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Jodeh W, Sparks PJ, Higgins JM, Tom A, Anilovich N, Moit H, Korff L, Hadad I, Wang X, Imel EA, Donegan DM. Parathyroid hormone-related peptide induced hypercalcemia of pregnancy due to mammary hyperplasia. JBMR Plus 2024; 8:ziae083. [PMID: 39035786 PMCID: PMC11260271 DOI: 10.1093/jbmrpl/ziae083] [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: 03/17/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 07/23/2024] Open
Abstract
Maternal Parathyroid Hormone-related Protein (PTHrP) is involved in the placental transport of calcium. Autonomous overproduction of PTHrP is a rare cause of hypercalcemia in pregnancy. Prior cases of PTHrP-induced hypercalcemia in pregnancy have been managed with either dopamine agonists, fetal delivery, termination of pregnancy, or mastectomy. However, PTHrP level normalization following mastectomy has not previously been documented. Herein, we present a 39-year-old female hospitalized at 19 weeks of gestation for acute encephalopathy due to PTHrP induced hypercalcemic crisis (calcium 15.8 mg/dL, PTHrp 46.5 pmol/L [normal 0-3.4]). Mammary hyperplasia resulting in gigantomastia significantly impaired her ability to ambulate and perform activities of daily living. She remained hypercalcemic during hospitalization despite aggressive hydration, calcitonin, and 2 weeks of dopamine agonist treatment. Bisphosphonate therapy was not administered due to pregnancy and potential effects on the fetus. Our patient underwent bilateral mastectomy along with excision of a large axillary mass. The pathology of all three specimens revealed mammary stromal hyperplasia. PTHrP was undetectable on post-op day 2 and calcium normalized by post-op day 3. At discharge, she was able to ambulate independently. To our knowledge, this is the first reported case of PTHrP induced hypercalcemia related to gigantomastia, documenting resolution of hypercalcemia, and PTHrP levels following mastectomy. Mastectomy is a potential option in the second trimester for pregnant patients with PTHrP induced severe hypercalcemia due to gigantomastia, refractory to treatment with dopamine agonist therapy.
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Affiliation(s)
- Wade Jodeh
- Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Payton J Sparks
- Marian University College of Osteopathic Medicine, Marian University, Indianapolis, IN 46222, United States
| | - Jasmine M Higgins
- Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Alan Tom
- Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Natanie Anilovich
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Harley Moit
- Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Lisa Korff
- Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Ivan Hadad
- Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Xiaoyan Wang
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN 46202United States
| | - Erik A Imel
- Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Diane M Donegan
- Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis, IN 46202, United States
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Arshad MF, Elamin A, Bennet W, Choudhari YK, Balasubramanian SP. Abnormal Calcium Levels are Associated With Worse Maternal and Fetal Outcomes; Results From an Exploratory Study. J Clin Endocrinol Metab 2023; 108:e1642-e1648. [PMID: 37307222 DOI: 10.1210/clinem/dgad340] [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: 03/01/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Abstract
CONTEXT Precise estimates of the incidence of hyper- and hypocalcemia in pregnancy are unknown. Abnormal calcium levels have been associated with unfavorable pregnancy-related outcomes. OBJECTIVE Determine frequency of hypercalcemia and hypocalcemia in pregnancy when tested and their associations with maternal and fetal outcomes. DESIGN Exploratory retrospective cohort study. SETTING Single tertiary care maternity unit. PATIENTS Pregnant women with expected delivery date between 2017 and 2019 and a second additional cohort of pregnant women with hypercalcemia between 2014 and 2016 and 2020 and 2021. INTERVENTIONS Observational. MAIN OUTCOMES MEASURED (1) Incidence of hyper- and hypocalcemia when calcium tested; (2) maternal outcomes: incidence of preterm delivery, emergency cesarean section, and blood loss during delivery; and (3) fetal outcomes: fetal loss (miscarriage/stillbirth), neonatal intensive care unit admission, and fetal birth weight (for term deliveries). RESULTS Total number of gestations and livebirths recorded were 33 118 and 20 969, respectively, with median [interquartile range] age of 30.1 [25.6-34.3] years. A total of 15.7% (n = 5197) of all gestations had albumin-adjusted calcium tested, and incidence of hypercalcemia and hypocalcemia when tested was 0.8% (n = 42) and 9.5% (n = 495), respectively. Both hypercalcemia (including additional cohort n = 89) and hypocalcemia were associated with increased incidence of preterm delivery (P < .001), emergency cesarean section (P < .001 and .019), blood loss (P < .001), and neonatal intensive care unit admission (P < .001). A total of 27% in the hypercalcemic group had an established diagnosis of primary hyperparathyroidism. CONCLUSIONS Abnormal calcium levels during pregnancy are common and associated with worse pregnancy-related outcomes, which raises the possible need for routine calcium testing. Prospective studies to confirm the incidence, etiology, and effects of abnormal calcium in pregnancy are recommended.
