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Tsai SH, Kan WC, Jhen RN, Chang YM, Kao JL, Lai HY, Liou HH, Shiao CC. Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy. Clin Med (Lond) 2024; 24:100238. [PMID: 39208984 DOI: 10.1016/j.clinme.2024.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts.
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Affiliation(s)
- Shin-Hwa Tsai
- Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan, ROC.
| | - Wei-Chih Kan
- Department of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd., Yongkang Dist., Tainan City, 71004, Taiwan, ROC; Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, No.89, Wenhua 1st St., Rende Dist., Tainan City, 71703, Taiwan, ROC.
| | - Rong-Na Jhen
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, 265, Yilan County, Taiwan, ROC.
| | - Yu-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, 265, Yilan County, Taiwan, ROC.
| | - Jsun-Liang Kao
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, 265, Yilan County, Taiwan, ROC.
| | - Hsien-Yung Lai
- Department of Anesthesiology, Da Chien General. Hospital, No. 36 Gongjing Rd., Miaoli City, Miaoli County, 360012, Taiwan, ROC.
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, No. 387 Chong-Cheng Rd., Xinzhuang District, 242009, New Taipei City, Taiwan, ROC.
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, No. 160, Zhongzheng S. Rd., Luodong Township, 265, Yilan County, Taiwan, ROC.
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Guedes A, Becker RG, Nakagawa SA, Guedes AAL. Update on brown tumor of hyperparathyroidism. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S132. [PMID: 38865551 PMCID: PMC11164281 DOI: 10.1590/1806-9282.2024s132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 06/14/2024]
Affiliation(s)
- Alex Guedes
- Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Orthopedic Oncology Group – Salvador (BA), Brazil
| | - Ricardo Gehrke Becker
- Universidade Federal do Rio Grande do Sul, Hospital of Clinics of Porto Alegre, Orthopedic Trauma Service – Porto Alegre (RS), Brazil
| | - Suely Akiko Nakagawa
- Reference Center for Bone Tumors and Sarcomas, A.C. Camargo Cancer Center – São Paulo (SP), Brazil
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Sapundzhieva T, Sapundzhiev L, Klinkanov K, Mitev M, Batalov A. Severe Acro-osteolysis Mimicking Arthritis Mutilans in a Patient with Primary Hyperparathyroidism: A Case Report. Curr Rheumatol Rev 2024; 20:574-585. [PMID: 38314597 DOI: 10.2174/0115733971273126231214063403] [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: 08/19/2023] [Revised: 09/28/2023] [Accepted: 10/19/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) should be considered in the differential diagnosis of a patient with suspected secondary osteoporosis, and severe osteoporosis with multiple fractures is frequently the first clinical manifestation of the disease. CASE PRESENTATION Mutilating arthritis (arthritis mutilans) can be part of the clinical presentation of a number of rheumatic diseases, most commonly seen in psoriatic arthritis, rheumatoid arthritis, and juvenile idiopathic arthritis, but also in systemic lupus, systemic sclerosis, and multicentric reticulohistiocytosis. Evidence exists that subperiosteal and subchondral bone resorption, seen in PHPT, could induce the so-called 'osteogenic synovitis', which could eventually lead to the development of a secondary osteoarthritis with bone deformities. CONCLUSION Here, we present a case report of a patient initially diagnosed with PHPT who presented with mutilating arthritis of the finger joints and discuss whether the severe acro-osteolysis is a manifestation of the endocrinopathy or whether there is a co-existing undiagnosed inflammatory joint disease.
