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Liao Z, Ye Z, Zhang X, Zhang J, He P, Hong H, Mi J. Impact of Surgical Parathyroidectomy on Craniofacial Morphology in Patients With Renal Failure. Am Surg 2024:31348241272425. [PMID: 39116316 DOI: 10.1177/00031348241272425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PURPOSE Parathyroidectomy is beneficial in tertiary hyperparathyroidism (THPT) consequent to chronic renal failure. The craniofacial morphology of patients who undergo total parathyroidectomy and autologous transplantation (tPTX + AT) has not been widely studied. This study assessed the efficacy of tPTX + AT in THPT and evaluated possible improvements in craniofacial features. METHODS This retrospective analysis included patients who were diagnosed with medically refractory THPT and had undergone tPTX + AT between September 2013 and May 2021. The VAS was used to evaluate improvements in various symptoms including bone pain and pruritus. Changes in serum calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (iPTH) levels were also assessed. The impact of the procedure was assessed by comparing two-photon X-ray bone mineral density measurements obtained 1 year before and after surgery. RESULTS The VAS of pain and pruritus decreased significantly on the first postoperative day (P < 0.05). Calcium levels changed significantly (from 2.50 ± 0.22 mmol/L to 2.10 ± 0.26 mmol/L) on postoperative day 1 (P = 0.0000); iPTH levels also declined substantially on this day, reducing from 211.00 (122.10, 252.80) to 5.04 (2.96, 9.40) pmol/L. Bone mineral density increased significantly across various regions including the greater trochanter of the femur, intertrochanteric area, total hip, and third lumbar vertebra (P < 0.05). The angles between the upper incisor and mandibular plane and the lower lip and Ricketts E line (drawn from the tip of the nose to the soft tissue area) also improved (P = 0.043, P = 0.001). CONCLUSION Total parathyroidectomy and autologous transplantation can rapidly alleviate bone pain and skin itching in THPT. It may also improve bone density and facial soft tissue.
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Affiliation(s)
- Zhenpeng Liao
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Zhongkang Ye
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Xu Zhang
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Jun Zhang
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Peng He
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Haiyu Hong
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Jiaoping Mi
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology, Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China
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García Romero JM, Guerrero Morales PH, Rico Razo MF, Córdova Argueta JM, Olaya Niebla E. Sagliker Syndrome: A Case Report of Facial Deformities and Renal Osteodystrophy Secondary to Hyperparathyroidism in End-Stage Renal Disease. Cureus 2024; 16:e64399. [PMID: 39130819 PMCID: PMC11317026 DOI: 10.7759/cureus.64399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Sagliker syndrome (SS) is a rare but distinctive form of renal osteodystrophy associated with poorly managed secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD). We present a case of a 28-year-old male with end-stage CKD on hemodialysis for 10 years, who exhibited progressive facial deformities and maxillofacial bone pain. Physical examination revealed bilateral expansion of the maxillary and mandibular bones and facial asymmetry. Radiological findings included diffuse bone thickening and multilocular cysts in the maxillofacial bones, while laboratory tests showed decreased levels of calcium and elevated parathyroid hormone, confirming SHPT. Despite multidisciplinary management involving nephrology, endocrinology, and maxillofacial surgery, the patient's condition deteriorated and he manifested community-acquired pneumonia leading to cardiopulmonary arrest and death. This case underscores the challenges in managing severe HPT in CKD and emphasizes the importance of early assessment and comprehensive multidisciplinary care to prevent irreversible complications.
