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Lau JHYH, Ng KK, Wong WC, Kung BT. Giant parathyroid adenoma and hungry bone syndrome in MEN1 syndrome: A case report. Radiol Case Rep 2024; 19:2959-2964. [PMID: 38737174 PMCID: PMC11087690 DOI: 10.1016/j.radcr.2024.04.024] [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: 03/12/2024] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
An 18-year-old male with multiple endocrine neoplasm type 1 (MEN1) syndrome presented with hyperparathyroidism. Parathyroidectomy was performed. Patient complained of bone pain afterwards, multiple imaging modalities revealed features of osteitis fibrosa cystica and biochemical profile showed features of hungry bone syndrome. Incidental suspicious pancreatic lesion was initially revealed by 18F-FDG PET/CT scan while MRI further characterized the possibility of insulinoma. Ultimately, the patient was diagnosed of MEN1 syndrome by genetic test. This case report demonstrates the utilization of various imaging modalities such as ultrasound, Tc99m-sestamibi parathyroid scintigraphy, bone scintigraphy, CT, PET/CT and MRI, which leads to ultimately the diagnosis of MEN1 syndrome.
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Affiliation(s)
| | - Koon Kiu Ng
- Nulcear Medicine Unit, Queen Elizabeth Hospital, Hong Kong
| | - Wai Chung Wong
- Nulcear Medicine Unit, Queen Elizabeth Hospital, Hong Kong
| | - Boom Ting Kung
- Nulcear Medicine Unit, Queen Elizabeth Hospital, Hong Kong
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Krumeich LN, Santos A, Fraker DL, Kelz RR, Wachtel H. Modern Trends for Primary Hyperparathyroidism: Intervening on Less Biochemically Severe Disease. J Surg Res 2024; 296:489-496. [PMID: 38325011 DOI: 10.1016/j.jss.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is defined by autonomous parathyroid hormone secretion, which has broad physiologic effects. Parathyroidectomy is the only cure and is recommended for patients demonstrating symptomatic disease and/or end organ damage. However, there may be a benefit to intervening before the development of complications. We sought to characterize institutional trends in the biochemical and symptomatic presentation of PHPT and the associated cure and complication rates. METHODS We performed a retrospective cohort study of 1087 patients undergoing parathyroidectomy for PHPT, evaluating patients at 2-year intervals between 2002 and 2019. We identified signs and symptoms of PHPT based on the 2016 American Association of Endocrine Surgery Guidelines. Trends were evaluated with Kruskal Wallis, Chi-square tests, and Fisher's exact tests. RESULTS Patients with PHPT are presenting with lower parathyroid hormone (P = 0.0001) and calcium (P = 0.001) in the current era. Parathyroidectomy is more commonly performed for borderline guideline concordant patients with osteopenia (40.2%) and modest calciuria (median 246 mg/dL/24 h). 93.7% are cured, with no difference over time or between groups by guideline concordance. CONCLUSIONS Parathyroidectomy is increasingly performed for patients who demonstrate modest bone and renal dysfunction. Patients experience excellent cure rates and rarely experience postoperative hypocalcemia, suggesting a role for broader surgical indications.
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Affiliation(s)
- Lauren N Krumeich
- Department for Surgery, University of Michigan, Ann Arbor, Michigan; Department for Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Angelica Santos
- Department for Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas L Fraker
- Department for Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department for Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Wachtel
- Department for Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Primary hyperparathyroidism (PHPT), the most common cause of hypercalcemia, is most often identified in postmenopausal women with hypercalcemia and parathyroid hormone (PTH) levels that are either frankly elevated or inappropriately normal. The clinical presentation of PHPT includes three phenotypes: target organ involvement of the renal and skeletal systems; mild asymptomatic hypercalcemia; and more recently, high PTH levels in the context of persistently normal albumin-corrected and ionized serum calcium values. The factors that determine which of these three clinical presentations is more likely to predominate in a given country include the extent to which biochemical screening is employed, the prevalence of vitamin D deficiency, and whether a medical center or practitioner tends to routinely measure PTH levels in the evaluation of low bone density or frank osteoporosis. When biochemical screening is common, asymptomatic primary hyperparathyroidism is the most likely form of the disease. In countries where vitamin D deficiency is prevalent and biochemical screening is not a feature of the health care system, symptomatic disease with skeletal abnormalities is likely to predominate. Finally, when PTH levels are part of the evaluation for low bone mass, the normocalcemic variant is seen. Guidelines for surgical removal of hyperfunctioning parathyroid tissue apply to all three clinical forms of the disease. If guidelines for surgery are not met, parathyroidectomy can also be an appropriate option if there are no medical contraindications to surgery. In settings where either the serum calcium or bone mineral density is of concern, and surgery is not an option, pharmacological approaches are available and effective. Referencing in this article the most current published articles, we review the different presentations of PHPT, with particular emphasis on recent advances in our understanding of target organ involvement and management.
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Affiliation(s)
- Barbara C Silva
- Division of Endocrinology, Felicio Rocho and Santa Casa Hospital, Belo Horizonte, Brazil
| | - Natalie E Cusano
- Division of Endocrinology, Lenox Hill Hospital, New York, NY, USA
| | - John P Bilezikian
- Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Milat F, Ramchand SK, Herath M, Gundara J, Harper S, Farrell S, Girgis CM, Clifton-Bligh R, Schneider HG, De Sousa SMC, Gill AJ, Serpell J, Taubman K, Christie J, Carroll RW, Miller JA, Grossmann M. Primary hyperparathyroidism in adults-(Part I) assessment and medical management: Position statement of the endocrine society of Australia, the Australian & New Zealand endocrine surgeons, and the Australian & New Zealand bone and mineral society. Clin Endocrinol (Oxf) 2024; 100:3-18. [PMID: 34931708 DOI: 10.1111/cen.14659] [Citation(s) in RCA: 1] [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: 08/31/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To formulate clinical consensus recommendations on the presentation, assessment, and management of primary hyperparathyroidism (PHPT) in adults. METHODS Representatives from relevant Australian and New Zealand Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing nine key questions. RESULTS PHPT is a biochemical diagnosis. Serum calcium should be measured in patients with suggestive symptoms, reduced bone mineral density or minimal trauma fractures, and in those with renal stones. Other indications are detailed in the manuscript. In patients with hypercalcaemia, intact parathyroid hormone, 25-hydroxy vitamin D, phosphate, and renal function should be measured. In established PHPT, assessment of bone mineral density, vertebral fractures, urinary tract calculi/nephrocalcinosis and quantification of urinary calcium excretion is warranted. Parathyroidectomy is the only definitive treatment and is warranted for all symptomatic patients and should be considered for asymptomatic patients without contraindications to surgery and with >10 years life expectancy. In patients who do not undergo surgery, we recommend annual evaluation for disease progression. Where the diagnosis is not clear or the risk-benefit ratio is not obvious, multidisciplinary discussion and formulation of a consensus management plan is appropriate. Genetic testing for familial hyperparathyroidism is recommended in selected patients. CONCLUSIONS These clinical consensus recommendations were developed to provide clinicians with contemporary guidance on the assessment and management of PHPT in adults. It is anticipated that improved health outcomes for individuals and the population will be achieved at a decreased cost to the community.
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Affiliation(s)
- Frances Milat
- Department of Endocrinology, Monash Health, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
- Department of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | - Sabashini K Ramchand
- Department of Endocrinology, Austin Health, Victoria, Australia
- Department of Medicine, Austin Health, University of Melbourne, Victoria, Australia
| | - Madhuni Herath
- Department of Endocrinology, Monash Health, Victoria, Australia
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
- Department of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | - Justin Gundara
- Department of Surgery, Redland Hospital, Metro South and Faculty of Medicine, University of Queensland, Australia
- Department of Surgery, Logan Hospital, Metro South and School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Simon Harper
- Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand
- Department of Surgery, University of Otago, Wellington, New Zealand
| | - Stephen Farrell
- Department of Surgery, St Vincent's Hospital, Victoria, Australia
- Department of Surgery, Austin Hospital, Victoria, Australia
- Department of Surgery, Royal Children's Hospital, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Christian M Girgis
- Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Roderick Clifton-Bligh
- Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Kolling Institute, University of Sydney, New South Wales, Australia
| | - Hans G Schneider
- Clinical Biochemistry Unit, Alfred Pathology Service, Alfred Health, Victoria, Australia
- Department of Endocrinology, Alfred Hospital, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Victoria, Australia
| | - Sunita M C De Sousa
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
- South Australian Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Anthony J Gill
- Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Jonathan Serpell
- Department of General Surgery, The Alfred Hospital, Victoria, Australia
- Monash University Department of Endocrine Surgery, Victoria, Australia
| | - Kim Taubman
- Department of Medical Imaging, St Vincent's Hospital, Victoria, Australia
- Department of Endocrinology, St Vincent's Hospital, Victoria, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | | | - Richard W Carroll
- Endocrine, Diabetes, and Research Centre, Wellington Regional Hospital, Wellington, New Zealand
| | - Julie A Miller
- Department of Surgery, University of Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, Victoria, Australia
- Epworth Hospital Network, Victoria, Australia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, Victoria, Australia
- Department of Medicine, Austin Health, University of Melbourne, Victoria, Australia
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Song A, Chen R, Guan W, Yu W, Yang Y, Wang J, Nie M, Jiang Y, Li M, Xia W, Xing X, Wang O. Trabecular Bone Score as a More Sensitive Tool to Evaluate Bone Involvement in MEN1-related Primary Hyperparathyroidism. J Clin Endocrinol Metab 2023; 109:135-142. [PMID: 37539859 DOI: 10.1210/clinem/dgad460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/07/2023] [Accepted: 08/02/2023] [Indexed: 08/05/2023]
Abstract
CONTEXT The skeletal involvement of multiple endocrine neoplasia type 1-related primary hyperparathyroidism (MHPT) is not exactly the same as that of sporadic primary hyperparathyroidism (SHPT). Trabecular bone score (TBS) as a texture parameter has been reported to reflect trabecular bone damage. OBJECTIVE This study aimed to compare the clinical characteristics, especially the skeletal involvement, between patients with MHPT and SHPT. METHODS The clinical characteristics were retrospectively collected in 120 patients with MHPT and compared with 360 patients with SHPT in the same period. Dual-energy X-ray absorptiometry were conducted in some patients with MHPT, in whom bone mineral density (BMD) and calculated TBS derived from lumbar spine dual-energy X-ray absorptiometry images were compared with those of patients with SHPT. RESULTS Although the duration of disease in the MHPT group was longer, the age at hospital visit was significantly lower than that in the SHPT group (43.5 [interquartile range, 31.5-52.0] vs 52.0 [interquartile range, 40.5-61.0], P < .001). The proportion of skeletal involvement in the MHPT group was significantly lower. However, in the subgroup of MHPT cases (n = 86) with data of BMD, there was no significant difference in skeletal involvement from SHPT cases matched for gender and age. Although the BMD and TBS in the lumbar spines of patients with MHPT were lower than those of patients with SHPT (BMD: 0.91 ± 0.18 g/cm2 vs 1.01 ± 0.17 g/cm2; TBS: 1.22 ± 0.14 vs 1.29 ± 0.11, P < .001). According to TBS, among 34 patients with MHPT with normal BMD, 15 patients had bone microstructure damage. CONCLUSION The cancellous bone microarchitecture was more severely damaged in patients with MHPT according to TBS, which suggested that TBS could be a sensitive supplemental index in addition to BMD to identify bone-involvement risk in patients with MHPT.