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Affiliation(s)
- Tanya Sapundzhieva
- Department of Propedeutics of Internal Diseases, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
- Rheumatology Department, University Hospital 'Pulmed', Plovdiv, Bulgaria
| | - Lyubomir Sapundzhiev
- Department of Propedeutics of Internal Diseases, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
- Rheumatology Department, University Hospital 'Pulmed', Plovdiv, Bulgaria
| | - Kamen Klinkanov
- Department of Propedeutics of Internal Diseases, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
- Rheumatology Department, University Hospital 'Pulmed', Plovdiv, Bulgaria
| | - Martin Mitev
- Rheumatology Department, University Hospital 'Pulmed', Plovdiv, Bulgaria
| | - Anastas Batalov
- Department of Propedeutics of Internal Diseases, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
- Rheumatology Clinic, University Hospital 'Kaspela', Plovdiv, Bulgaria
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Limenis E, Stimec J, Kannu P, Laxer RM. Lost bones: differential diagnosis of acro-osteolysis seen by the pediatric rheumatologist. Pediatr Rheumatol Online J 2021; 19:113. [PMID: 34261502 PMCID: PMC8278612 DOI: 10.1186/s12969-021-00596-0] [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: 02/03/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Acro-osteolysis is a radiographic finding which refers to bone resorption of the distal phalanges. Acro-osteolysis is associated with various conditions and its presence should prompt the clinician to search for the underlying etiology. The aim of this review is to discuss disorders with which acro-osteolysis is associated and their distinguishing features, with a focus on the pediatric population. METHODS A targeted literature review was performed using the term "acro-osteolysis" in combination with other key terms. The primary search results were supplemented using reference citations. Articles published prior to the year 2000 were included if they described additional associations not encountered in the more recent literature. RESULTS Genetic disorders (particularly primary hypertrophic osteoarthropathy and skeletal dysplasias) and rheumatic diseases (particularly psoriatic arthritis and systemic sclerosis) are the most frequently encountered conditions associated with acro-osteolysis in children. Hyperparathyroidism, neuropathy, local trauma and thermal injury, and spinal dysraphism should also be included in the differential diagnosis. CONCLUSION Although acro-osteolysis is uncommon, its presence should prompt the clinician to consider a differential diagnosis based on clinical and radiographic features.
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Affiliation(s)
- Elizaveta Limenis
- Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
| | - Jennifer Stimec
- grid.42327.300000 0004 0473 9646Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Peter Kannu
- grid.42327.300000 0004 0473 9646Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Ronald M. Laxer
- grid.42327.300000 0004 0473 9646Division of Rheumatology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
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Jørgensen HS, David K, Salam S, Evenepoel P. Traditional and Non-traditional Risk Factors for Osteoporosis in CKD. Calcif Tissue Int 2021; 108:496-511. [PMID: 33586002 DOI: 10.1007/s00223-020-00786-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
Osteoporosis is a state of bone fragility with reduced skeletal resistance to trauma, and consequently increased risk of fracture. A wide range of conditions, including traditional risk factors, lifestyle choices, diseases and their treatments may contribute to bone fragility. It is therefore not surprising that the multi-morbid patient with chronic kidney disease (CKD) is at a particularly high risk. CKD is associated with reduced bone quantity, as well as impaired bone quality. Bone fragility in CKD is a composite of primary osteoporosis, accumulation of traditional and uremia-related risk factors, assaults brought on by systemic disease, and detrimental effects of drugs. Some risk factors are modifiable and represent potential targets for intervention. This review provides an overview of the heterogeneity of bone fragility in CKD.
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Affiliation(s)
- Hanne Skou Jørgensen
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karel David
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Syazrah Salam
- Sheffield Kidney Institute, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
- Academic Unit of Bone Metabolism and 3 Mellanby Centre for Bone Research, Medical School, University of Sheffield, Sheffield, UK
| | - Pieter Evenepoel
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.