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Affiliation(s)
- José Manuel García Romero
- Transplant and Donation Department, Regional General Hospital 1 of the Mexican Social Security Institute, Querétaro, MEX
| | - Pedro Hugo Guerrero Morales
- Transplant and Donation Department, Regional General Hospital 1 of the Mexican Social Security Institute, Querétaro, MEX
| | - Maria Fernanda Rico Razo
- Transplant and Donation Department, Regional General Hospital 1 of the Mexican Social Security Institute, Querétaro, MEX
| | - José Macario Córdova Argueta
- Transplant and Donation Department, Regional General Hospital 1 of the Mexican Social Security Institute, Querétaro, MEX
| | - Erick Olaya Niebla
- Transplant and Donation Department, Regional General Hospital 1 of the Mexican Social Security Institute, Querétaro, MEX
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Salimkhanov R, Bondarenko E, Eremkina A, Bibik E, Kim E, Begova K, Kim I, Kuznetsov S, Mokrysheva N. Case report: Sagliker syndrome in the patient with recurrent tertiary hyperparathyroidism due to intrathyroidal parathyroid carcinoma. Front Endocrinol (Lausanne) 2024; 14:1292993. [PMID: 38250739 PMCID: PMC10796468 DOI: 10.3389/fendo.2023.1292993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Sagliker syndrome (SS) is an extremely rare disorder that manifests in patients with advanced chronic kidney disease (CKD) undergoing programmed hemodialysis as a renal replacement therapy. Treatment of secondary hyperparathyroidism (SHPT) in these patients is still challenging. The main clinical manifestations of SS include craniofacial and fingertip deformities, dental anomalies, gingival hyperplasia, short stature, hearing loss, neurological and psychiatric impairment. The etiology and pathogenesis of SS in patients with SHPT require further clarification. However, mutations in the GNAS1, FGF23, and FGFR3 genes were described in some patients, suggesting a possible role of genetic predisposition to the syndrome. The preferred therapeutic approach for SS is surgery, but the volume of the operation is debated. The main surgical strategies include total, subtotal parathyroidectomy, or total parathyroidectomy with autotransplantation of the parathyroid gland (PG). Unfortunately, parathyroidectomy does not contribute to the regression of significant skeletal deformities. We present a unique clinical case of a patient with classical features of SS, recurrent tertiary hyperparathyroidism (THPT) after total parathyroidectomy due to intrathyroidal parathyroid carcinoma (PC).
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Affiliation(s)
- Rustam Salimkhanov
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Center, Moscow, Russia
| | | | - Anna Eremkina
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Center, Moscow, Russia
| | - Ekaterina Bibik
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Center, Moscow, Russia
| | - Ekaterina Kim
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Center, Moscow, Russia
| | - Kamila Begova
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Center, Moscow, Russia
| | - Ilya Kim
- Department of Endocrine Surgery, Endocrinology Research Center, Moscow, Russia
| | - Sergey Kuznetsov
- Department of Endocrine Surgery, Endocrinology Research Center, Moscow, Russia
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Mi JP, He P, Shi K, Feng SY, Chen XZ, He QQ, Zhao MY, Ge PJ, Fan YP. Cephalometric craniofacial features of patients with Sagliker syndrome: a primary analysis of our experience. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:963. [PMID: 34277763 PMCID: PMC8267326 DOI: 10.21037/atm-21-1544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022]
Abstract
Background Sagliker syndrome (SS) is characterized by a severe uglifying facial appearance resulting from untreated or inadequately treated secondary hyperparathyroidism (SHPT). To date, the craniofacial morphology of patients with SS has yet to be analyzed. The present research sought to cephalometrically evaluate the craniofacial features of patients with SS and to perform an in-depth analysis of their serum biochemical parameters, with the aim of furthering the theoretical basis for the early diagnosis and prevention of SS. Methods A retrospective chart review of 9 patients who fulfilled the diagnostic criteria for SS were included in this study, and their serum biochemical parameters were collected. After subjecting standard lateral cephalometric radiographic images to correction for distortions caused by magnification followed by digitization, we conducted a cephalometric analysis. Student's two-tailed t tests or Mann-Whitney U tests were used to analyze the data. Thirty-three patients with patients with SHPT alone were also included as controls. Results The lower anterior facial height (ANS-ME) and total anterior facial height (N-Me) measurements of patients with SS were significantly increased compared to those of the controls. The angles between the Frankfort horizontal, palatal, and occlusal planes and the mandibular plane, were greater in the SS group than in the control group, as was the gonial angle. Patients with SS also exhibited a significantly larger maxillary protrusion angle and relative position of the maxilla to the mandible. Most patients with SS had class II malocclusion, whereas most of the controls exhibited normal occlusion. Soft tissue largely followed the same pattern as craniofacial changes. Our investigation also showed that among patients with SHPT, female sex, longer duration of dialysis, and higher serum levels of alkaline phosphatase and intact parathyroid hormone were associated with development to SS. Conclusions Patients with SS show facial and biochemical differences compared to patients with SHPT. Female sex, long dialysis duration, and high serum levels of intact parathyroid hormone and alkaline phosphatase may be potential risk factors for SS.