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Affiliation(s)
- Muhammad Fahad Arshad
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2RX, UK
- Sheffield Teaching Hospitals, Sheffield S10 2RA, UK
| | - Aisha Elamin
- Sheffield Teaching Hospitals, Sheffield S10 2RA, UK
| | | | | | - Saba P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2RX, UK
- Sheffield Teaching Hospitals, Sheffield S10 2RA, UK
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John Levy Barnett M. A Scoping Review of the Apparent Phenomenon of the Improvement in Hypoparathyroidism in Pregnant and Postpartum Females. Cureus 2023; 15:e46123. [PMID: 37790033 PMCID: PMC10544865 DOI: 10.7759/cureus.46123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
Hypoparathyroidism requires management with both calcium supplementation and active vitamin D to avert a state of hypocalcemia. During late gestation and the postpartum period (specifically lactation), there is an under-recognized, yet intriguing occurrence of apparent 'pseudohyperparathyroidism', whereby supplementation dosages may need to either be reduced or discontinued, to prevent hypercalcemia. The explanation for this apparent phenomenon of improved parathyroid status ('remission' or 'resolution') is incompletely understood; the purpose of this review is to analyze the case reports of this enigma within the medical (and grey) literature, providing an overall pathophysiological explanation and recommendation for the management of such patients. A literature search was conducted through PubMed/Medline, CINAHL, Cochrane Library Database, Scopus, UpToDate, Google Scholar, and the grey literature without a time-restricted period, analyzing all available articles within the literature describing an apparent improvement in parathyroid status in late-gestation and postpartum (lactating) females. Non-hypoparathyroid case reports were also included to further analyze and synthesize an overall likely pathophysiological explanation. Through the literature search, 24 papers were identified covering such a phenomenon in patients with hypoparathyroidism, alongside multiple additional reports of a similar occurrence in patients without underlying hypoparathyroidism. The pathophysiology is believed to occur due to the placental production of parathyroid hormone-related peptide (PTHrP) during gestation, with further production from the lactating mammary glands during the postpartum period. A typical pattern is observed, with increased PTHrP and suppressed PTH throughout both gestation and lactation (present in both normal and hypoparathyroid subjects). The concept of PTHrP-induced hypercalcemia is further demonstrated in patients without hypoparathyroidism, including subjects with placental hypersecretion and mammary gland enlargement. It is evident that patients with hypoparathyroidism may require a dosage reduction during late gestation and lactation, due to the risk for hypercalcemia. In addition to patients with hypoparathyroidism, this pathophysiological phenomenon occurs in unsuspecting patients, demonstrating the need for all clinicians in contact with pregnant females to be aware of this uncommon - yet perilous - occurrence.
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Singh VP, Das L, Kumar P, Bal A, Gaba S, Tripathy S, Dutta P. The role of steroid receptors, peptides and growth factors in the aetiopathogenesis of idiopathic gynecomastia. Andrologia 2022; 54:e14414. [PMID: 35297077 DOI: 10.1111/and.14414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/07/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022] Open
Abstract
Idiopathic gynecomastia is a diagnosis of exclusion. We aimed to evaluate the role of steroids, peptides and growth factors in these patients. Those with bilateral idiopathic gynecomastia (n = 29) (Simon's grade IIb or III) who underwent gland excision were evaluated by immunohistochemical techniques using semi-quantitative grading for oestrogen receptor (ER), progesterone receptor (PR), aromatase, androgen receptor (AR), peptides (IGF-1, IGF-2, HER-2, parathyroid-hormone related peptide [PTHrP]) and growth factors (EGFR, TGFβ). The cohort comprised 29 patients, with a mean age of 25.3 ± 5.1 years and a mean body mass index of 27.2 ± 2.3 kg/m2 . Grade IIb gynecomastia was present in 79.1% and moderate-to-severe insulin resistance (HOMA-IR >3) in 53.7% of patients. ER expression was positive in 100% samples, followed by AR (96.5%), aromatase (96.5%) and PR (93.1%). IGF-1 was expressed in 86.2% of the cohort, IGF2 in 27.5% and HER-2 in only two samples, with both showing weak immunoexpression. None of the patients had positive expression of EGFR, TGF-β or PTHrP. There was no association between immunoexpression and gynecomastia grade. This study demonstrates the predominant role of oestrogen, aromatase and insulin resistance in the aetiopathogenesis of idiopathic gynecomastia and implicates the paracrine hyperestrogenic milieu in its causation as circulating hormones were normal.