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Improvement in bone involvement of secondary hyperparathyroidism post-parathyroidectomy. Joint Bone Spine 2020; 87:662. [PMID: 32599062 DOI: 10.1016/j.jbspin.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 11/21/2022]
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Jia Q, Gao X, Zhou Z, Lan B, Zhao J, Liu T, Yang X, Wei H, Xiao J. Urgent surgery for spinal instability or neurological impairment caused by spinal brown tumors occurring in the context of end-stage renal disease. J Neurosurg Spine 2019; 30:850-857. [PMID: 30835712 DOI: 10.3171/2018.12.spine181044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal instability or neurological impairment caused by spinal brown tumors (BTs) with end-stage renal disease (ESRD) is an acute condition that needs urgent surgery. There is not much published information on BTs of the mobile spine given the rarity of the disease, and the literature shows inconsistent treatment options and ambiguous follow-up information. The aim of the present study was to elucidate the clinical features, anesthesia management, and surgical treatment for this rare disease through long-term follow-up observations. METHODS Clinical, laboratory, radiological, and perioperative data on 6 consecutive patients with spinal BTs who had been admitted to the authors' institution between 2010 and 2016 were retrospectively reviewed. The literature on spinal BT with secondary hyperparathyroidism was also reviewed. Summaries of the clinical features and anesthesia management are provided. RESULTS The mean age of the 6 patients was 45.5 years (range 35-62 years). Lesions were located in the cervical segment (2 cases) and thoracic segment (4 cases). Localized pain was the most common complaint, and pathological fracture occurred in 5 patients. Elevation of serum alkaline phosphate (AKP) and parathyroid hormone (PTH) was a common phenomenon. Four patients underwent circumferential resection and 2 underwent laminectomy, with parathyroidectomy performed in all patients. The anesthesia process was uneventful for all patients. The mean follow-up was 33 months (range 26-40 months). No spinal lesion progression occurred in any patient. The Karnofsky Performance Status score improved to 80-90 by 3 months after surgery. CONCLUSIONS Although uncommon, spinal BTs should be a diagnostic consideration in patients with ESRD. The thoracic spine is the most frequently affected site. ESRD is not a contraindication for surgery; with the assistance of experienced anesthesiologists, urgent surgery is the preferred option to alleviate neurological impairment and restore spinal stability.
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Affiliation(s)
- Qi Jia
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Xin Gao
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Zhenhua Zhou
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Bin Lan
- 2Medical Center of Military Unit 32151, Xingtai, Hebei, People's Republic of China
| | - Jian Zhao
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Tielong Liu
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Xinghai Yang
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Haifeng Wei
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
| | - Jianru Xiao
- 1Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai; and
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Evaluation of renal osteodystrophy in the dental clinic by assessment of mandibular and phalangeal cortical indices. Oral Radiol 2018; 34:172-178. [PMID: 30484132 DOI: 10.1007/s11282-017-0302-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Secondary hyperparathyroidism (SHPT) is a disease that affects patients with chronic kidney disease, and is characterized by mineral disturbance and bone loss, known as renal osteodystrophy. The aim of this study was to assess the validity of using intraoral phosphor storage plates to take radiographs of the middle phalanges to evaluate bone loss resulting from SHPT during follow-up of these patients. METHODS The sample consisted of 24 patients with chronic kidney disease, 12 with parathyroid hormone (PTH) levels ≥500 pg/ml, and 12 with PTH levels <500 pg/ml, who underwent hemodialysis weekly. For each patient, a panoramic radiograph and digital radiographs of the ring, index, and middle fingers of both hands were taken. The Mandibular Cortical Index (MCI) and the Trabecular Bone Pattern Index (TBP) were applied to the panoramic radiographs, while the Phalangeal Cortical Index (PCI) was applied to the digital radiographs of the phalanges. Three evaluators performed all analyses. RESULTS Significant correlations were found between the PTH levels and the MCI (p = 0.023), the PCI (p = 0.039) and the TBP index (p = 0.032). These parameters were also significantly interrelated (MCI × PCI = 0.001; MCI × TBP = 0.004 and PCI × TBP = 0.009). The PCI was shown to have the highest correlation with PTH levels. CONCLUSION In patients with chronic renal disease, it is clinically relevant to use panoramic and digital radiographs using intraoral storage plates to assess a number of quantitative parameters that can be linked to PTH levels.