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Affiliation(s)
- Jiao-Ping Mi
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Peng He
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Kai Shi
- Department of Stomatology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Shao-Yan Feng
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xian-Zhen Chen
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Qing-Qing He
- Department of Otolaryngology Head and Neck Surgery, Zhuhai Maternal and Child Health Hospital, Zhuhai, China
| | - Ming-Yue Zhao
- The Graduate School of Zunyi Medical University, Zunyi, China
| | - Ping-Jiang Ge
- Department of Otolaryngology Head and Neck Surgery, Guangdong Provincial General Hospital, Guangzhou, China
| | - Yun-Ping Fan
- Department of Otolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.,Department of Otolaryngology Head and Neck Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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Abstract
In this report, we present a case of a patient with a history of complex airway anatomy secondary to Sagliker syndrome (SS) who presented with acute exacerbation of chronic respiratory failure. The patient's difficult airway, complicated medical comorbidities, and poor psychosocial status posed a unique challenge for providing safe care during an emergency. The perioperative anesthesia service (PAS), led by critical care anesthesiologists, coordinated a multidisciplinary airway management plan. The PAS team also assisted this medically complex patient with her decision-making process. A 37-year-old female with SS, which is characterized by irreversible disfiguring of head and neck anatomy secondary to end-stage renal disease (ESRD) and poorly controlled hyperparathyroidism, presented with acute exacerbation of chronic respiratory failure due to hypervolemia. The patient's respiratory status rapidly deteriorated despite aggressive hemodialysis, requiring transfer to the ICU. Given the challenging anatomy and poor respiratory reserve in this patient, the PAS team helped coordinate a comprehensive airway plan that involved transnasal fiberoptic intubation, and in case of emergency, extracorporeal membrane oxygenation (ECMO) as a bridge to a surgical airway. During the decision-making process, the patient was found to be in psychological distress and had limited insights into her condition. The PAS team helped facilitated multidisciplinary goals-of-care discussions for the patient and her family. Fortunately, the patient's oxygenation improved with noninvasive oxygen support and aggressive hemodialysis without the need for intubation. She was discharged with outpatient follow-up appointments arranged to discuss long-term management. This is the first reported case of SS in the United States. The early involvement by the PAS team helped coordinate a multidisciplinary care plan for this patient with a difficult airway and complex comorbidities. This report highlights an innovative airway algorithm for a potentially "cannot-intubate, cannot ventilate" complex airway, and the PAS team's role in providing support for the patient's physical and psychological needs, suggesting that a comprehensive perioperative service can improve the quality and safety of care, not only for surgical patients but also for medically complex patients as well.
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Affiliation(s)
- QiLiang Chen
- Department of Anesthesiology, Stanford University, Stanford, USA
| | - Javier Lorenzo
- Department of Anesthesiology, Stanford University, Stanford, USA
| | - Amy Lu
- Department of Anesthesiology, Stanford University, Stanford, USA
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Panezai MA, Ahmed S, Colbert GB. Sagliker syndrome in a patient with end-stage renal disease with secondary hyperparathyroidism. Proc (Bayl Univ Med Cent) 2019; 32:624-626. [PMID: 31656444 DOI: 10.1080/08998280.2019.1624092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022] Open
Abstract
Sagliker syndrome (SS), also known as an "uglifying human face syndrome," is one of the severe manifestations of chronic kidney disease in patients with uncontrolled secondary hyperparathyroidism. Patients with SS develop short stature, maxillary and mandibular bone overgrowth, nasal bone and cartilage destruction, widely spaced teeth with anterior positioning, soft tissue tumors in the oral cavity, auditory loss, and neurological and psychological features. SS can possibly be prevented with proper treatment of secondary hyperparathyroidism using disease-modifying medication and surgical therapies. We report a case of SS in a patient in the USA with end-stage renal disease achieving adequate hemodialysis.