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Affiliation(s)
- An Song
- Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Rong Chen
- Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wenmin Guan
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yi Yang
- Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jiajia Wang
- Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Min Nie
- Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yan Jiang
- Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Mei Li
- Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Weibo Xia
- Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiaoping Xing
- Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ou Wang
- Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Bandeira L, de Oliveira LB, de Lima MVS, Rêgo D, Griz L, Bandeira F. Hypopituitarism due to a Large Osteoclastoma Arising from the Sphenoid Bone Invading the Pituitary Fossa in a Patient with Parathyroid Carcinoma. Case Rep Endocrinol 2023; 2023:8274108. [PMID: 38156081 PMCID: PMC10754633 DOI: 10.1155/2023/8274108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/15/2023] [Accepted: 11/21/2023] [Indexed: 12/30/2023] Open
Abstract
Background Parathyroid carcinoma accounts for <1% of cases of primary hyperparathyroidism (PHPT). This rare condition may present with severe hypercalcemia and bone complications such as osteoclastomas and pathologic fractures. Here, we present a rare condition of panhypopituitarism resulting from an osteoclastoma in the sphenoid bone that invaded the pituitary fossa due to parathyroid carcinoma. Case Report. A 47-year-old woman previously diagnosed with PHPT underwent a parathyroidectomy 6 years earlier, with histological examination indicating a parathyroid adenoma. After surgery, she continued to exhibit high serum parathyroid hormone (PTH) and calcium levels, with the development of bone pain and spontaneous fractures. Imaging exams showed a large osteoclastoma of the sphenoid bone, invading the pituitary fossa, causing hypopituitarism. A new parathyroidectomy was performed, with histological confirmation of parathyroid carcinoma and regression of the osteoclastoma. Conclusion This case illustrates an unusual presentation of parathyroid carcinoma, in which an osteoclastoma of the sphenoid bone caused hypopituitarism.
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Affiliation(s)
- Leonardo Bandeira
- FBandeira Endocrine Institute, Recife, Brazil
- Grupo Fleury, Recife, Brazil
| | - Lucian Batista de Oliveira
- Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Maria Vitória Silva de Lima
- Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Daniella Rêgo
- Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Luiz Griz
- Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Francisco Bandeira
- FBandeira Endocrine Institute, Recife, Brazil
- Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
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Maldar AN, Shah NF, Chauhan PH, Lala M, Kirtane MV, Chadha M. Differences in the Presentation and Outcome between Premenopausal and Postmenopausal Primary Hyperparathyroidism Indian Women: A Single-Center Experience. J Midlife Health 2023; 14:73-80. [PMID: 38029031 PMCID: PMC10664047 DOI: 10.4103/jmh.jmh_142_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/29/2023] [Accepted: 03/06/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Primary hyperparathyroidism (PHPT) is an endocrine disorder wherein enlargement of one or more of the parathyroid glands causes autonomous overproduction of the parathyroid hormone (PTH), which leads to high serum calcium levels. Objective The objective of this study was to compare the clinical, laboratory, and operative variables between premenopausal (pre-M) and postmenopausal (post-M) women with PHPT. Materials and Methods A retrospective analysis of the data of female patients who underwent surgery for PHPT at a single center, from January 2011 to December 2020, was done. Patients with familial PHPT and secondary hyperparathyroidism were not included. Results Of the 130 women with PHPT, 44.6% were pre-M and 55.4% were post-M. A significantly higher number of pre-M females were symptomatic compared to post-M females (pre-M vs. post-M, 84.5% vs. 68.1%, P = 0.031). Renal calculi were more common in pre-M women (34.5% vs. 18.1%, P = 0.032), while the rest of the clinical features were comparable between the two groups. The proportion of women with osteoporosis (6.7% vs. 19.4%, P = 0.071), hypertension (13.8% vs. 34.7%, P = 0.012), and diabetes mellitus (3.5% vs. 16.7%, P = 0.033) was lesser in the pre-M group. Elevated serum alkaline phosphatase levels were significantly more prevalent in the pre-M group (37.9% vs. 20.8%, P = 0.032). The mean serum calcium (12.35 ± 1.28 vs. 11.96 ± 1.22 mg/dL, P = 0.079), median serum PTH (334 vs. 239 pg/mL, P = 0.051), and median weight of the operated adenomas (1.75 vs. 1.45 g, P = 0.075) were also higher in pre-M females. The proportion of ectopic adenomas and multiple adenomas, presurgery adenoma localization rates, and disease cure rates did not differ according to the menopausal status. The occurrence of postoperative hungry bone syndrome was higher in the pre-M women (15.5% vs. 1.4%, P = 0.008). Conclusion The majority of women with PHPT are post-M, but symptomatic presentation is more common in pre-M females. The severity of the disease appears to be more in pre-M women; however, imaging and operative variables generally did not significantly differ between the two groups.
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Affiliation(s)
- Aasim N. Maldar
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Nishitkumar F. Shah
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Phulrenu H. Chauhan
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Murad Lala
- Department of Surgical Oncology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Milind V. Kirtane
- Department of ENT Surgery, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Manoj Chadha
- Department of Endocrinology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Piskinpasa H, Dogansen SC, Metin D, Sahbaz NA, Esen A, Bozkur E, Aydin H, Turgut S, Pamuk N, Mert M, Cakir İ. The significance of forearm bone mineral density evaluation in determining surgical indications in primary hyperparathyroidism. ANNALES D'ENDOCRINOLOGIE 2023; 84:8-13. [PMID: 36252847 DOI: 10.1016/j.ando.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/11/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Forearm osteoporosis is a well-known complication of primary hyperparathyroidism (PHPT). However, measuring forearm bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) at the distal radius is often neglected in clinical practice despite the fact that osteoporosis at any site is a criterion indicating surgery. We aimed to evaluate the importance and priority of forearm BMD and to determine its association with biochemical parameters. MATERIAL AND METHODS Three hundred fourteen patients (272 females, 42 males) with PHPT who had BMD measurements at 3 sites were recruited for this retrospective study. The effect on surgical indications of osteoporosis only in the forearm was evaluated. Group 1 (n=151) with forearm osteoporosis and group 2 (n=163) without were compared in terms of biochemical and clinical parameters. RESULTS In the overall study population, 165 of the 314 patients had osteoporosis in at least 1 site. Twenty seven percent (n=86/314) had osteoporosis only in the forearm, while the other 2 sites (lumbar spine and femoral neck) were normal or osteopenic. Surgery was indicated based on osteoporosis only in the forearm in 10% of patients (n=30/314). Corrected calcium and parathyroid hormone levels were significantly higher in group 1 than group 2 (p=0.001 and p<0.001, respectively) and were also negatively correlated with distal radius BMD, T-score and Z-score in the whole study group. CONCLUSION Including the distal radius in BMD measurement increased the number of patients diagnosed with osteoporosis and for whom surgery was indicated. Calcium and PTH were also more frequently elevated in patients with forearm osteoporosis. These results show that distal radius BMD is relevant to the management of PHPT.
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Affiliation(s)
- Hamide Piskinpasa
- Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Sema Ciftci Dogansen
- Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Duygu Metin
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Nuri Alper Sahbaz
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Ayşe Esen
- Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Evin Bozkur
- Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Husnu Aydin
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Seda Turgut
- Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Naim Pamuk
- Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Meral Mert
- Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - İlkay Cakir
- Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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Yamauchi R, Ohshika S, Ono H, Saruga T, Ogawa T, Ishibashi Y. Diagnosis and Treatment of Brown Tumor in the Femur Induced by Parathyroid Carcinoma: A Case Report. Case Rep Oncol 2022; 15:1074-1080. [PMID: 36605224 PMCID: PMC9808300 DOI: 10.1159/000527637] [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: 06/21/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open
Abstract
Brown tumors are rare destructive bone lesions caused by hyperparathyroidism. As their clinical symptoms, radiographic findings, and laboratory results closely mimic those of metastatic tumors or multiple myeloma, the diagnosis may often be mistaken. We report a case of a 61-year-old woman with brown tumors in both femurs due to parathyroid carcinoma. The patient presented with multiple osteolytic lesions that caused pain in the right thigh. Whole-body computed tomography (CT), including the neck, suspected a parathyroid tumor, and a biopsy of the bone lesion revealed no malignancy. Following parathyroidectomy, she was diagnosed with a brown tumor with hyperparathyroidism due to a very rare parathyroid carcinoma. Although the right femoral lesion was indicated as an impending fracture, conservative treatment was performed because of the instability of her general condition after parathyroidectomy and her wishes. Bone remodeling of the right femur progressed, and the patient was ambulatory; however, 9 months postoperatively, the patient fell, developed a pathological fracture, and underwent internal fixation. When multiple osteolytic bone lesions are present, CT imaging of the neck should be performed to determine the possibility of a brown tumor due to parathyroid disease. Bone lesions of brown tumors are known to be naturally cured after treatment for hyperparathyroidism. However, when the lesion of a brown tumor in the femur is an impending fracture, prophylactic internal fixation is recommended aggressively if the patient's general condition permits.
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Affiliation(s)
- Ryota Yamauchi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shusa Ohshika
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroya Ono
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tasturo Saruga
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Testuya Ogawa
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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10
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Diagnostic and therapeutic determinants in parathyroid surgery: A retrospective cohort study. Ann Med Surg (Lond) 2022; 82:104751. [PMID: 36268338 PMCID: PMC9577851 DOI: 10.1016/j.amsu.2022.104751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/12/2022] [Accepted: 09/18/2022] [Indexed: 10/26/2022] Open
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11
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Xu XL, Yang CP, Lu SJ, Pei H, Chen SG, Liao QM. A patient with femoral osteitis fibrosa cystica mimicking bone neoplasm: a case report. BMC Musculoskelet Disord 2022; 23:322. [PMID: 35379205 PMCID: PMC8981958 DOI: 10.1186/s12891-022-05274-0] [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: 12/01/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Osteitis fibrosa cystica is a rare, benign and osteolytic lesion attributed to hyperparathyroidism. The high level of parathyroid hormone cause rapid bone loss. Case presentation The patient is a 50-year-old male complaining of severe and persistent pain in the right knee joint. Imaging studies were suspicious for a benign tumor in the right distal femur. Biopsy under CT guidance showed numerous osteoclast aggregation and hemosiderin deposition around the bone trabeculae. Blood tests disclosed significantly elevated parathyroid hormone, serum calcium, serum alkaline phosphatase. Parathyroid ultrasonography and CT scan showed a solid mass in front of the trachea at the thoracic entrance plane. After resection of the mass, the clinical symptoms were relieved and the radiological results were significantly improved, which further confirmed the diagnosis. Conclusions Metabolic diseases-associated bone lesions require a comprehensive diagnosis of multiple inspection items. An interprofessional team approach to the diagnosis and treatment of osteitis fibrosa cystica will provide the best outcome.
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Affiliation(s)
- Xiao-Long Xu
- Department of Orthopedic Surgery, Jingzhou Central Hospital, The Second Clinical Medical College of Yangtze University, No. 26, Chuyuan Ave, Jingzhou District, Jingzhou, Hubei, 434020, People's Republic of China
| | - Cui-Ping Yang
- Department of Pathology, Jingzhou Central Hospital, The Second Clinical Medical College of Yangtze University, No. 26, Chuyuan Ave, Jingzhou District, Jingzhou, Hubei, 434020, People's Republic of China
| | - Sheng-Jun Lu
- Department of Orthopedic Surgery, Jingzhou Central Hospital, The Second Clinical Medical College of Yangtze University, No. 26, Chuyuan Ave, Jingzhou District, Jingzhou, Hubei, 434020, People's Republic of China
| | - Hong Pei
- Department of Orthopedic Surgery, Jingzhou Central Hospital, The Second Clinical Medical College of Yangtze University, No. 26, Chuyuan Ave, Jingzhou District, Jingzhou, Hubei, 434020, People's Republic of China
| | - Shun-Guang Chen
- Department of Orthopedic Surgery, Jingzhou Central Hospital, The Second Clinical Medical College of Yangtze University, No. 26, Chuyuan Ave, Jingzhou District, Jingzhou, Hubei, 434020, People's Republic of China
| | - Quan-Ming Liao
- Department of Orthopedic Surgery, Jingzhou Central Hospital, The Second Clinical Medical College of Yangtze University, No. 26, Chuyuan Ave, Jingzhou District, Jingzhou, Hubei, 434020, People's Republic of China.