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The clothes maketh the sign. Insights Imaging 2016; 7:629-40. [PMID: 27271510 PMCID: PMC4956632 DOI: 10.1007/s13244-016-0507-4] [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: 03/03/2016] [Revised: 05/24/2016] [Accepted: 05/27/2016] [Indexed: 11/28/2022] Open
Abstract
Abstract Pattern recognition is a key tool that enables radiologists to evoke certain diagnoses based on a radiologic appearance. In Shakespeare’s Hamlet, Polonius tells his son Laertes to dress well because “apparel oft proclaims the man”; this phrase is now expressed in modern parlance as “the clothes maketh the man”. Similarly in radiology, appearances are everything, and in the case of radiologic signs, occasionally “the clothes maketh the sign”. The radiologic signs described in this pictorial review resemble items of clothing, fabric types, headwear, or accessories and are found in the musculoskeletal, pulmonary, gastrointestinal, and genitourinary systems. These “clothing signs” serve as a useful visual trigger to help radiologists to identify particular disease entities. Teaching Points • Pattern recognition enables radiologists to evoke a diagnosis based on radiologic appearance. • The radiologic signs described in this review resemble clothing, fabric, or accessories. • These “clothing signs” serve as visual triggers that evoke particular disease entities.
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Secondary Hyperparathyroidism With “Superscan-Like” Hypermetabolic FDG PET/CT Pattern. Clin Nucl Med 2015; 40:888-9. [DOI: 10.1097/rlu.0000000000000952] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guler I, Koplay M, Nayman A, Kivrak AS, Tolu I. The rugger jersey spine sign. Spine J 2015; 15:1903. [PMID: 25912498 DOI: 10.1016/j.spinee.2015.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/02/2015] [Accepted: 04/15/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Ibrahim Guler
- Department of Radiology, Selcuk University Faculty of Medicine, Konya 42075, Turkey
| | - Mustafa Koplay
- Department of Radiology, Selcuk University Faculty of Medicine, Konya 42075, Turkey
| | - Alaaddin Nayman
- Department of Radiology, Selcuk University Faculty of Medicine, Konya 42075, Turkey
| | - Ali Sami Kivrak
- Department of Radiology, Selcuk University Faculty of Medicine, Konya 42075, Turkey
| | - Ismet Tolu
- Department of Radiology, Konya Research and Education Hospital, Konya, Turkey
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Irie T, Mawatari T, Ikemura S, Matsui G, Iguchi T, Mitsuyasu H. Brown tumor of the patella caused by primary hyperparathyroidism: a case report. Korean J Radiol 2015; 16:613-6. [PMID: 25995691 PMCID: PMC4435992 DOI: 10.3348/kjr.2015.16.3.613] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/16/2015] [Indexed: 12/04/2022] Open
Abstract
It has been reported that the common sites of brown tumors are the jaw, pelvis, ribs, femurs and clavicles. We report our experience in a case of brown tumor of the patella caused by primary hyperparathyroidism. An initial radiograph and CT showed an osteolytic lesion and MR images showed a mixed solid and multiloculated cystic tumor in the right patella. One month after the parathyroidectomy, rapid bone formation was observed on both radiographs and CT images.
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Affiliation(s)
- Tomoko Irie
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka 810-8539, Japan
| | - Taro Mawatari
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka 810-8539, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka 810-8539, Japan
| | - Gen Matsui
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka 810-8539, Japan
| | - Takahiro Iguchi
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka 810-8539, Japan
| | - Hiroaki Mitsuyasu
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka 810-8539, Japan
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Baracaldo RM, Bao D, Iampornpipopchai P, Fogel J, Rubinstein S. Facial disfigurement due to osteitis fibrosa cystica or brown tumor from secondary hyperparathyroidism in patients on dialysis: A systematic review and an illustrative case report. Hemodial Int 2015; 19:583-92. [DOI: 10.1111/hdi.12298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Rafael M. Baracaldo
- Division of Nephrology and Hypertension; Nassau University Medical Center; East Meadow NY USA
| | - Dashi Bao
- Division of Nephrology and Hypertension; Nassau University Medical Center; East Meadow NY USA
| | - Pichet Iampornpipopchai
- Division of Nephrology and Hypertension; Nassau University Medical Center; East Meadow NY USA
| | - Joshua Fogel
- Department of Finance and Business Management; Brooklyn College; Brooklyn NY USA
| | - Sofia Rubinstein
- Division of Nephrology and Hypertension; Nassau University Medical Center; East Meadow NY USA
