, its safety in renal failure and the fact that denosumab may reduce PTH-induced bone loss, we endorse its use in the management of hypercalcemia in patients with parathyroid carcinoma and perhaps other conditions with PTH-induced hypercalcemia.
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Itoshima S, Yuno A, Kato T, Kamada H, Ikota A, Usui T, Shimatsu A, Koizumi S. Denosumab for the Treatment of Refractory Hypercalcemia in Metastatic Parathyroid Carcinoma. AACE Clin Case Rep 2015. [DOI: 10.4158/ep14449.cr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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33
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Tong CV, Hussein Z, Noor NM, Mohamad M, Ng WF. Use of denosumab in parathyroid carcinoma with refractory hypercalcemia. QJM 2015; 108:49-50. [PMID: 25099611 DOI: 10.1093/qjmed/hcu166] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C V Tong
- From the Department of Medicine, Endocrine Unit, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Presint 7, 62250 Putrajaya, Malaysia
| | - Z Hussein
- From the Department of Medicine, Endocrine Unit, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Presint 7, 62250 Putrajaya, Malaysia
| | - N Mohd Noor
- From the Department of Medicine, Endocrine Unit, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Presint 7, 62250 Putrajaya, Malaysia
| | - M Mohamad
- From the Department of Medicine, Endocrine Unit, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Presint 7, 62250 Putrajaya, Malaysia
| | - W F Ng
- From the Department of Medicine, Endocrine Unit, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Presint 7, 62250 Putrajaya, Malaysia
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34
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Crouzeix G, Kerlan V. Hyperparathyroïdie primaire : nouveaux concepts, nouvelles recommandations. ANNALES D'ENDOCRINOLOGIE 2014; 75 Suppl 1:S21-36. [DOI: 10.1016/s0003-4266(14)70024-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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35
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Loya-Solís A, Mendoza-García A, Ceceñas-Falcón L, Rodríguez-Gutiérrez R. Sphenoid brown tumor associated with a parathyroid carcinoma. Case Rep Endocrinol 2014; 2014:837204. [PMID: 25276444 PMCID: PMC4172926 DOI: 10.1155/2014/837204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/25/2014] [Indexed: 11/21/2022] Open
Abstract
Brown tumors are osteolytic bone lesions that occur as a result of persistent hyperparathyroidism. They usually appear late in the natural history of the disease and are currently very rare due to an earlier diagnosis of primary hyperparathyroidism. We present the case of a 53-year-old female with a 2-month history of bitemporal hemianopsia and diplopia. A computed tomography showed an osteolytic bone lesion that involved the sphenoid corpus and clivus. A biopsy was made and the histopathology result was consistent with a brown tumor. The aforementioned location is very infrequent to such tumors, and therefore represented a diagnostic challenge. However, in this case, its association to primary hyperparathyroidism was the clue for the diagnosis. The association of a brown tumor secondary to a parathyroid carcinoma has been seldom reported. This case represents, to our knowledge, one of the few brown tumors described in such location and the first secondary to a parathyroid carcinoma.
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Affiliation(s)
- Abelardo Loya-Solís
- Pathology Department, University Hospital “Dr. José E. González” and Medical School of the Universidad Autónoma de Nuevo León, Avenida Madero y Avenida Gonzalitos s/n, Colonia Mitras Centro, 64460 Monterrey, NL, Mexico
| | - Alejandra Mendoza-García
- Internal Medicine Department, University Hospital “Dr. José E. González” and Medical School of the Universidad Autónoma de Nuevo León, Avenida Madero y Avenida Gonzalitos s/n, Colonia Mitras Centro, 64460 Monterrey, NL, Mexico
| | - Luis Ceceñas-Falcón
- Pathology Department, University Hospital “Dr. José E. González” and Medical School of the Universidad Autónoma de Nuevo León, Avenida Madero y Avenida Gonzalitos s/n, Colonia Mitras Centro, 64460 Monterrey, NL, Mexico
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, University Hospital “Dr. José E. González” and Medical School of the Universidad Autónoma de Nuevo León, Avenida Madero y Avenida Gonzalitos s/n, Colonia Mitras Centro, 64460 Monterrey, NL, Mexico
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Nadarasa K, Theodoraki A, Kurzawinski TR, Carpenter R, Bull J, Chung TT, Drake WM. Denosumab for management of refractory hypercalcaemia in recurrent parathyroid carcinoma. Eur J Endocrinol 2014; 171:L7-8. [PMID: 24939719 DOI: 10.1530/eje-14-0482] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- K Nadarasa
- Department of EndocrinologySt Bartholomew's Hospital, London, UKDepartment of Diabetes and EndocrinologyUCLH NHS Foundation Trust, London, UKDepartment of Endocrine SurgeryUCLH NHS Foundation Trust, London, UKDepartment of NeurosurgeryThe Royal London Hospital, London, UK
| | - A Theodoraki
- Department of EndocrinologySt Bartholomew's Hospital, London, UKDepartment of Diabetes and EndocrinologyUCLH NHS Foundation Trust, London, UKDepartment of Endocrine SurgeryUCLH NHS Foundation Trust, London, UKDepartment of NeurosurgeryThe Royal London Hospital, London, UK