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12
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Zhong Y, Huang Y, Luo J, Ye Y. Misdiagnosis of brown tumour caused by primary hyperparathyroidism: a case report with literature review. BMC Endocr Disord 2022; 22:66. [PMID: 35287634 PMCID: PMC8919606 DOI: 10.1186/s12902-022-00971-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Brown tumour is a rare tumour-like lesion of the bone, which is considered as an end-stage lesion of abnormal bone metabolism caused by persistently high parathyroid hormone (PTH) levels. Brown tumour can be found in any part of the skeleton; in some cases, it can occur in multiple bones and can be easily misdiagnosed as a metastatic tumour. CASE PRESENTATION We report the case of a 44-year-old man who presented to the Department of Oncology in our hospital with a 2-month history of local pain in his left shoulder joint. The initial diagnosis was an aneurysmal bone cyst by biopsy, for which the patient underwent tumour resection surgery. The diagnosis of a malignant tumour was made again following postoperative pathological examination. The pathological sections and all clinical data were sent to the Department of Pathology of the First Affiliated Hospital of Sun Yat-sen University; the diagnosis made there was brown tumour. His blood PTH level was 577 pg/ml (15-65 pg/ml). Colour Doppler ultrasonography of the parathyroid gland suggested a parathyroid adenoma. For further treatment, the left parathyroid adenoma was removed by axillary endoscopic resection. Postoperatively, a pathologic examination was performed, and the diagnosis of a parathyroid adenoma was confirmed. One year after the surgery, the left humerus was completely healed, and the left shoulder joint had a good range of movement. CONCLUSIONS In summary, histopathological diagnosis is not sufficient for the diagnosis of brown tumours. A comprehensive analysis combining clinical symptoms with findings of imaging and laboratory tests is also required. Generally, the treatment of brown tumour includes only partial or complete resection of the parathyroid glands. However, when the tumour is large, especially when it involves the joint, surgery is indispensable.
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Affiliation(s)
- Yanchun Zhong
- Department of spine surgery, First Affiliated Hospital of Gannan Medical University, No. 128 Jin Ling Road, 341000, Ganzhou, Jiangxi, China
| | - Yuxi Huang
- Department of basic medicine, Gannan Health Vocational College, No. 12 Rong Jiang Road, 341000, Ganzhou, Jiangxi, China
| | - Jiaquan Luo
- Department of spine surgery, First Affiliated Hospital of Gannan Medical University, No. 128 Jin Ling Road, 341000, Ganzhou, Jiangxi, China
| | - Yongjun Ye
- Department of spine surgery, First Affiliated Hospital of Gannan Medical University, No. 128 Jin Ling Road, 341000, Ganzhou, Jiangxi, China.
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13
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Baranowsky A, Jahn D, Jiang S, Yorgan T, Ludewig P, Appelt J, Albrecht KK, Otto E, Knapstein P, Donat A, Winneberger J, Rosenthal L, Köhli P, Erdmann C, Fuchs M, Frosch KH, Tsitsilonis S, Amling M, Schinke T, Keller J. Procalcitonin is expressed in osteoblasts and limits bone resorption through inhibition of macrophage migration during intermittent PTH treatment. Bone Res 2022; 10:9. [PMID: 35087025 PMCID: PMC8795393 DOI: 10.1038/s41413-021-00172-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 07/01/2021] [Accepted: 08/10/2021] [Indexed: 12/13/2022] Open
Abstract
Intermittent injections of parathyroid hormone (iPTH) are applied clinically to stimulate bone formation by osteoblasts, although continuous elevation of parathyroid hormone (PTH) primarily results in increased bone resorption. Here, we identified Calca, encoding the sepsis biomarker procalcitonin (ProCT), as a novel target gene of PTH in murine osteoblasts that inhibits osteoclast formation. During iPTH treatment, mice lacking ProCT develop increased bone resorption with excessive osteoclast formation in both the long bones and axial skeleton. Mechanistically, ProCT inhibits the expression of key mediators involved in the recruitment of macrophages, representing osteoclast precursors. Accordingly, ProCT arrests macrophage migration and causes inhibition of early but not late osteoclastogenesis. In conclusion, our results reveal a potential role of osteoblast-derived ProCT in the bone microenvironment that is required to limit bone resorption during iPTH.
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Affiliation(s)
- Anke Baranowsky
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany.,Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Denise Jahn
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany.,Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany
| | - Shan Jiang
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Timur Yorgan
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Peter Ludewig
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, 20251, Germany
| | - Jessika Appelt
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany.,Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany
| | - Kai K Albrecht
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany
| | - Ellen Otto
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany.,Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany
| | - Paul Knapstein
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Antonia Donat
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Jack Winneberger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, 20251, Germany
| | - Lana Rosenthal
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Paul Köhli
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany.,Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany
| | - Cordula Erdmann
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Melanie Fuchs
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany.,Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Serafeim Tsitsilonis
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany.,Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Berlin, 13353, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Thorsten Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Johannes Keller
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany. .,Berlin Institute of Health, Berlin, 10178, Germany.
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14
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Bal SK, Sorensen MJ, Crawford AR. A Diagnosis of Normocalcemic Primary Hyperparathyroidism Prompted by “Salt and Pepper” Lesions of the Calvarium. AACE Clin Case Rep 2022; 8:37-40. [PMID: 35097201 PMCID: PMC8784707 DOI: 10.1016/j.aace.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/04/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background We report a case of normocalcemic primary hyperparathyroidism, a diagnosis prompted by radiographic “salt and pepper” calvarial lesions, typically described in hypercalcemic primary hyperparathyroidism or secondary hyperparathyroidism. Case Report A 60-year-old woman noticed indentations of her scalp and presented to her primary care provider. Radiography of the calvarium demonstrated granular “salt and pepper” lesions, prompting investigation. The patient was found to have an elevated parathyroid hormone (PTH) level of 79 pg/mL (reference range, 14-54 pg/mL) and a normal albumin-corrected calcium level of 9.8 mg/dL (reference range, 8.6-10.4 mg/dL). She was referred to our endocrine clinic and described having bone aches, fevers, leg cramps, and a remote history of nephrolithiasis. Her physical examination revealed hypertension. Repeat laboratory evaluation confirmed elevated PTH and normal albumin-corrected calcium. Secondary causes of hyperparathyroidism were ruled out. Her 25-hydroxyvitamin D level was 35 ng/mL (reference range, 30-100 ng/mL), with a normal creatinine level (0.73 mg/dL; reference range, 0.5-0.99 mg/dL). The patient underwent ultrasound and sestamibi scintigraphy, with uptake in the right inferior thyroid pole. She was found to have a 6-mm parathyroid adenoma and underwent a targeted parathyroidectomy, with normalization of serum PTH. Discussion Many cases of normocalcemic primary hyperparathyroidism are diagnosed in asymptomatic patients presenting with low bone mass; however, imaging prompted this patient's evaluation. Ultimately, the calvarial lesions were thought secondary to bone resorption from increased osteoclast activity. Conclusion This case highlights an atypical presentation of normocalcemic primary hyperparathyroidism in that the evaluation was precipitated by unexpected radiographic evidence of metabolic bone disease, rather than by symptoms or biochemical studies.
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15
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Abstract
Sporadic primary hyperparathyroidism is a common endocrinopathy, particularly afflicting postmenopausal women and both African American men and women. Although classic signs and symptoms of the disease are well appreciated and described, because of the ease and availability and low threshold for screening, the disorder often is diagnosed in patients who are minimally symptomatic or asymptomatic. Surgery conducted by experienced endocrine surgeons has a high cure rate, particularly if guided by concordant imaging. In patients who cannot safely undergo surgery or who fail to be cured, medical therapy with the oral calcimimetic cinacalcet is a validated option for controlling serum calcium levels.
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Affiliation(s)
- Stephanie J Kim
- Division of Endocrinology and Metabolism, University of California, 400 Parnassus Avenue A549, San Francisco, CA 94143, USA.
| | - Dolores M Shoback
- Endocrine Research Unit - 111N, San Francisco Department of Veterans Affairs Medical Center, Division of Endocrinology and Metabolism, San Francisco VA Medical Center, University of California, 1700 Owens Street, 3rd floor Room 369, San Francisco, CA 94158, USA
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16
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Silva BC, Bilezikian JP. Skeletal abnormalities in Hypoparathyroidism and in Primary Hyperparathyroidism. Rev Endocr Metab Disord 2021; 22:789-802. [PMID: 33200346 DOI: 10.1007/s11154-020-09614-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/22/2022]
Abstract
Both hypoparathyroidism (HypoPT), as well as its pathological counterpart, primary hyperparathyroidism (PHPT), can lead to skeletal abnormalities. Chronic deficiency of PTH in patients with HypoPT is associated with a profound reduction in bone remodeling, with consequent increases in bone density, and abnormalities in microarchitecture and bone strength. It is still not clear whether there is an increase in fracture risk in HypoPT. While standard therapy with calcium supplements and active vitamin D does not restore bone homeostasis, treatment of HypoPT with PTH appears to correct some of those abnormalities. In PHPT, the continuous exposure to high levels of PTH causes an increase in bone remodeling, in which bone resorption prevails. In the symptomatic form of PHPT, patients can present with fragility fractures, and/or the classical radiological features of osteitis fibrosa cystica. However, even in mild PHPT, catabolic skeletal actions of PTH are evident through reduced BMD, deterioration of bone microarchitecture and increased risk of fragility fractures. Successful parathyroidectomy improves skeletal abnormalities. Medical treatment, such as bisphosphonates and denosumab, can also increase bone density in patients with PHPT who do not undergo surgery. This article reviews skeletal involvement in HypoPT and in PHPT, as assessed by bone remodeling, DXA, trabecular bone score, and quantitative computed tomography, as well as data on bone strength and fracture risk. The effects of PTH replacement on the skeleton in subjects with HypoPT, and the outcome of parathyroidectomy in patients with PHPT, are also reviewed here.
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Affiliation(s)
- Barbara C Silva
- Department of Medicine, Centro Universitario de Belo Horizonte - UNI BH, Belo Horizonte, Brazil
- Endocrinology Unit, Felicio Rocho Hospital, Belo Horizonte, Brazil
- Endocrinology Unit, Santa Casa Hospital, Belo Horizonte, Brazil
| | - John P Bilezikian
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, 630 W. 168th Street, PH 8E: 105G, New York, NY, 10032, USA.
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17
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Sferopoulos NK. Primary Hyperparathyroidism in the Common Orthopaedic Practice. Open Orthop J 2021. [DOI: 10.2174/1874364102115010157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
An extensive review of the publications on primary hyperparathyroidism (pHPT) is presented in this report. It has strongly been emphasized in the literature that patients with pHPT may present either with the classical symptomatology or with asymptomatic disease, emerged due to biochemical screening. The clinical and epidemiological presentation of pHPT in western countries has changed profoundly during the past few decades, and bone disease is nowadays a distinct rarity. The introduction of serum calcium screening for osteoporosis and the technological advances in the laboratory assessment of parathyroid hormone have played important roles in early diagnosis. Subsequently, the disease is increasingly being detected as asymptomatic hypercalcaemia without guiding signs or symptoms. A third type of disease, the normocalcaemic variant, has been recently described in the literature. However, the potential diagnosis of pHPT should always be on the orthopaedics’ list of differential diagnoses in female or elderly patients with vertebral fractures and nephrolithiasis, either symptomatic or asymptomatic, as well as when solitary or multiple osteolytic lesions are encountered on the radiographs.