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Affiliation(s)
- Vinay Pal Singh
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Liza Das
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Parmod Kumar
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, PGIMER, Chandigarh, India
| | - Sunil Gaba
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satyaswarup Tripathy
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India
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Appelman-Dijkstra NM, Ertl DA, Zillikens MC, Rjenmark L, Winter EM. Hypercalcemia during pregnancy: management and outcomes for mother and child. Endocrine 2021; 71:604-610. [PMID: 33544354 PMCID: PMC8016748 DOI: 10.1007/s12020-021-02615-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
Diagnosing and treating hypercalcemia during pregnancy can be challenging due to both the physiological changes in calcium homeostasis and the underlying cause for the hypercalcemia. During pregnancy and lactation there is increased mobilization of calcium in the mother to meet the fetus' calcium requirements. Here we discuss the diagnostic challenges, management, and patient perspective of hypercalcemia during pregnancy in two particular cases and in other rare conditions causing hypercalcemia.
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Affiliation(s)
- Natasha M Appelman-Dijkstra
- Department of Internal Medicine, Division of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands.
| | - Diana- Alexandra Ertl
- Department for Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Center of Expertise for Rare Disorders of Bone, Growth and Mineralization, Vienna Bone and Growth Center, Vienna, Austria
| | - M C Zillikens
- Department of Internal Medicine, Erasmus MC Bone Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lars Rjenmark
- Department of Clinical Medicine; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Elizabeth M Winter
- Department of Internal Medicine, Division of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
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Mahabbat N, Abdulla A, Alsufayan F, Alharbi A, Rafique A, Alqahtani M, Hashem F. Gestational gigantomastia on a Saudi woman: A case report on surgical removal and reconstruction and management of complications, KFSH&RC. Int J Surg Case Rep 2020; 77:157-160. [PMID: 33166811 PMCID: PMC7653081 DOI: 10.1016/j.ijscr.2020.10.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Gestational gigantomastia (GG) is a rare condition manifesting as a fast and excessive growth of the breasts in pregnant women. Its etiology is still unclear, with theories ranging from hormonal imbalances, unregulated immune response, to hypersensitivity. Medical interventions are mainly surgical in nature, though some pharmacological medications are of debatable efficacy. CASE PRESENTATION A 33-year old Saudi gravida 3 para 2 presents continuous breast enlargement since the start of her pregnancy. She complains of skin ulcerations and discharge which was initially treated conservatively with topical antibiotics. Days after she came back with worsening GG symptoms, and was admitted for bilateral skin sparing mastectomy and reconstruction, and successfully recovered. The patient came back with problems concerning the surgical implant and wound infection. Emergency operation was performed for implant removal and wound treatment. Labor induction was performed by the OB-GYN on her 39 week. The patient opted for autogenous reconstruction by bilateral latissimus dorsi flap months after delivery. After treatment of minor surgical complications, the patient successfully recovered. DISCUSSION Surgery is one of the most effective interventions for GG. Total mastectomy is preferred due to lesser risk of recurrence in subsequent pregnancies. Reduction mammoplasty offers the breastfeeding option if conducted before the delivery, but poses higher risk of recurrence in future pregnancies. CONCLUSION The patient's gestational gigantomastia condition was complicated by several ulcerations and infections. Surgery was conducted alongside antibiotic treatment. This report also highlights the importance of follow ups in managing complications.