| | - T R Kurzawinski
- Department of EndocrinologySt Bartholomew's Hospital, London, UKDepartment of Diabetes and EndocrinologyUCLH NHS Foundation Trust, London, UKDepartment of Endocrine SurgeryUCLH NHS Foundation Trust, London, UKDepartment of NeurosurgeryThe Royal London Hospital, London, UK
| | - R Carpenter
- Department of EndocrinologySt Bartholomew's Hospital, London, UKDepartment of Diabetes and EndocrinologyUCLH NHS Foundation Trust, London, UKDepartment of Endocrine SurgeryUCLH NHS Foundation Trust, London, UKDepartment of NeurosurgeryThe Royal London Hospital, London, UK
| | - J Bull
- Department of EndocrinologySt Bartholomew's Hospital, London, UKDepartment of Diabetes and EndocrinologyUCLH NHS Foundation Trust, London, UKDepartment of Endocrine SurgeryUCLH NHS Foundation Trust, London, UKDepartment of NeurosurgeryThe Royal London Hospital, London, UK
| | - T T Chung
- Department of EndocrinologySt Bartholomew's Hospital, London, UKDepartment of Diabetes and EndocrinologyUCLH NHS Foundation Trust, London, UKDepartment of Endocrine SurgeryUCLH NHS Foundation Trust, London, UKDepartment of NeurosurgeryThe Royal London Hospital, London, UK
| | - W M Drake
- Department of EndocrinologySt Bartholomew's Hospital, London, UKDepartment of Diabetes and EndocrinologyUCLH NHS Foundation Trust, London, UKDepartment of Endocrine SurgeryUCLH NHS Foundation Trust, London, UKDepartment of NeurosurgeryThe Royal London Hospital, London, UK
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37
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Kolluri S, Lal K, Chang R, Mandava N. Parathyroid carcinoma: a silent presentation. Gland Surg 2014; 3:211-4. [PMID: 25207215 PMCID: PMC4139129 DOI: 10.3978/j.issn.2227-684x.2014.07.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/29/2014] [Indexed: 01/23/2023]
Abstract
Primary hyperparathyroidism is most commonly diagnosed in the setting of benign parathyroid adenoma(s). However, it can also rarely be caused by parathyroid malignancy and when it is, the clinical manifestations far supercede the presentation of benign parathyroid adenoma. We report a case of suspected benign parathyroid adenoma induced primary hyperparathyroidism in which pathologic diagnosis of parathyroid carcinoma was made. Due to the lack of signs and symptoms, this indicates parathyroid malignancy can be masked clinically as benign adenomas, until a histologic diagnosis can be ascertained.
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38
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Karuppiah D, Thanabalasingham G, Shine B, Wang LM, Sadler GP, Karavitaki N, Grossman AB. Refractory hypercalcaemia secondary to parathyroid carcinoma: response to high-dose denosumab. Eur J Endocrinol 2014; 171:K1-5. [PMID: 24743399 DOI: 10.1530/eje-14-0166] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Hypercalcaemia is an important cause of increased morbidity and mortality in patients with parathyroid carcinoma. Surgical resection is the mainstay of treatment but, equally, managing hypercalcaemia is of paramount importance. At present, few therapies have been shown to be effective in the most severe cases. This report describes the efficacy of denosumab in a patient with parathyroid carcinoma when conventional therapies had been shown to be relatively ineffective.SUBJECT, METHODS AND RESULTS: A 50-year-old man presented with symptomatic hypercalcaemia 1 year after the surgery for his parathyroid carcinoma. Investigations revealed raised serum calcium and parathyroid hormone concentrations consistent with the recurrence of the disease. Imaging failed to localise any surgically remediable foci. Medical management with loop diuretics, calcimimetics and bisphosphonates failed to provide a sustained response. Denosumab, as a monthly injection, led to a gradual decrement in his peak calcium concentrations with the values now persistently below 3 mmol/l. CONCLUSIONS Denosumab, a fully human MAB that binds to the 'receptor activator of nuclear factor κB ligand (RANKL)', was shown to have a profound effect in modulating malignant hypercalcaemia. This medication should be considered as an effective option in patients with refractory hypercalcaemia secondary to parathyroid carcinoma.
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Affiliation(s)
- Dharshini Karuppiah
- Departments of EndocrinologyChemical PathologyCellular PathologyEndocrine SurgeryOxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Gaya Thanabalasingham
- Departments of EndocrinologyChemical PathologyCellular PathologyEndocrine SurgeryOxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Brian Shine
- Departments of EndocrinologyChemical PathologyCellular PathologyEndocrine SurgeryOxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Lai Mun Wang
- Departments of EndocrinologyChemical PathologyCellular PathologyEndocrine SurgeryOxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Gregory P Sadler
- Departments of EndocrinologyChemical PathologyCellular PathologyEndocrine SurgeryOxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Niki Karavitaki
- Departments of EndocrinologyChemical PathologyCellular PathologyEndocrine SurgeryOxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Ashley B Grossman
- Departments of EndocrinologyChemical PathologyCellular PathologyEndocrine SurgeryOxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
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