Additionally, a middle aged woman with parathyroid adenoma and subsequent brown tumors detected on the pelvic radiographs is reported. Her initial laboratory findings indicated a minimal increase of the serum calcium, a mild increase of the erythrocyte sedimentation rate, and a significant increase in total serum alkaline phosphatase. Finally, the detection of elevated parathyroid hormone levels indicated the diagnosis of pHPT and necessitated imaging studies of the parathyroid glands, which indicated a parathyroid adenoma. Following successful excision of the parathyroid adenoma, the patient suffered from the hungry bone syndrome. After a follow-up of 20 years, the patient had normal calcium, vitamin D, and parathyroid hormone serum levels, while a pelvic radiograph indicated no significant changes in the appearance of the brown tumors.
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18
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Sferopoulos NK. Primary Hyperparathyroidism in the Common Orthopaedic Practice. Open Orthop J 2021. [DOI: 10.2174/1874325002115010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
An extensive review of the publications on primary hyperparathyroidism (pHPT) is presented in this report. It has strongly been emphasized in the literature that patients with pHPT may present either with the classical symptomatology or with asymptomatic disease, emerged due to biochemical screening. The clinical and epidemiological presentation of pHPT in western countries has changed profoundly during the past few decades, and bone disease is nowadays a distinct rarity. The introduction of serum calcium screening for osteoporosis and the technological advances in the laboratory assessment of parathyroid hormone have played important roles in early diagnosis. Subsequently, the disease is increasingly being detected as asymptomatic hypercalcaemia without guiding signs or symptoms. A third type of disease, the normocalcaemic variant, has been recently described in the literature. However, the potential diagnosis of pHPT should always be on the orthopaedics’ list of differential diagnoses in female or elderly patients with vertebral fractures and nephrolithiasis, either symptomatic or asymptomatic, as well as when solitary or multiple osteolytic lesions are encountered on the radiographs.
Additionally, a middle aged woman with parathyroid adenoma and subsequent brown tumors detected on the pelvic radiographs is reported. Her initial laboratory findings indicated a minimal increase of the serum calcium, a mild increase of the erythrocyte sedimentation rate, and a significant increase in total serum alkaline phosphatase. Finally, the detection of elevated parathyroid hormone levels indicated the diagnosis of pHPT and necessitated imaging studies of the parathyroid glands, which indicated a parathyroid adenoma. Following successful excision of the parathyroid adenoma, the patient suffered from the hungry bone syndrome. After a follow-up of 20 years, the patient had normal calcium, vitamin D, and parathyroid hormone serum levels, while a pelvic radiograph indicated no significant changes in the appearance of the brown tumors.
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19
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Santos LMD, Ohe MN, Pallone SG, Nacaguma IO, Kunii IS, da Silva REC, Vieira JGH, Lazaretti-Castro M. Trabecular Bone Score (TBS) in Primary Hyperparathyroidism (PHPT): A Useful Tool? J Clin Densitom 2021; 24:563-570. [PMID: 34045135 DOI: 10.1016/j.jocd.2021.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/31/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Primary Hyperparathyroidism (PHPT) often leads to bone loss, even in its asymptomatic presentations. Trabecular Bone Score (TBS) is a method to assess the trabecular bone structure of the spine. This study aimed to evaluate TBS measurements combined with Dual X-ray Absorptiometry (DXA) values in the search for more accurate bone fragility risk assessment among PHPT patients. From 2017 to 2019, patients diagnosed with PHPT (n = 64), before surgery, were invited to participate in this study. Bone mineral density (BMD) by DXA at the lumbar spine, total hip, femoral neck, distal third radius, and TBS were determined in patients and controls (n = 63). The vertebral fracture was defined using the Genant method in vertebral images by DXA and vertebral fracture assessment (VFA). Patients and controls did not differ in age, sex, menopausal status, or body mass index (BMI). The PHPT patients presented significantly lower BMD values than the controls in all sites evaluated. The TBS measurements were also statistically lower in PHPT patients than controls (mean TBS PHPT = 1.233 vs TBS controls = 1.280, p = 0.044). Osteoporosis was observed in 50% of PHPT patients and 26.6% of controls (p = 0.02). However, lumbar spine T-Score < -2.5 was observed only in 21.8% of PHPT patients. Vertebral fractures were detected in nine individuals (14%) from the PHPT group and four (6.3%) in the controls (p = 0.24). The TBS area under the curve (AUC) was higher than DXA AUC in all sites, for vertebral fracture assessment. The TBS AUC was significant in the PHPT group (0.75, 95% CI 0.62 - 0.88, p = 0.02) and not significant in the DXA analysis. The ROC curve showed that TBS values < 1.187 are associated with a significantly higher risk of vertebral fracture among PHPT patients (p = 0.02). The TBS used as a complement to DXA measurements is a useful tool which may better assess fragility risk among PHPT patients.
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Affiliation(s)
- Lívia Marcela Dos Santos
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Monique Nakayama Ohe
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sthefanie Giovanna Pallone
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Isabela Ohki Nacaguma
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ilda Sizue Kunii
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Renata Elen Costa da Silva
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Marise Lazaretti-Castro
- Department of Medicine, Endocrinology Unit, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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20
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De Martinis M, Allegra A, Sirufo MM, Tonacci A, Pioggia G, Raggiunti M, Ginaldi L, Gangemi S. Vitamin D Deficiency, Osteoporosis and Effect on Autoimmune Diseases and Hematopoiesis: A Review. Int J Mol Sci 2021; 22:ijms22168855. [PMID: 34445560 PMCID: PMC8396272 DOI: 10.3390/ijms22168855] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022] Open
Abstract
Vitamin D (VD) is essential for bone homeostasis, but it is also involved in pleiotropic effects on various organs and tissues. In adults, VD deficiency can cause or exacerbate osteoporosis and induce osteomalacia. However, every tissue and cell in the body has a VD receptor, including the brain, heart, stomach, pancreas, skin, gonads, and immune cells, and a deficiency may modify the function of these organs. Thus, the wide-ranging actions of VD help to explain why a reduction in VD amount has been correlated with numerous chronic diseases. In fact, VD deficiency increases the risk of osteoporosis and several other diseases and complications characterized by impaired bone metabolisms, such as autoimmune diseases, inflammatory bowel diseases, allergy, endocrinological diseases, hematological malignancies, and bone marrow transplantation. This review aims to investigate the link between VD deficiency, osteoporosis, and its concomitant diseases. Further epidemiological and mechanistic studies are necessary in order to ascertain the real role of hypovitaminosis in causing the reported diseases; however, adequate vitamin supplementation and restoration of metabolic normality could be useful for better management of these pathologies.
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Affiliation(s)
- Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Alessandro Allegra
- Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, Division of Haematology, University of Messina, 98125 Messina, Italy
- Correspondence: ; Tel.: +39-0902-212-364
| | - Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), 56124 Pisa, Italy;
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy;
| | - Martina Raggiunti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy;
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21
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Tabacco G, Naciu AM, Messina C, Sanson G, Rinaudo L, Cesareo R, Falcone S, Manfrini S, Napoli N, Bilezikian JP, Ulivieri FM, Palermo A. DXA-Based Bone Strain Index: A New Tool to Evaluate Bone Quality in Primary Hyperparathyroidism. J Clin Endocrinol Metab 2021; 106:2304-2312. [PMID: 33963754 PMCID: PMC8599893 DOI: 10.1210/clinem/dgab317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) is associated with impaired bone quality and increased fracture risk. Reliable tools for the evaluation of bone quality parameters are not yet clinically available. Bone Strain Index (BSI) is a new metric for bone strength based on Finite Element Analysis from lumbar spine and femoral neck dual-energy x-ray absorptiometry (DXA) images. OBJECTIVE To assess the lumbar spine (LS), femoral neck (FN), and total hip (TH) BSI in PHPT patients compared with controls and to investigate the association of BSI with vertebral fractures (VFs) in PHPT. METHODS This case-control study enrolled 50 PHPT patients and 100 age- and sex-matched control subjects from an outpatient clinic. The main outcome measures were LS-BSI, FN-BSI, and TH-BSI. RESULTS FN bone mineral density (BMD) and one-third distal radius BMD were lower in the PHPT group than in controls (FN 0.633 ± 0.112 vs 0.666 ± 0.081, P = 0.042; radius 0.566 ± 0.07 vs 0.625 ± 0.06, P < 0.001). PHPT group has significant lower TBS score compared with controls (1.24 ± 0.09 vs 1.30 ± 0.10, P < 0.001). BSI was significantly higher at LS (2.28 ± 0.59 vs 2.02 ± 0.43, P = 0.009), FN (1.72 ± 0.41 vs 1.49 ± 0.35, P = 0.001), and TH (1.51 ± 0.33 vs 1.36 ± 0.25, P = 0.002) in PHPT. LS-BSI showed moderate accuracy for discriminating VFs (AUC 0.667; 95% CI, 0.513-0.820). LS-BSI ≥ 2.2 and was a statistically significant independent predictor of VFs, with an adjusted odds ratio ranging from 5.7 to 15.1. CONCLUSION BSI, a DXA-derived bone quality index, is impaired in PHPT and may help to identify PHPT subjects at high risk of fractures.
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Affiliation(s)
- Gaia Tabacco
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Anda M Naciu
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Gianfranco Sanson
- School of Nursing, Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Roberto Cesareo
- UOS Malattie Metaboliche, Santa Maria Goretti Hospital, Latina, Italy
| | - Stefania Falcone
- Unit of Endocrinology and Metabolic Diseases, CTO A. Alesini Hospital, University Tor Vergata, Rome, Italy
| | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - John P Bilezikian
- Department of Medicine, Division of Endocrinology, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York 10032, USA
| | - Fabio M Ulivieri
- U.O. Medicina Nucleare, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
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22
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Parikh P, Shetty S, Rodrigues G, Bhat SN. Brown tumour mimicking skeletal metastasis. BMJ Case Rep 2021; 14:14/7/e243478. [PMID: 34257125 DOI: 10.1136/bcr-2021-243478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Brown tumours of bone are highly vascular osteolytic lesions that depict a reparative cellular process instead of a neoplastic process in hyperparathyroidism (HPT) patients. These tumours have the potential to be aggressive and destructive. We report a case of a 30-year-old woman who presented with left thigh and lower back pain. The radiological evaluation showed multiple bony lesions in the pelvis and the spine, which mimicked multiple metastatic tumours. However, on biochemistry evaluation, serum calcium, alkaline phosphatase, and parathyroid hormone were all high, while serum phosphate was low, indicating primary HPT (PHPT), which was confirmed by parathyroid scintigraphy showing left parathyroid adenoma. Hence, the bony lesions were diagnosed as brown tumours secondary to PHPT. The patient underwent parathyroidectomy and developed severe hungry bone syndrome requiring parenteral calcium infusion along with oral calcium and active vitamin D supplementation. The clinical symptoms of bone pain improved after surgery.
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Affiliation(s)
- Pankti Parikh
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sahana Shetty
- Department of Endocrinology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gabriel Rodrigues
- Department of General Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shyamasunder N Bhat
- Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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23
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Nasser ML, Medawar S, Younan T, Abboud H, Trak-Smayra V. Osteitis fibrosa cystica mimicking bone tumor, a case report. BMC Musculoskelet Disord 2021; 22:479. [PMID: 34034731 PMCID: PMC8152144 DOI: 10.1186/s12891-021-04374-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background We report a case of osteitis fibrosa cystica, a rare benign resorptive bone lesion caused by hyperparathyroidism, that presented on imaging as an aggressive bone tumor. Case presentation The patient is a 51-year-old male complaining of severe sustained pain of the right hip region. Imaging studies were suspicious for a malignant tumor of the right iliac bone. Biopsy under CT guidance was performed and showed remodeled bone trabeculae with numerous osteoclasts, excluding bone tumor and raising the possibility of osteitis fibrosa cystica. Complementary tests disclosed elevated blood level of parathyroid hormone and a partially cystic enlarged left inferior parathyroid gland consistent with adenoma. After parathyroidectomy, the clinical symptoms were relieved and the radiological findings were significantly improved, which confirmed the diagnosis. Conclusions Metabolic diseases-associated bone lesions should always be considered in the differential diagnosis of bone tumors, to avoid unnecessary surgeries and treatments.