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Affiliation(s)
| | - Sana Ahmed
- Division of Nephrology, Department of Internal Medicine, Baylor University Medical Center at DallasDallasTexas
| | - Gates B Colbert
- Division of Nephrology, Department of Internal Medicine, Baylor University Medical Center at DallasDallasTexas
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Radiological manifestations of renal osteodystrophy in the orofacial region: a case report and literature review. Oral Radiol 2018; 34:262-266. [PMID: 30484027 DOI: 10.1007/s11282-017-0291-y] [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: 02/22/2017] [Accepted: 05/15/2017] [Indexed: 02/05/2023]
Abstract
Renal osteodystrophy (ROD) is a metabolic skeletal pathology that frequently affects the orofacial region and presents with characteristic radiological manifestations. This paper reports a case of ROD causing diffused orofacial bone alterations in a female patient with end-stage chronic kidney disease. The radiological features on panoramic, posteroanterior and lateral skull and computed tomography radiographs are described for this case. Previous reports in the literature are reviewed and discussed with a focus on radiological characteristics and differential diagnoses.
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Pontes FSC, Lopes MA, de Souza LL, dos Santos da Mata Rezende D, Santos-Silva AR, Jorge J, da Silva WG, Pires FR, Rocha AC, de Campos WG, Caldato MCF, Martin RM, Fonseca FP, Pontes HAR. Oral and maxillofacial manifestations of chronic kidney disease–mineral and bone disorder: a multicenter retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:31-43. [DOI: 10.1016/j.oooo.2017.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 12/14/2022]
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Demirhan O, Arslan A, Sagliker Y, Akbal E, Ergun S, Bayraktar R, Sagliker HS, Dogan E, Gunesacar R, Ozkaynak PS. Gene mutations in chronic kidney disease patients with secondary hyperparathyroidism and Sagliker syndrome. J Ren Nutr 2015; 25:176-86. [PMID: 25701941 DOI: 10.1053/j.jrn.2014.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/22/2014] [Accepted: 12/22/2014] [Indexed: 12/26/2022] Open
Abstract
Sagliker syndrome (SS) develops particularly before puberty while chronic kidney disease (CKD) reaches stage 3 with overt secondary hyperparathyroidism. We conducted screening for mutations in all the 13 exons of GNAS1 gene, all 3 exons of FGF23, and all 18 exons in FGFR3 genes in 23 patients. In 73.9% (17 of 23) patients, 17 genetic abnormalities in GNAS1 were detected. Seven (58.3%) of 12 nucleotide alterations comprised novel missense mutations and 3 nonsense. Mismutations were in different manner. There were also 6 heterozygous transversion polymorphisms in exons. Six were introngenic mutations (introns 65626, 70387, 70817). We found 10 mutations with different manner in FGF23 gene. Two were defined previously but remaining 8 were novel mutations. Three were in intronic region near exon 2. We sequenced all exons and intronic regions near exon-exon junction regions of FGFR3 gene. We found 22 mutations with different manner. Six were defined previously and remaining 16 were novel mutations. Eight of them were in intronic region near exon 11 and the last 2 were in noncoding exonic region of exons. One was in the exon-exon junction region between exon 11 and 12, therefore this mutation might be preventing splicing of this intron. Because the incidence of CKD late stage 3 is around 8% but the incidence of SS is around 0.5% in CKD, these gene mismutations might be responsible for bone deformities such as McCune-Albright syndrome and achondroplasias. Although our patients were not resembling any of them, they could be in between, and SS might be a combination-compulsion of bone dysplasias-hereditary osteodystrophies and CKD.
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Affiliation(s)
| | | | - Yahya Sagliker
- Sagliker Hypertension and Nephrology Unit, Adana, Turkey.
| | | | | | | | | | - Ekrem Dogan
- Sutcu Imam University, Kahramanmaras, Turkey
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