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Affiliation(s)
- Nehal Mahabbat
- Plastic and Reconstructive Surgery Section, Surgery Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
| | - Asma Abdulla
- Plastic and Reconstructive Surgery Section, Surgery Department, Security Forces Hospital, Saudi Arabia.
| | - Fares Alsufayan
- Plastic and Reconstructive Surgery Section, Surgery Department, Prince Mohammed Bin Abdulaziz Hospital, Saudi Arabia.
| | - Ahmed Alharbi
- Plastic and Reconstructive Surgery Section, Surgery Department, King Khalid University Hospital, Saudi Arabia.
| | - Atif Rafique
- Section of Plastic Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
| | - Moraya Alqahtani
- Consultant Plastic and Reconstructive Surgery, Surgery Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
| | - Foad Hashem
- Consultant Plastic and Reconstructive Surgery, Surgery Department, King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
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Vyas S, Greenwood HI, Jankowski T, Freimanis RI, Kallianos KG, Henry TS, Strachowski LM. A case of acute onset gigantomastia in a 20-year-old woman. Clin Imaging 2020; 68:57-60. [PMID: 32570010 DOI: 10.1016/j.clinimag.2020.06.020] [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] [Received: 04/03/2020] [Revised: 05/07/2020] [Accepted: 06/12/2020] [Indexed: 12/29/2022]
Abstract
Gigantomastia is an abnormal and rare breast condition characterized by excessive breast tissue growth that can result in physical and psychosocial debilitation. While the etiology is not fully understood, it is postulated that abnormal endogenous hormone stimulation plays a contributory role and often requires mastectomy for definitive treatment. Proliferation of all elements is commonly observed, including glands, ducts, stroma, fat, vessels and skin. Pseudoangiomatous stromal hyperplasia (PASH) is an additional benign breast disease defined microscopically by proliferation of mammary stroma. PASH often clinically presents as an incidental finding while evaluating other benign or malignant lesions, or less commonly as a palpable, well-circumscribed breast mass. Uncommon cases have been reported in which PASH presents as a bilateral, diffuse process. In this case presentation, we report a rare case of a 20-year-old woman presenting with acute onset gigantomastia most likely due to diffuse PASH.
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Affiliation(s)
- Shrilakshmi Vyas
- University of California San Francisco, Department of Radiology and Biomedical Imaging, 1825 4th St, San Francisco, CA 94158, USA.
| | - Heather I Greenwood
- University of California San Francisco, Department of Radiology and Biomedical Imaging, 1825 4th St, San Francisco, CA 94158, USA.
| | - Tyler Jankowski
- University of California San Francisco, UCSF, Department of Pathology, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Rita I Freimanis
- University of California San Francisco, Department of Radiology and Biomedical Imaging, 1825 4th St, San Francisco, CA 94158, USA.
| | - Kimberly G Kallianos
- University of California San Francisco, Department of Radiology and Biomedical Imaging, 1825 4th St, San Francisco, CA 94158, USA.
| | - Travis S Henry
- University of California San Francisco, Department of Radiology and Biomedical Imaging, 1825 4th St, San Francisco, CA 94158, USA.
| | - Loretta M Strachowski
- University of California San Francisco, Department of Radiology and Biomedical Imaging, 1825 4th St, San Francisco, CA 94158, USA.
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Benign Disorders of the Breast in Pregnancy and Lactation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1252:43-51. [PMID: 32816261 DOI: 10.1007/978-3-030-41596-9_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Benign cystic or solid lumps frequently occur in the breasts of young women, and consequently can also be seen during pregnancy and lactation. Simple cysts do not increase the risk of malignancy. The current management is routine follow-up. Complex cysts are thick walled or contain a mass, and should be followed by a US-guided biopsy and then treated similar to any non-gravid, non-lactating patient.Galactoceles can be detected during the last trimester of pregnancy and during or after stopping lactation. Aspiration can be done to confirm the content. Co-existence of galactocele and malignancy is extremely rare, and the key is to follow up until it resolves.Fibroadenoma is the most frequent lesion found during pregnancy and lactation. Management is usually conservative after triple assessment. Surgery is usually not recommended in pregnant and lactating women unless rapid increase in size occurs or there is discordance in the triple assessment.Lactating adenomas are sometimes interpreted as a variant of fibroadenoma . They can naturally disappear at the end of pregnancy or lactation. Management is usually conservative, and an excisional biopsy is only mandated if it is rapidly enlarging or if there is discordance in the triple assessment.Gestational gigantomastia is a rare condition consisting of diffuse severe hypertrophy of both breasts during pregnancy . Mastectomy and reconstruction may rarely be required in such cases.