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Affiliation(s)
- Maya L Nasser
- Pathology Department, Hotel-Dieu de France Hospital, Saint Joseph University Medical School, PO Box 16-6830, Alfred Naccache Bvd, Ashrafieh, Beirut, Lebanon
| | - Serge Medawar
- Pathology Department, Hotel-Dieu de France Hospital, Saint Joseph University Medical School, PO Box 16-6830, Alfred Naccache Bvd, Ashrafieh, Beirut, Lebanon
| | - Tonine Younan
- Radiology Department, Hotel-Dieu de France Hospital, Saint Joseph University Medical School, Beirut, Lebanon
| | - Halim Abboud
- Neurology Department, Hotel-Dieu de France Hospital, Saint Joseph University Medical School, Beirut, Lebanon
| | - Viviane Trak-Smayra
- Pathology Department, Hotel-Dieu de France Hospital, Saint Joseph University Medical School, PO Box 16-6830, Alfred Naccache Bvd, Ashrafieh, Beirut, Lebanon.
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Computed Tomography Osteodensitometry for Assessment of Bone Mineral Density of the Canine Head-Preliminary Results. Animals (Basel) 2021; 11:ani11051413. [PMID: 34069215 PMCID: PMC8156747 DOI: 10.3390/ani11051413] [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: 03/22/2021] [Revised: 04/22/2021] [Accepted: 05/10/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Metabolic bone disease can have disastrous consequences on canine health. Unlike in human medicine where awareness of osteoporosis and bone mineral density (BMD) disorders have led to the holistic application of osteodensitometry, application of osteodensitometry in dogs is limited. We aimed to assess the utility of quantitative computed tomography (qCT) bone mineral density (BMD) measurement of the canine calvarium using semiautomated osteodensitometry software and define host factors associated with canine BMD in a skeletally healthy population. Calvarium qCT can be used to rapidly obtain BMD measurement of dogs. Canine BMD was negatively associated with weight, whereas there was no relationship between BMD and age or sex. Many chronic canine diseases can significantly affect bone health via a variety of pathophysiological mechanisms. This efficient qCT method could facilitate rapid BMD screening in dogs undergoing CT evaluation and ultimately encourage further BMD investigation. Abstract Despite bone mineral density (BMD) being regularly measured in human patients, BMD studies in clinical cohorts of dogs is lacking. In order to facilitate BMD assessment and in turn better identify dogs suffering from metabolic bone disease, rapid, easy and precise computed tomography (qCT) techniques are required. In this study we aimed to assess the utility of quantitative computed tomography (qCT) bone mineral density (BMD) measurement of the canine calvarium using a semiautomated osteodensitometry software and define host factors associated with canine bone mineral density in a skeletally healthy population. Calvarial qCT at the level of the temporomandibular joints was performed on 323 dogs using a dedicated osteodensitometry calibration phantom during a clinically indicated head computed tomography (CT). Calvarial BMD was analyzed using a dedicated semiautomatic osteodensitometry software for contouring of the calvarial lamellar bone margins and BMD calculation. The mean duration of the calvarial qCT scanning was 64.6 s, and the mean duration of BMD analysis was 34 s, with a mean of two manual adjustments required for the bone margin tracing. The median BMD of all dogs in our study was 659 mg Calcium hydroxyapatite/mL. There was a negative linear correlation between BMD and body weight, but no correlation with age, sex or neutered status. Canine BMD assessment using qCT of the calvarium is a practical and fast technique that can be added to a clinical CT examination with minimal extra time requirements. Canine BMD host-dependent factors exhibit different relationships from that of humans; however, further investigation is warranted.
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Yao X, Jiang T, Wei B, Chang H. Clinical characteristics of the patients with asymptomatic primary hyperparathyroidism. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2021; 46:368-372. [PMID: 33967082 PMCID: PMC10930305 DOI: 10.11817/j.issn.1672-7347.2021.200356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The prevalence of asymptomatic primary hyperparathyroidism (PHPT) in China is lower than that in European and American countries and the study about the characteristics of asymptomatic PHPT was rare in China. This study aims to explore the characteristics of asymptomatic PHPT. METHODS Clinical data of 150 patients with PHPT confirmed by operation and pathological examination were retrospectively analyzed. The patients were assigned into a symptomatic PHPT group (n=124) and an asymptomatic PHPT group (n=26). RESULTS The proportion of adenomas was higher than that of adenocarcinoma in the asymptomatic PHPT group. The proportion of the first diagnosis due to hypercalcemia found via biochemical examination in the asymptomatic PHPT group was higher than that in the symptomatic PHPT group (76.92% vs 25.81%, P<0.001). The duration was shorter in the asymptomatic PHPT patients than that in the symptomatic PHPT patients (median 12 months vs 24 months, P=0.004). The serum calcium, the albumin-corrected serum calcium, and parathyroid hormone (PTH) were lower in the asymptomatic PHPT patients than those in the symptomatic PHPT (P=0.003, P=0.006, and P=0.042, respectively). The serum 1,25-dihydroxyvitamin D3 was higher (P<0.001), the diameter was shorter (P=0.028), and the bone mineral densities (BMD) of L2~4 and femoral neck were higher in the asymptomatic PHPT patients than those in the symptomatic PHPT patients (both P<0.001). CONCLUSIONS Only a minority of PHPT patients are asymptomatic. Compared with the symptomatic PHPT patients, the primary cause of diagnosis is hypercalcemia, the duration of diagnosis and the diameter of parathyroid gland are shorter, the levels of serum calcium, and PTH are lower, the proportion of adenomas, vitamin D, and the BMD of L2-4 and femoral neck are higher, and the pathological type is benign in the asymptomatic PHPT patients.
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Affiliation(s)
- Xiao'ai Yao
- Department of Endocrinology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038.
| | - Tao Jiang
- Department of Endocrinology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038.
| | - Bojun Wei
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038
| | - Hong Chang
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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26
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Bird RP, Eskin NAM. The emerging role of phosphorus in human health. ADVANCES IN FOOD AND NUTRITION RESEARCH 2021; 96:27-88. [PMID: 34112356 DOI: 10.1016/bs.afnr.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Phosphorus, an essential nutrient, performs vital functions in skeletal and non-skeletal tissues and is pivotal for energy production. The last two decades of research on the physiological importance of phosphorus have provided several novel insights about its dynamic nature as a nutrient performing functions as a phosphate ion. Phosphorous also acts as a signaling molecule and induces complex physiological responses. It is recognized that phosphorus homeostasis is critical for health. The intake of phosphorus by the general population world-wide is almost double the amount required to maintain health. This increase is attributed to the incorporation of phosphate containing food additives in processed foods purchased by consumers. Research findings assessed the impact of excessive phosphorus intake on cells' and organs' responses, and highlighted the potential pathogenic consequences. Research also identified a new class of bioactive phosphates composed of polymers of phosphate molecules varying in chain length. These polymers are involved in metabolic responses including hemostasis, brain and bone health, via complex mechanism(s) with positive or negative health effects, depending on their chain length. It is amazing, that phosphorus, a simple element, is capable of exerting multiple and powerful effects. The role of phosphorus and its polymers in the renal and cardiovascular system as well as on brain health appear to be important and promising future research directions.
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Affiliation(s)
- Ranjana P Bird
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada.
| | - N A Michael Eskin
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada
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27
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Narayanan N, Palui R, Merugu C, Kar SS, Kamalanathan S, Sahoo J, Selvarajan S, Naik D. The Risk of Fractures in Primary Hyperparathyroidism: A Meta-Analysis. JBMR Plus 2021; 5:e10482. [PMID: 33869997 PMCID: PMC8046118 DOI: 10.1002/jbm4.10482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/21/2020] [Accepted: 02/16/2021] [Indexed: 12/25/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) is a common metabolic bone disease affecting 1% of the adult population. Patients with PHPT have reduced BMD, especially at the cortical bone. However, studies evaluating its impact on fracture risk have shown contradictory results. In an effort to further inform fracture risk for this patient population, a meta‐analysis of studies of fracture in patients with PHPT compared with a control population was undertaken. Articles were searched in PubMed/MEDLINE, Excerpta Medica, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, and Web of Science bibliographic databases. The meta‐analysis included 17 studies involving 3807 PHPT cases and 11,908 controls. The primary outcome was to determine the risk of vertebral fracture (VF), nonvertebral fracture, hip fracture, distal radius fracture, and total fracture (TF) among patients with PHPT in comparison with a control population. BMD (lumbar spine, femoral neck, total hip, and distal radius) and serum 25‐hydroxy vitamin D level, as well as possible predictors of VF as secondary outcomes were assessed. From this meta‐analysis, it was found that there was a significantly increased risk of VF (risk ratio [RR], 2.57; 95% CI, 1.3–5.09; p = 0.007) and TF (RR, 1.71; 95% CI, 1.48–1.97; p < 0.00001) in patients with PHPT. There was a significant decrease in BMD in patients with PHPT versus controls at all four sites. Older age, longer duration since menopause, and lower BMD at lumbar spine and distal radius were predictors for VF. To conclude, patients with PHPT had a significantly higher risk for VF and TF in comparison with controls. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Niya Narayanan
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Rajan Palui
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Chandhana Merugu
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Sadishkumar Kamalanathan
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Jayaprakash Sahoo
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Sandhiya Selvarajan
- Department of Clinical Pharmacology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Dukhabandhu Naik
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
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28
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Mihashi I, Ishii K, Ogawa Y, Uchida A, Hara H, Tamaoka A. Normocalcemic Primary Hyperparathyroidism Presenting with Muscle Weakness and Body Pain. Intern Med 2021; 60:953-956. [PMID: 33250466 PMCID: PMC8024951 DOI: 10.2169/internalmedicine.6131-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/02/2020] [Indexed: 11/06/2022] Open
Abstract
We herein report a 39-year-old woman who had aggravated body pain, waddling gait, and fatigability for the past 2 years. A neurological examination showed hyperreflexia and proximal muscle weakness. The serum calcium level was normal (10.1 mg/dL). However, serum alkaline phosphatase (3,855 IU/I) and parathyroid hormone (1,008 pg/mL) levels were remarkably high. Cervical ultrasonography revealed parathyroid goiter. The patient was diagnosed with hyperparathyroidism. Her muscle weakness and pain improved within three months after parathyroidectomy. Our findings suggest that clinicians should consider hyperparathyroidism as a differential diagnosis in patients with proximal muscle weakness, even if the serum calcium level is normal.
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Affiliation(s)
- Izumi Mihashi
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kazuhiro Ishii
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yasuhiro Ogawa
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
| | - Ayako Uchida
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
| | - Hisato Hara
- Department of Endocrine Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Akira Tamaoka
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
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29
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Differences in Primary Hyperparathyroidism Between Pre- and Postmenopausal Women in India. Endocr Pract 2021; 27:710-715. [PMID: 33685668 DOI: 10.1016/j.eprac.2020.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Primary hyperparathyroidism (PHPT) is a common endocrine disorder in women which becomes more prevalent after menopause. In this study, we compared the demographic, clinical, and biochemical variables between premenopausal (pre-M) and postmenopausal (post-M) women with PHPT. METHODS A retrospective analysis (from 2005 to 2019) of enrolled women PHPT patients from an online Indian PHPT registry. RESULTS Of the women with PHPT, 232 and 122 were pre-M and post-M, respectively. The number of post-M PHPT cases registered had a 3.3-fold increase in 2015-2019 from 2005-2009 compared with only a 2.5-fold increase in pre-M cases in the same duration. The majority were symptomatic (90%), although pre-M had a higher proportion of symptomatic than post-M (92% vs 85%; P = .04). Pre-M women showed more prevalence of osteitis fibrosa cystica than post-M women (28% vs 13%; P = .03), although hypertension and gallstone disease were seen more frequently in post-M PHPT women. Pre-M women had a significantly higher median PTH (403 vs 246 pg/mL; P = .02) and median alkaline phosphatase (202 vs 145 pg/mL; P = .02) than post-M women, and vitamin D deficiency was more common in pre-M women (58% vs 45%; P = .03). Gland localization, tumor weight, and disease cure rates did not differ according to menopausal status. CONCLUSION PHPT was more prevalent in pre-M women, although the number of post-M cases had significantly increased in the last 10 years. Pre-M women had generally more severe clinical and biochemical variables than post-M PHPT women.