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El Harraqui R, Karimi I, Chemlal A, Ismaili FA, Haddiya I. [Particular mode of revelation of a brown tumor in a chronic hemodialysis patient]. Pan Afr Med J 2014; 18:223. [PMID: 25422698 PMCID: PMC4239437 DOI: 10.11604/pamj.2014.18.223.4051] [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: 02/18/2014] [Accepted: 05/04/2014] [Indexed: 11/23/2022] Open
Abstract
Les tumeurs brunes constituent une complication rare mais sévère de la dialyse, le plus souvent asymptomatique. Nous rapportons le cas d'une patiente dont le mode de révélation de la tumeur brune fut atypique. Observation médicale: Madame F. est une patiente hémodialysée chronique depuis 14 ans suite à une néphropathie indéterminée. Sur le plan phosphocalcique, elle présente une ostéoporose depuis plus de 10 ans, ainsi qu'une hyperparathyroïdie secondaire. A la date du 24 octobre 2013, elle rapporte qu'elle a constaté la présence d'une petite « bosse » pariétale, apparue de façon spontanée la veille, sans notion de traumatisme. A l'examen clinique, nous trouvons une petite tuméfaction de 2cm de diamètre environs, de consistance dure, indolore, mobile par rapport au cuir chevelu. L’échographie a conclu à un lipome. Le lendemain matin, la patiente entre dans un état de coma profond. Le scanner cérébral a révélé la présence d'un hématome extradural associé à un hématome superficiel extra-crânien en regard d'une lyse de l'os pariétal, qui est en fait une tumeur brune. La patiente est transférée en réanimation où elle décède dans la journée.
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Affiliation(s)
- Ryme El Harraqui
- Service de Néphrologie-Dialyse, Centre Hospitalier Universitaire Mohamed VI, Université Mohamed I , Oujda, Maroc
| | - Ilham Karimi
- Service de Néphrologie-Dialyse, Centre Hospitalier Universitaire Mohamed VI, Université Mohamed I , Oujda, Maroc
| | - Abdeljalil Chemlal
- Service de Néphrologie-Dialyse, Centre Hospitalier Universitaire Mohamed VI, Université Mohamed I , Oujda, Maroc
| | - Fatiha Alaoui Ismaili
- Service de Néphrologie-Dialyse, Centre Hospitalier Universitaire Mohamed VI, Université Mohamed I , Oujda, Maroc
| | - Intissar Haddiya
- Service de Néphrologie-Dialyse, Centre Hospitalier Universitaire Mohamed VI, Université Mohamed I , Oujda, Maroc
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Vernace N, Bancroft LW. Multiple brown tumors and pathologic patellar fracture in a patient with secondary hyperparathyroidism. Orthopedics 2014; 37:564-7. [PMID: 25102499 DOI: 10.3928/01477447-20140728-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 79-year-old woman presents with left anterior knee pain after a fall.
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Yang G, Zhang B, Zha XM, Wang NN, Xing CY. Total parathyroidectomy with autotransplantation for a rare disease derived from uremic secondary hyperparathyroidism, the uremic leontiasis ossea. Osteoporos Int 2014; 25:1115-21. [PMID: 23989901 DOI: 10.1007/s00198-013-2488-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/02/2013] [Indexed: 12/21/2022]
Abstract
SUMMARY We described six uremic leontiasis ossea (ULO) patients who underwent total parathyroidectomy with autotransplantation. ULO demonstrated more a systemic disease than a simple craniofacial deformation. The surgery seemed an effective treatment to alleviate secondary hyperparathyroidism and to improve patients' quality of life. ULO may have a high postoperative recurrence tendency. INTRODUCTION ULO is a rare disease derived from uremic secondary hyperparathyroidism (SHPT). Previous studies mostly focused on the craniofacial deformations. This study aims to investigate the systemic features of the disease and the surgical outcomes. METHODS The present study retrospectively assessed six ULO patients who underwent total parathyroidectomy (TPTX) with autotransplantation (AT). Follow-up data were recorded. The follow-up status was considered as "effectiveness" if serum intact parathyroid hormone (iPTH) levels were <150 pg/mL in the first 3 days after surgery, or as "recurrence" if serum iPTH gradually increased >300 pg/mL during follow-up in patients whose status was initially considered as "effectiveness". RESULTS Craniofacial deformations, short stature, thoracocyllosis, spine malformations, osteodynia, and muscle weakness were observed in all patients. Abnormal pulmonary functions were observed in five patients. After surgery, one patient died from respiratory failure. Surgery was effective in the remaining five patients with relieved osteodynia and stopped craniofacial deformation. A mean follow-up of 7.6 (4 to 12) months was available. Three patients suffered from recurrence of hyperparathyroidism originating from autografts. CONCLUSIONS Our data suggests that ULO is not only a simple disease with craniofacial malformations but is a severe systemic disease leading to increased surgical risks. TPTX with AT seems an effective treatment to relieve SHPT and to improve quality of life. ULO may have a high postoperative recurrence tendency.