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Das L, Rai A, Vaiphei K, Garg A, Mohsina S, Bhansali A, Dutta P, Tripathy S. Idiopathic gigantomastia: newer mechanistic insights implicating the paracrine milieu. Endocrine 2019; 66:166-177. [PMID: 31502211 DOI: 10.1007/s12020-019-02065-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Gigantomastia refers to pathological breast enlargement usually occurring in the peripubertal or peripartum period. Idiopathic gigantomastia, however, is a rare entity with hypotheses citing local expression of hormones and growth factors in causing this disease, none of which have been systemically analysed. The purpose of this study was to delve deeper into the mechanistic pathways causing this condition. METHODS Herein, we describe three patients of idiopathic gigantomastia, all of whom had had normal puberty and uneventful pregnancies. Further, one of the patients had postmenopausal gigantomastia which is extremely rare, with only four cases described in the literature. Serum markers of autoimmunity, incriminated hormones and growth factors analysed, were normal in all the cases. Breast tissue specimens were subjected to histopathological examination and immunohistochemistry for ER, PR and Her-2-Neu. Quantitative immunofluorescence for aromatase, IGF2, EGFR, TGF-β, PDGFR-α, β, IGF1 and PTHrP was also performed. RESULTS Of these, the tissue expression of aromatase, IGF2, EGFR, TGF-β, PDGFR-α and β were found to be upregulated, whereas IGF1 and PTHrP were comparable to normal breast. CONCLUSION This observation that paracrine overexpression of these factors is responsible for the pathogenesis of apparently idiopathic gigantomastia may have therapeutic ramifications in the future for patients with this debilitating condition.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Ashutosh Rai
- Department of Translational and Regenerative Medicine, PGIMER, Chandigarh, India
| | - Kim Vaiphei
- Department of Pathology, PGIMER, Chandigarh, India
| | - Akhil Garg
- Department of Plastic surgery, PGIMER, Chandigarh, India
| | - Subair Mohsina
- Department of Plastic surgery, PGIMER, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India.
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Modarressi T, Levine MA, Khan AN. Response to Letter to the Editor: "Gestational Gigantomastia Complicated by PTHrP-Mediated Hypercalcemia". J Clin Endocrinol Metab 2019; 104:5100-5101. [PMID: 30977835 DOI: 10.1210/jc.2019-00820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 02/13/2023]
Affiliation(s)
- Taher Modarressi
- Diabetes & Endocrine Associates of Hunterdon, Flemington, New Jersey
| | - Michael A Levine
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amna N Khan
- Department of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Section of Endocrinology, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
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The Place of Reductive Surgery in the Management of Gestational Ulcerative Gigantomastia: A Case Report at Sourô Sanou Teaching Hospital. Case Rep Surg 2019; 2019:7946240. [PMID: 31236302 PMCID: PMC6545764 DOI: 10.1155/2019/7946240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/26/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction Gestational gigantomastia is a rare benign disease of unknown cause. We report a case of bilateral gigantomastia in pregnancy in order to locate the place of reductive surgery in its care which is quite controversial. Case A 25-year-old woman gravida 2 para 1 was referred for an exaggerated bilateral breast enlargement at 32-week gestation. The examination showed bilateral giant breasts with collateral venous circulation and trophic changes marked by the necrosis of the distal third of the mammary skin involving the nipple-areolar complex. She underwent a biopsy of the ulcerative breast tissue, and the histology report did not show a malignant cell. After active foetal lung maturation and induced delivery, a breast reductive surgery with nipple plasty was performed 21 days postpartum. The postoperative course was marked by a period of lymphangitis. The cosmetic and psychological result was satisfactory at 6 months and at 18 months. Conclusion Gestational gigantomastia is a benign disease that can simulate carcinomatous mastitis. The breast reductive plasty keeps its place in our context.
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12
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Winter EM, Appelman-Dijkstra NM. Letter to the Editor: "Gestational Gigantomastia Complicated by PTHrP-Mediated Hypercalcemia". J Clin Endocrinol Metab 2019; 104:1440. [PMID: 30541082 DOI: 10.1210/jc.2018-02287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Elizabeth M Winter
- Center for Bone Quality, Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Natasha M Appelman-Dijkstra
- Center for Bone Quality, Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
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