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30
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Arya AK, Kumari P, Bhadada SK, Agrawal K, Singh P, Mukherjee S, Sood A, Rao SD. Progressive rise in the prevalence of asymptomatic primary hyperparathyroidism in India: Data from PHPT registry. J Bone Miner Metab 2021; 39:253-259. [PMID: 32894354 DOI: 10.1007/s00774-020-01142-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT), a third common endocrine disorder, varies from asymptomatic disease, mostly seen in the West where routine biochemical screening is practiced, to the classical symptomatic disease mostly seen in the Eastern countries. We aimed to compare the demographic, clinical, biochemical measurements in patients with asymptomatic and symptomatic PHPT from the Indian PHPT registry. MATERIAL AND METHODS Data of PHPT patients from the last 25 years (1995-2019) were analyzed for demographic, clinical presentation and biochemical measurements, and compared these characteristics between asymptomatic and symptomatic PHPT patients. RESULTS Of the 554 patients, 54 (10%) patients had asymptomatic PHPT. There was a sharp rise in the proportion of asymptomatic PHPT patients of 3% in the first decade to 13% in the second decade of the century (p = 0.003). Patients with asymptomatic PHPT were significantly older (50 vs. 42 years; p < 0.0001) and had higher mean body mass index (27.8 vs. 23.5 kg/m2; p < 0.0001) compared to the symptomatic PHPT group. In addition, asymptomatic PHPT patients had significantly lower median plasma iPTH (180 vs. 370 pg/mL; p < 0.0001), serum alkaline phosphatase (119 vs. 172 IU/L; p < 0.0001), and parathyroid adenoma weight (1.0 vs. 2.62 g; p = 0.006) compared to the symptomatic PHPT group. CONCLUSION Although symptomatic PHPT is still most prevalent (> 90%) in India with higher indices of the disease and tumor weights, there is a progressive rise in the prevalence of asymptomatic PHPT patients in the last decade. Improvements in calcium and vitamin D nutrition might account for this change as in the Western series.
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Affiliation(s)
- Ashutosh Kumar Arya
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Poonam Kumari
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Kanhaiya Agrawal
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Priyanka Singh
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Soham Mukherjee
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudhaker D Rao
- Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, USA
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31
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Slouma M, Rahmouni S, Dhahri R, Abbes M, Gharsallah I, Metoui L, Louzir B. Hypercalcemia in a patient with a bowing femur. Clin Case Rep 2021; 9:516-521. [PMID: 33489206 PMCID: PMC7813087 DOI: 10.1002/ccr3.3569] [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: 06/17/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 11/11/2022] Open
Abstract
Hypercalcemia in PDB is rare; its occurrence requires thorough investigations as it may reveal several diseases, such as primary hyperparathyroidism, malignant transformation, metastases, or myeloma.
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Affiliation(s)
- Maroua Slouma
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Safa Rahmouni
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Rim Dhahri
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Maissa Abbes
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Imen Gharsallah
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Leila Metoui
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Bassem Louzir
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
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Abdala R, Gonzalez Pernas MS. Coexistence of brown tumors due to secondary hyperparathyroidism and prostate cancer in a patient. Osteoporos Int 2021; 32:205-208. [PMID: 32772143 DOI: 10.1007/s00198-020-05558-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
We present the case of a 65-year-old man with brown tumors due to secondary hyperparathyroidism. Magnetic resonance imaging of the pelvis showed multiple lesions with expansive bone appearance. Additionally, prostate cancer was diagnosed during this time. For this reason, differential diagnosis was performed through biopsy of the right iliac bone lesion. Brown tumors are caused by osteoclastic activity and fibroblast proliferation; the differential diagnosis of these bone lesions includes giant tumors, metastases, Paget's disease, and paraneoplastic syndrome with high levels of parathyroid hormone-related peptide (PTHrP). This case report describes the coexistence of two pathologies that could explain these images. In this report, we present a case of a 65-year-old man with brown tumors due to secondary hyperparathyroidism and prostate cancer. In this setting, histologic confirmation is recommended.
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Affiliation(s)
- Ruben Abdala
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Libertad 836, 1st Floor, 1012, Buenos Aires, Argentina
| | - Mariana S Gonzalez Pernas
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Libertad 836, 1st Floor, 1012, Buenos Aires, Argentina.
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Changes in Bone Metabolism and Structure in Primary Hyperparathyroidism. ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Parathyroid hormone (PTH) is a key regulator of bone turnover. Depending on the duration of action, the hormone causes catabolic and anabolic effects by binding with specific receptors (PTHR1) in the bone. Various cells expressing PTHR1 on their surface are involved in the process – osteoblasts, osteocytes, bone marrow stromal cells, T-lymphocytes and macrophages. In physiological conditions PTH balances the bone metabolism. Intermittent pharmacological doses of PTH lead to the prevalence of bone formation and are used in the treatment of osteoporosis. Persistently elevated levels of PTH stimulate bone resorption by impacting mainly the cortical bone. New imaging and analysis techniques show that high PTH levels can also have an adverse effect on trabecular microarchitecture. Primary hyperparathyroidism (PHPT) is a disease characterized by increased bone metabolism, decreased bone mineral density (BMD), inadequate osteoid mineralization and an increased risk of fractures. Prolonged overproduction of PTH leads to stimulation of bone resorption and defects in bone formation, mainly causing loss of cortical bone mass, while in the trabecular bone predominate demineralization processes. One explanation of these findings is the enhanced stimulation of RANKL expression by osteoblasts with decreased OPG expression and bone formation at the same time.
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Lu S, Gong M, Zha Y, Cui A, Chen C, Yang H, Sun W, Hua K, Tian W, Jiang X. Changes in bone mineral density after parathyroidectomy in patients with moderate to severe primary hyperparathyroidism. J Int Med Res 2020; 48:300060520964698. [PMID: 33135515 PMCID: PMC7780563 DOI: 10.1177/0300060520964698] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Primary hyperparathyroidism (PHPT) is relatively common in China and results in severe damage to the skeletal system. This study aimed to investigate changes in bone mineral density (BMD) over 2 years in patients with PHPT after parathyroidectomy. METHODS This retrospective cohort study included patients with PHPT who underwent parathyroidectomy between January 2010 and December 2015. BMD and T-scores and Z-scores of the lumbar spine (L1, L2, L3, and L4) and total hip (femoral neck, great trochanter, and Ward's triangle) at baseline and 2 years after surgery were measured by dual-energy X-ray absorptiometry. RESULTS Thirty patients with moderate to severe PHPT (17 men and 13 women) aged 38.90±15.48 years were included. BMD, and T-score and Z-score values at the lumbar spine and total hip at 6 months, 1 year, and 2 years after parathyroidectomy were significantly improved compared with preoperative values. Improvement in BMD was largest at L4 (46.7%) and smallest at L1 (37.4%) in the lumbar spine 2 years after parathyroidectomy. For the total hip, the increase in BMD was largest at Ward's triangle (42.6%) and smallest at the femoral neck (37.5%). CONCLUSIONS BMD of the lumbar spine and total hip is improved after parathyroidectomy in patients with PHPT.
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Affiliation(s)
- Shuai Lu
- Department of Orthopedic Trauma, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Maoqi Gong
- Department of Orthopedic Trauma, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Yejun Zha
- Department of Orthopedic Trauma, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Aimin Cui
- Department of General Surgery, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Chen Chen
- Department of Orthopedic Trauma, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Hao Yang
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Weitong Sun
- Department of Orthopedic Trauma, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Kehan Hua
- Department of Orthopedic Trauma, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Xieyuan Jiang
- Department of Orthopedic Trauma, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China
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Stutz C, Batool F, Petit C, Strub M, Kuchler-Bopp S, Benkirane-Jessel N, Huck O. Influence of parathyroid hormone on periodontal healing in animal models: A systematic review. Arch Oral Biol 2020; 120:104932. [PMID: 33113458 DOI: 10.1016/j.archoralbio.2020.104932] [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: 04/26/2020] [Revised: 07/10/2020] [Accepted: 09/21/2020] [Indexed: 12/09/2022]
Abstract
OBJECTIVES The purpose of this systematic review was to determine the potential interest of parathyroid hormone (PTH) as an adjunct to periodontal treatment based on studies performed in rodents. MATERIALS & METHODS Electronic databases (MEDLINE, Web of Science) were searched up to December 2019. Studies assessing the impact of PTH administration in experimental periodontitis in rodents have been identified. RESULTS Amongst the 247 identified articles, 10 met the inclusion criteria and were included in this systematic review. Experimental periodontitis was mainly induced by ligature placement or surgically with a dental bur. All studies considered bone healing after PTH administration at different frequencies as primary outcome. Results showed that an intermittent administration of PTH promoted bone healing and neovascularization. Nevertheless, a decrease of soft tissue inflammation was also observed. CONCLUSION Intermittent administration of PTH appears to enhance significantly periodontal healing and to promote alveolar bone regeneration. However, due to the risk of side effects, the development of scaffolds allowing its local and time-controlled delivery is of importance.
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Affiliation(s)
- Céline Stutz
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Fareeha Batool
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Catherine Petit
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France; Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France; Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marion Strub
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France; Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France; Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sabine Kuchler-Bopp
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Nadia Benkirane-Jessel
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Olivier Huck
- INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France; Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France; Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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Serna J, Bergwitz C. Importance of Dietary Phosphorus for Bone Metabolism and Healthy Aging. Nutrients 2020; 12:E3001. [PMID: 33007883 PMCID: PMC7599912 DOI: 10.3390/nu12103001] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/13/2022] Open
Abstract
Inorganic phosphate (Pi) plays a critical function in many tissues of the body: for example, as part of the hydroxyapatite in the skeleton and as a substrate for ATP synthesis. Pi is the main source of dietary phosphorus. Reduced bioavailability of Pi or excessive losses in the urine causes rickets and osteomalacia. While critical for health in normal amounts, dietary phosphorus is plentiful in the Western diet and is often added to foods as a preservative. This abundance of phosphorus may reduce longevity due to metabolic changes and tissue calcifications. In this review, we examine how dietary phosphorus is absorbed in the gut, current knowledge about Pi sensing, and endocrine regulation of Pi levels. Moreover, we also examine the roles of Pi in different tissues, the consequences of low and high dietary phosphorus in these tissues, and the implications for healthy aging.