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Affiliation(s)
- G Yang
- Department of Nephrology, First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, Jiangsu, 210029, China
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Meriglier E, Roblot P, Fritz O, Le Mao G, Bachelet-Rousseau C, Leroy F. [Multiple costal lesions in a hemodialysis patient]. Rev Med Interne 2013; 35:405-6. [PMID: 24074967 DOI: 10.1016/j.revmed.2013.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Affiliation(s)
- E Meriglier
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
| | - P Roblot
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - O Fritz
- Service de néphrologie, groupe hospitalier de La-Rochelle-Ré-Aunis, rue du Docteur-Schweitzer, 17019 La-Rochelle cedex, France
| | - G Le Mao
- Service de néphrologie, groupe hospitalier de La-Rochelle-Ré-Aunis, rue du Docteur-Schweitzer, 17019 La-Rochelle cedex, France
| | - C Bachelet-Rousseau
- Service de néphrologie, groupe hospitalier de La-Rochelle-Ré-Aunis, rue du Docteur-Schweitzer, 17019 La-Rochelle cedex, France
| | - F Leroy
- Service de néphrologie, groupe hospitalier de La-Rochelle-Ré-Aunis, rue du Docteur-Schweitzer, 17019 La-Rochelle cedex, France
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Kaur G, Singh P, Mittal N, Singla MK. Resolution of "salt and pepper" appearance of the skull with vitamin D therapy. Indian J Endocrinol Metab 2013; 17:S194-S197. [PMID: 24251156 PMCID: PMC3830302 DOI: 10.4103/2230-8210.119569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic hypovitaminosis D leads to state of decreased mineralization and generalized osteomalacia. It also results in secondary hyperparathyroidism causing increased bone turn over and decreased bone mass, manifested radiologically as a "salt and pepper" appearance in skull, subperiosteal resorption, bone cysts and lytic lesions. In this case, a young male patient with hypovitaminosis D and secondary hyperparathyroidism, radiological features show resolution of "salt and pepper" appearance of the skull with vitamin D in 11 months and regression of other lytic lesions.
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Affiliation(s)
- Gursimran Kaur
- Department of Internal Medicine (Endocrinology), Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Parminder Singh
- Department of Endocrinology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Naveen Mittal
- Department of Endocrinology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Mani Kant Singla
- Department of Endocrinology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Simon I, Gevenois PA, Del Marmol V, El Kazzi W, Trepant AL, Gastaldello K, Nortier JL. Sarcoma-like pyogenic granuloma of the thumb and respiratory restrictive syndrome in a non-compliant hemodialysis patient. CASE REPORTS IN NEPHROLOGY AND UROLOGY 2012. [PMID: 23197971 PMCID: PMC3507275 DOI: 10.1159/000345281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Pyogenic granuloma is a benign vascular tumor of the skin or mucosae usually observed after irritative processes. We report the case of a non-compliant hemodialysis patient with severe hyperparathyroidism who rapidly developed growing pyogenic granuloma of the distal part of the left thumb. This tumor mimicked sarcoma and caused recurrent bleeding during hemodialysis sessions. Hand radiograph revealed an osteolytic lesion compatible with a brown tumor. Among other brown tumors, several of those found in the ribs were responsible of a severe respiratory restrictive deficit. This report highlights the difficulty to choose the adequate treatment of severe hyperparathyroidism, and discusses the benefit/risk balance of performing parathyroidectomy.