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Affiliation(s)
- Juan Serna
- Yale College, Yale University, New Haven, CT 06511, USA;
| | - Clemens Bergwitz
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06519, USA
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Guimarães LM, Gomes IP, Pereira TDSF, de Andrade BAB, Romañach MJ, de Lacerda JCT, Pontes HAR, Brennan PA, Rahimi S, Carlos R, Mosqueda-Taylor A, Bologna-Molina R, Passador-Santos F, Gomez RS, Gomes CC. KRAS mutations in brown tumor of the jaws in hyperparathyroidism. J Oral Pathol Med 2020; 49:796-802. [PMID: 32492752 DOI: 10.1111/jop.13048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Brown tumors are giant cell-rich lesions that result from abnormal bone metabolism in hyperparathyroidism, one of the most common endocrine disorders worldwide. Brown tumors occasionally affect the jaws and, despite well-known clinical and microscopic features, their molecular pathogenesis remains unclear. We investigated the presence of pathogenic activating mutations in TRPV4, FGFR1, and KRAS in a cohort of brown tumors since these have recently been reported in giant-cell lesions of the jaws and non-ossifying fibromas of the bones (FGFR1 and KRAS), which are histologic mimics of brown tumors. METHODS We target sequenced 13 brown tumors of the jaws associated with primary or secondary hyperparathyroidism. As mutations in these genes are known to activate the MAPK/ERK signaling pathway, we also assessed the immunostaining of the phosphorylated form of ERK1/2 (pERK1/2) in these lesions. RESULTS KRAS pathogenic mutations were detected in seven cases (p.G12V n = 4, p.G12D n = 1, p.G13D n = 1, p.A146T n = 1). KRAS variants of unknown significance (VUS), p.A134T and p.E37K, were also detected. All samples showed wild-type sequences for FGFR1 and TRPV4 genes. The activation of the MAPK/ERK signaling pathway was demonstrated by pERK1/2 immunohistochemical positivity of the brown tumors´ mononuclear cells. CONCLUSION Mutations in KRAS and activation of the MAPK/ERK signaling pathway were detected in brown tumors of hyperparathyroidism of the jaws, expanding the spectrum of giant cell lesions whose molecular pathogenesis involve RAS signaling.
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Affiliation(s)
- Letícia Martins Guimarães
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Isadora Pereira Gomes
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Thaís Dos Santos Fontes Pereira
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Hélder Antônio Rebelo Pontes
- Service of Oral Pathology, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará (UFPA), Belém, Brazil
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Siavash Rahimi
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
- Frontier Pathology-Royal Sussex County Hospital, Brighton, UK
| | - Román Carlos
- Centro Clinico de Cabeza y Cuello, Guatemala City, Guatemala
| | | | - Ronell Bologna-Molina
- Molecular Pathology Area, School of Dentistry, Universidad de la República (UDELAR), Montevideo, Uruguay
| | | | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Carolina Cavaliéri Gomes
- Department of Pathology, Institute of Biological Science, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Physical Activity-Dependent Regulation of Parathyroid Hormone and Calcium-Phosphorous Metabolism. Int J Mol Sci 2020; 21:ijms21155388. [PMID: 32751307 PMCID: PMC7432834 DOI: 10.3390/ijms21155388] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022] Open
Abstract
Exercise perturbs homeostasis, alters the levels of circulating mediators and hormones, and increases the demand by skeletal muscles and other vital organs for energy substrates. Exercise also affects bone and mineral metabolism, particularly calcium and phosphate, both of which are essential for muscle contraction, neuromuscular signaling, biosynthesis of adenosine triphosphate (ATP), and other energy substrates. Parathyroid hormone (PTH) is involved in the regulation of calcium and phosphate homeostasis. Understanding the effects of exercise on PTH secretion is fundamental for appreciating how the body adapts to exercise. Altered PTH metabolism underlies hyperparathyroidism and hypoparathyroidism, the complications of which affect the organs involved in calcium and phosphorous metabolism (bone and kidney) and other body systems as well. Exercise affects PTH expression and secretion by altering the circulating levels of calcium and phosphate. In turn, PTH responds directly to exercise and exercise-induced myokines. Here, we review the main concepts of the regulation of PTH expression and secretion under physiological conditions, in acute and chronic exercise, and in relation to PTH-related disorders.
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Pushpasekaran N, Vasudevan G, Khaleel VM, Sebastain A, Das S. Overt metabolic bone failure as the initial manifestation of neglected primary hyperparathyroidism: An unusual presentation and review of current practice guidelines. J Clin Orthop Trauma 2020; 11:S671-S674. [PMID: 32774048 PMCID: PMC7394783 DOI: 10.1016/j.jcot.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/10/2020] [Accepted: 01/17/2020] [Indexed: 11/18/2022] Open
Abstract
Varied symptomatology exists in hyperparathyroidism. The current approaches and evaluation of altered calcium homeostasis have led to the practice of early identification and subsequent management of the adenomas. Hence, bony manifestations (deformities, lesions, and fractures) termed to be end stage of bone metabolism failure, have rarely been encountered in the last two decades. We report this infrequent presentation in a 47-year-old female, who visited the emergency department following a trivial fall. Her background history recorded left superior parathyroidectomy three months prior to fall. The clinical and radiological evaluations were suggestive of insufficiency fractures of right proximal humerus and right shaft of femur, multiple lytic lesions and other bony manifestations pathognomonic of hyperparathyroidism. Metabolic profile revealed a primary cause despite prior adenectomy, and targeted scintigraphy demonstrated a hyper-functioning right inferior parathyroid gland. The high resolution ultrasound used before the prior surgery failed to localise additional hyper-functioning glands. Post-parathyroidectomy, the hungry bone disease was adequately managed. The femur fracture required surgical stabilization. In conclusion, bony manifestations of hyperparathyroidism can be disabling and difficult to treat. Although a rare clinical presentation, the severity of bony manifestations arise from a preventable cause and that the initial evaluation of hyperparathyroidism should also include parathyroid scintigraphy, and not limited to screening of the neck with ultrasonography, for its combined additive information and improved diagnostic value.
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Affiliation(s)
| | - Gokuldev Vasudevan
- Department of Orthopaedics, Medical Trust Hospital, Cochin, Kerala, India
| | | | - Antony Sebastain
- Department of Cardiothoracic and Vascular Surgery, Medical Trust Hospital, Cochin, Kerala, India
| | - Saubhik Das
- Orthopaedics, Rajendra Institute of Medical Sciences (RIMS), Ranchi, India
- Corresponding author. Orthopaedics, Rajendra Institute of Medical Sciences (RIMS), Bariatu, Ranchi, 834009, India.
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40
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Strother RK, Meunier M. Hypercalcemia in the Presence of an Ectopic Mediastinal Mass. J Prim Care Community Health 2020; 11:2150132720932411. [PMID: 32552312 PMCID: PMC7307481 DOI: 10.1177/2150132720932411] [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] [Indexed: 11/16/2022] Open
Abstract
A 72-year-old gentleman who presented to the outpatient clinic for a preventive health appointment with symptoms of depression and fatigue was found to have persistent hypercalcemia on routine laboratory monitoring. Initial laboratory testing was consistent with primary hyperparathyroidism with elevation in parathyroid hormone and low vitamin D levels. Further imaging demonstrated an ectopic mediastinal parathyroid adenoma. The ectopic lesion was treated surgically and lead to normalization of calcium levels and objective improvement in depressive symptoms. Primary hyperparathyroidism, which can be secondary to an adenoma, multigland hyperplasia, or neoplasm, can lead to the development of bone pain, fractures, and nephrolithiasis among other symptoms. The evaluation of hypercalcemia and the identification of primary hyperparathyroidism are important for the primary care physician to recognize so as to reduce disease morbidity as well as identify patients in need of further specialty care.
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41
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Zhou J, Zheng S, Zhou L, Yong X, Zhang Y, QinXia, Zhang W, Wang C. Pathologic evaluation of the solid variant of aneurysmal bone cysts with USP6 rearrangement with an emphasis on the frequent diagnostic pitfalls. Pathol Int 2020; 70:502-512. [PMID: 32342641 DOI: 10.1111/pin.12941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/06/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022]
Abstract
The solid variant of aneurysmal bone cyst (SVABC) is very uncommon and frequently misdiagnosed. We reevaluated and summarized the clinicopathologic features of 17 SVABCs and further discussed the use of this nomenclature to differ SVABCs from extragnathic giant cell reparative granuloma (GCRG) in the setting of the USP6 rearrangement era. The immunohistochemical markers included α-SMA, SATB2, AE1/AE3, Ki67, S100, CD68 and P63. USP-6 status was detected by fluorescence in situ hybridization using a break-apart probe. The 17 patients with SVABCs comprised 10 males and 7 females ranging in age from 4 to 70 years. The involved locations included the long bone (n = 11), hand (n = 4), rib (n = 1) and vertebra (n = 1). The lesions were characterized by proliferated spindle cells with scattered giant cells and hemorrhages with variable positive α-SMA, SATB2, CD68 and Ki-67 expression. All patients had USP6 rearrangements without H3F3A glycine 34 mutations. Our study reveals that SVABC shares similar clinical and histologic features with other bone lesions, which may lead to an erroneous diagnosis. The presence of an USP-6 rearrangement contributes to the diagnosis SVABC; SVABC and most of the previously documented extragnathic GCRGs may be considered within the umbrella of primary aneurysmal bone cysts.
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Affiliation(s)
- Jun Zhou
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Saifang Zheng
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Luting Zhou
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiang Yong
- Department of Pathology, Wanbei Coal-Electricity Group General Hospital, Suzhou, Anhui, China
| | - Yanping Zhang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - QinXia
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjing Zhang
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chaofu Wang
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Abstract
Primary hyperparathyroidism (PHPT) is a condition that affects calcium metabolism due to parathyroid hormone (PTH) hypersecretion leading to hypercalcemia. Manifestations have changed over time, from a symptomatic disease with bone pain, fractures, nephrolithiasis, and muscle weakness, to a condition that is mainly asymptomatic (80-90%). Typical symptoms and signs occur in the bones and kidneys and atypical manifestations are cardiovascular, neuropsychiatric and cognitive, neuromuscular, rheumatological, and gastrointestinal. Diagnosis occurs, in most cases, in asymptomatic patients by a routine calcium measurement with corrected high total calcium associated with high or inappropriately abnormal PTH. If indicated, a search for the location of the involved parathyroid gland should be performed with ultrasound, scintigraphy, or 4D CT. Parathyroidectomy is the gold standard treatment. If surgery cannot be performed, clinical management is indicated. Surgical indications are osteoporosis, hypercalciuria, spine fractures, age <50 years, calcemic values above 1.0 mg/dL threshold value, creatinine clearance ≤60 mL/min, and nephrolithiasis or nephrocalcinosis.
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Chang W, Tu CL, Jean-Alphonse FG, Herberger A, Cheng Z, Hwong J, Ho H, Li A, Wang D, Liu H, White AD, Suh I, Shen W, Duh QY, Khanafshar E, Shoback DM, Xiao K, Vilardaga JP. PTH hypersecretion triggered by a GABA B1 and Ca 2+-sensing receptor heterocomplex in hyperparathyroidism. Nat Metab 2020; 2:243-255. [PMID: 32694772 PMCID: PMC7377265 DOI: 10.1038/s42255-020-0175-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/20/2020] [Indexed: 12/14/2022]
Abstract
Molecular mechanisms mediating tonic secretion of parathyroid hormone (PTH) in response to hypocalcaemia and hyperparathyroidism (HPT) are unclear. Here we demonstrate increased heterocomplex formation between the calcium-sensing receptor (CaSR) and metabotropic γ-aminobutyric acid (GABA) B1 receptor (GABAB1R) in hyperplastic parathyroid glands (PTGs) of patients with primary and secondary HPT. Targeted ablation of GABAB1R or glutamic acid decarboxylase 1 and 2 in PTGs produces hypocalcaemia and hypoparathyroidism, and prevents PTH hypersecretion in PTGs cultured from mouse models of hereditary HPT and dietary calcium-deficiency. Cobinding of the CaSR/GABAB1R complex by baclofen and high extracellular calcium blocks the coupling of heterotrimeric G-proteins to homomeric CaSRs in cultured cells and promotes PTH secretion in cultured mouse PTGs. These results combined with the ability of PTG to synthesize GABA support a critical autocrine action of GABA/GABAB1R in mediating tonic PTH secretion of PTGs and ascribe aberrant activities of CaSR/GABAB1R heteromer to HPT.