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Affiliation(s)
- Isabelle Simon
- Department of Nephrology, Université Libre de Bruxelles, Brussels, Belgium
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Correlation between hand/wrist and panoramic radiographs in severe secondary hyperparathyroidism. Clin Oral Investig 2012; 17:1611-7. [PMID: 22983499 DOI: 10.1007/s00784-012-0842-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Hand/wrist and dental radiographs are important for osteoporosis analysis in secondary hyperparathyroidism (SHPT). This study evaluated whether a correlation exists between the effects of the disease on the hands and jaws, and investigated the association between osteoporosis progression in the hands and parathyroid hormone (PTH) levels in chronic kidney disease (CKD) patients. MATERIALS AND METHODS Four panoramic radiographic parameters (mental index, mandibular cortical index, trabecular bone pattern, and calcification/resorption) and four corresponding hand/wrist radiographic parameters (metacarpal cortical thickness, phalangeal cortical index, trabecular bone pattern, and calcification/resorption) were applied to investigate possible correlation between the effects of SHPT on the jaws and hands/wrists, by Spearman's correlation coefficient. PTH levels and the hand/wrist radiographic parameters were also tested by spearman's correlation coefficient (p < 0.05). The presence of brown tumors, vascular calcifications, and acroosteolysis on the hands was also evaluated. RESULTS Mandibular cortical index was strongly correlated with the phalangeal cortical index (p = 0.000). Phalangeal cortical index and trabecular bone pattern of hand/wrist correlated with PTH levels (0.002 and 0.000, respectively). Brown tumors occurred in four CKD patients, while both vascular calcifications and acroosteolysis were observed in 19 patients. CONCLUSION There is a significant correlation between the morphological changes caused by secondary hyperparathyroidism in hand and jaw bones. The morphological status can be assessed using the mandibular cortical index, besides the phalangeal cortical index. The latter correlates well with parathyroid hormone levels of advanced chronic kidney disease. CLINICAL RELEVANCE Panoramic images reveal morphological changes in the jaw bone, indicating likewise changes in the hand/wrist in severe secondary hyperparathyroidism. The severity of the bone changes may be a reflection of the parathyroid hormone levels in advanced chronic kidney disease.
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Vascular calcifications and renal osteodystrophy in chronic hemodialysis patients: what is the relationship between them? Int Urol Nephrol 2010; 43:1179-86. [PMID: 20862543 DOI: 10.1007/s11255-010-9841-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 08/27/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vascular calcifications (VCs) and renal osteodystrophy (ROD) are frequently seen together and represent the major causes of morbidity and mortality in hemodialysis (HD) patients. Some studies suggest a pathogenic link between them, but there is no consensus as yet regarding this issue. The main objective of our study was to establish whether there is any relation between VCs and ROD in our HD patients. We evaluated the prevalence of VCs and ROD and the relationship between VCs and some clinical and biochemical characteristics of HD patients. METHODS We examined radiological signs of VCs and ROD on hands and pelvis bone radiographs in 81 chronic HD patients, and we calculated a VC score on this basis. RESULTS We found a significant relation between radiological signs of ROD and those of VC (P = 0.019). The patients with ROD had a higher mean VC score (P = 0.02). By linear regression, the VC score correlated directly with serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH) and CaxP product and inversely with serum albumin. The logistic regression model revealed that ROD, male gender and treatment with calcium salts were predictive of VCs development. There were no associations between VCs and age, HD vintage, diabetes, dialysate Ca concentration, vitamin D treatment, spKt/V, URR and C-reactive protein (CRP) levels. CONCLUSION There seems to be a pathogenetic link between bone and artery diseases in chronic HD patients. Both VCs and ROD have a high prevalence. ROD, male gender and treatment with calcium salts are risk factors for VCs.
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