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Affiliation(s)
- Wenhan Chang
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA.
| | - Chia-Ling Tu
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Frederic G Jean-Alphonse
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amanda Herberger
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Zhiqiang Cheng
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Jenna Hwong
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Hanson Ho
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Alfred Li
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Dawei Wang
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hongda Liu
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex D White
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Graduate Program in Molecular Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Insoo Suh
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Wen Shen
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Elham Khanafshar
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Dolores M Shoback
- Endocrine Research Unit, Department of Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | - Kunhong Xiao
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean-Pierre Vilardaga
- Laboratory for GPCR Biology, Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Ukai K. A case of primary hyperparathyroidism in an elderly patient who exhibited characteristic severe generalized pain: the second case report in the literature. Psychogeriatrics 2020; 20:232-234. [PMID: 31206991 DOI: 10.1111/psyg.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Katsuyuki Ukai
- Department of Psychogeriatrics, Kamiiida Daiichi General Hospital, Nagoya, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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45
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Bennett J, Suliburk JW, Morón FE. Osseous Manifestations of Primary Hyperparathyroidism: Imaging Findings. Int J Endocrinol 2020; 2020:3146535. [PMID: 32148487 PMCID: PMC7054819 DOI: 10.1155/2020/3146535] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/10/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022] Open
Abstract
Primary hyperparathyroidism is a systemic endocrine disease that has significant effects on bone remodeling through the action of parathyroid hormone on the musculoskeletal system. These findings are important as they can aid in distinguishing primary hyperparathyroidism from other forms of metabolic bone diseases and inform physicians regarding disease severity and complications. This pictorial essay compiles bone-imaging features with the aim of improving the diagnosis of skeletal involvement of primary hyperthyroidism.
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Affiliation(s)
- Jackson Bennett
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Fanny E. Morón
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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ÇALIŞKAN M, BEYSEL S, KIZILGÜL M, ÖZBEK M, ÇAKAL E. The effect of parathyroidectomy on bone mineral density in primary hyperparathyroidism. Turk J Med Sci 2019; 49:1674-1680. [PMID: 31655512 PMCID: PMC7518680 DOI: 10.3906/sag-1904-49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/28/2019] [Indexed: 12/25/2022] Open
Abstract
Background/aim This study aimed to investigate the change in bone mineral density (BMD) before and 1 year after parathyroidectomy in patients with primary hyperparathyroidism (PHPT). Materials and methods The clinical and biochemical parameters and DEXA screening of patients with symptomatic PHPT (n = 28) and asymptomatic PHPT (n = 63) were investigated before and 1 year after parathyroidectomy. Results Patients with symptomatic PHPT had a higher prevalence of nephrolithiasis (18.2% vs. 4.6%, P = 0.032) when compared to the prevalence in patients with asymptomatic PHPT. The prevalence of osteoporosis in the lumbar spine (63.0% vs. 37.5%, P = 0.026) and femoral neck (40.7% vs. 20.6%, P = 0.048) was higher in symptomatic PHPT when compared to the prevalence in asymptomatic PHPT. After parathyroidectomy, the decreases in the prevalence of osteoporosis in the lumbar spine (25.8% vs. 9.4%, P = 0.014), femoral neck (22.1% vs. 8.2%, P =0.009), and total hip (22.4% vs. 5.3%, P = 0.007) were higher in symptomatic PHPT compared to the asymptomatic PHPT group. A higher BMD gain (g/cm2) was seen in the lumbar spine (10.83% vs. 4.65%, P=0.016) and femoral neck (12.61% vs. 4.37%, P=0.005) in symptomatic PHPT compared to the asymptomatic PHPT group. Conclusion Parathyroidectomy provided more BMD gain in the lumbar spine and femoral neck in patients with symptomatic PHPT when compared to patients with asymptomatic PHPT 1 year after parathyroidectomy.
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Affiliation(s)
- Mustafa ÇALIŞKAN
- Department of Endocrinology and Metabolism, Atatürk Düzce State Hospital, DüzceTurkey
| | - Selvihan BEYSEL
- Department of Endocrinology and Metabolism, Afyonkarahisar Sağlık Bilimleri University, AfyonkarahisarTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Muhammed KIZILGÜL
- Department of Endocrinology and Metabolism, University of Health Sciences,Dışkapı Yıldırım Beyazıt Teaching and Research Hospital, AnkaraTurkey
| | - Mustafa ÖZBEK
- Department of Endocrinology and Metabolism, University of Health Sciences,Dışkapı Yıldırım Beyazıt Teaching and Research Hospital, AnkaraTurkey
| | - Erman ÇAKAL
- Department of Endocrinology and Metabolism, University of Health Sciences,Dışkapı Yıldırım Beyazıt Teaching and Research Hospital, AnkaraTurkey
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Yao XA, Wei BJ, Jiang T, Chang H. The characteristics of clinical changes in primary hyperparathyroidism in Chinese patients. J Bone Miner Metab 2019; 37:336-341. [PMID: 29721808 DOI: 10.1007/s00774-018-0922-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
In Western countries, the presentation of primary hyperparathyroidism (PHPT) changed from a symptomatic to an asymptomatic disease after the 1970s, whereas in China, only one study has evaluated the changing clinical characteristics and biochemical profiles of PHPT patients. The aim of this study was to explore changes in the clinical characteristics of PHPT in Chinese patients. Overall, 140 consecutive patients with PHPT were studied between January 1, 2010 and June 30, 2016. The patients were divided into two groups: 32 consecutive patients from January 1, 2010 to March 31, 2013 were included in group 1, and 108 consecutive patients from April 1, 2013 to June 30, 2016 were included in group 2. The most frequent complaints were ostealgia (46.02%), urolithiasis (41.59%), constipation (25.66%), fatigue (18.58%), polydipsia and polyuria (15.93%) and fracture history (15.04%). The number of cases in group 2 was 3.38-fold greater than that of group 1. The parathyroid hormone (PTH) and fasting blood glucose (FPG) levels were higher in group 1 than those in group 2 (p = 0.039, p < 0.001). In 62.14% of patients with PHPT, the proportion of the first diagnosis due to hypercalcemia found using a multichannel autoanalyzer in group 1 was lower than that found in group 2 (p = 0.039), and the proportion of the first diagnosis due to parathyroid lesions captured using routine neck ultrasonography in group 1 was higher than in group 2 (p = 0.003). The proportion of parathyroid carcinoma cases was higher in group 1 than group 2 (p = 0.036). Cases of PHPT increased with time, but the proportion of parathyroid carcinoma cases was lower in group 1 than that in group 2. Over time, the first diagnosis switched from parathyroid lesions captured by routine neck ultrasound to hypercalcemia found by a multichannel autoanalyser. At our centre, PHPT in Chinese patients still demonstrates classic characteristics.
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Affiliation(s)
- Xiao-Ai Yao
- Department of Endocrinology, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
| | - Bo-Jun Wei
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China.
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.
| | - Tao Jiang
- Department of Endocrinology, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China.
| | - Hong Chang
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
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Abstract
The spine is frequently involved in systemic diseases, including those with neuropathic, infectious, inflammatory, rheumatologic, metabolic, and neoplastic etiologies. This article provides an overview of systemic disorders that may affect the spine, which can be subdivided into disorders predominantly involving the musculoskeletal system (including bones, joints, disks, muscles, and tendons) versus those predominantly involving the nervous system. By identifying the predominant pattern of spine involvement, a succinct, appropriate differential diagnosis can be generated. The importance of reviewing the medical record, as well as prior medical imaging (including nonspine imaging), which may confer greater specificity to the differential diagnosis, is stressed.
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Affiliation(s)
- Sean C Dodson
- Radiology Specialists of Florida, 2600 Westhall Lane, Maitland, FL 32751, USA
| | - Nicholas A Koontz
- Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202-3082, USA.
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Martins JM, Aranha P. Bone turnover and bone mineral density in old persons with type 2 diabetes. J Clin Transl Endocrinol 2018; 14:12-18. [PMID: 30302313 PMCID: PMC6174825 DOI: 10.1016/j.jcte.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/09/2018] [Accepted: 09/21/2018] [Indexed: 01/01/2023] Open
Abstract
AIMS To understand the paradox of an increased fracture risk despite increased bone mineral density (BMD) in persons with type 2 diabetes (DM2). PATIENTS AND METHODS We studied 80 old persons with DM2. Mineral metabolism, parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), bone turnover - osteocalcin, procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX) - were measured and BMD was assessed at the lumbar spine (LS) and femoral neck (FN). Data was analyzed with the Statistical Package for the Social Sciences Program. RESULTS Low levels of 25OHD (84%) and high values of PTH (20%) were found. Osteocalcin was directly related to CTX, p < 0.001, with increased bone formation and increased BMD (z-score) at LS and FN. PTH was directly related to osteocalcin and CTX and inversely related to BMD at the FN, p < 0.05. Patients with dyslipidemia presented higher P1NP, p < 0.05 and patients with hypertension presented higher BMD at LS and FN, p < 0.01. CONCLUSION Old type 2 diabetics present increased bone formation, PTH-driven. Low grade secondary hyperparathyroidism may explain the paradox of an increased fracture risk despite increased BMD.
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Affiliation(s)
- João Martin Martins
- Endocrine Department, Hospital Santa Maria, 6th Floor, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Endocrine University Clinic, Lisbon Medical School, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Patrícia Aranha
- Internal Medicine Department, Hospital Santa Maria, 3rd Floor, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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Cristina EV, Alberto F. Management of familial hyperparathyroidism syndromes: MEN1, MEN2, MEN4, HPT-Jaw tumour, Familial isolated hyperparathyroidism, FHH, and neonatal severe hyperparathyroidism. Best Pract Res Clin Endocrinol Metab 2018; 32:861-875. [PMID: 30665551 DOI: 10.1016/j.beem.2018.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While primary hyperparathyroidism (PHPT) generally represents a common endocrine disorder, being the more frequent cause of hypercalcemia in outpatients, familial forms of PHPT (FPHPT) account for no more than 2-5% of the overall PHPT. In the last decades, many technical progresses in both molecular and biochemical-radiological evaluation have been made, and substantial advancements in understanding these disorders have been reached. Differences both in the pathogenesis and clinical presentation exist among the various hyperparathyroid syndromic forms, and, since FPHPT is frequently associated to other endocrine, proliferative and/or functional disorders, as also non-endocrine tumours, with varying clinical spectrum of occurrence in each syndrome, its early clinically detection for appropriately preventing complications (i.e. kidney and bone disorders) is strictly advised. In this review, the clinical-biochemical features and diagnostic procedures of each FPHPT form will be summarized and a general overview on surgical and pharmacological approaches to FPHPT has been also considered.
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MESH Headings
- Diagnosis, Differential
- Diagnostic Techniques, Endocrine
- Humans
- Hypercalcemia/diagnosis
- Hypercalcemia/etiology
- Hypercalcemia/therapy
- Hyperparathyroidism, Primary/complications
- Hyperparathyroidism, Primary/congenital
- Hyperparathyroidism, Primary/diagnosis
- Hyperparathyroidism, Primary/therapy
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/therapy
- Jaw Neoplasms/complications
- Jaw Neoplasms/diagnosis
- Jaw Neoplasms/therapy
- Multiple Endocrine Neoplasia/complications
- Multiple Endocrine Neoplasia/diagnosis
- Multiple Endocrine Neoplasia/therapy
- Multiple Endocrine Neoplasia Type 1/complications
- Multiple Endocrine Neoplasia Type 1/diagnosis
- Multiple Endocrine Neoplasia Type 1/therapy
- Multiple Endocrine Neoplasia Type 2a/complications
- Multiple Endocrine Neoplasia Type 2a/diagnosis
- Multiple Endocrine Neoplasia Type 2a/therapy
- Syndrome
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Affiliation(s)
| | - Falchetti Alberto
- EndOsMet, Endocrinology and Metabolic Bone Diseases Branch, Villa Donatello Private Hospital, Firenze, Italy; Endocrinology, Villa Alba Clinic, Villa Maria Group, Bologna, Italy.
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