RESUMO
INTRODUCTION: The causal relationship between hyperparathyroidism and kidney graft dysfunction remains inconclusive. Applying Bradford-Hill's temporality and consistency causation principles, we assessed the effect of parathyroid hormone (iPTH) on graft histology and eGFR trajectory on kidney transplant recipients (KTRs) with normal time-zero graft biopsies. METHODS: Retrospective cohort study evaluating the effect of hyperparathyroidism on interstitial fibrosis and tubular atrophy (IF/TA) development in 1232 graft biopsies. Pre-transplant hyperparathyroidism was categorized by KDIGO or KDOQI criteria, and post-transplant hyperparathyroidism by iPTH >1× and >2× the URL 1 year after transplantation. RESULTS: We included 325 KTRs (56% female, age 38 ± 13 years, follow-up 4.2 years [IQR: 2.7-5.8]). Based on pre-transplant iPTH levels, 26% and 66% exceeded the KDIGO and KDOQI targets, respectively. There were no significant differences in the development of >25% IF/TA between KTRs with pre-transplant iPTH levels above and within target range according to KDIGO (53% vs. 62%, P = .16, HR.94 [95% CI:.67-1.32]) and KDOQI (60% vs. 60%, P = 1.0, HR 1.19 [95% CI:.88-1.60]) criteria. Similarly, there were no differences when using 1 year post-transplant iPTH cut-offs > 88 pg/mL (58% vs. 64%, P = .33) and > 176 pg/mL (55% vs. 62%, P = .19). After adjusting for confounders, no significant differences were observed in eGFR trajectories among the iPTH strata. CONCLUSION: In young KTRs who received a healthy graft, no association was found between increased pre- and post-transplant iPTH levels and graft dysfunction, as assessed histologically and through eGFR trajectory. The concept of hyperparathyroidism as a risk factor for graft dysfunction in recipients at low risk requires reevaluation.
Assuntos
Aloenxertos , Taxa de Filtração Glomerular , Rejeição de Enxerto , Sobrevivência de Enxerto , Hiperparatireoidismo , Transplante de Rim , Complicações Pós-Operatórias , Humanos , Transplante de Rim/efeitos adversos , Feminino , Masculino , Estudos Retrospectivos , Adulto , Seguimentos , Hiperparatireoidismo/etiologia , Hiperparatireoidismo/patologia , Prognóstico , Fatores de Risco , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/patologia , Aloenxertos/patologia , Complicações Pós-Operatórias/etiologia , Testes de Função Renal , Falência Renal Crônica/cirurgia , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangueRESUMO
Hyperparathyroidism is one of the most common endocrine disorders worldwide. In countries where routine biochemical screening is not common, symptomatic hyperparathyroidism predominates. Its manifestations include skeletal alterations, calcification of soft tissues, kidney stones, and functional alterations in other systems. Notably, jaw alterations can be the first clinical sign of hyperparathyroidism, including brown tumor, renal osteodystrophy, osteitis fibrosa, and leontiasis ossea, and knowing such conditions is of core importance for the multidisciplinary diagnosis and management of hyperparathyroidism. We aimed to perform a concise review, systematizing the concepts and mechanisms underlying hyperparathyroidism and associated gnathic alterations. In addition, a detailed description of the clinical aspects of the jaw manifestations is presented.
Assuntos
Calcinose , Distúrbio Mineral e Ósseo na Doença Renal Crônica , Hiperostose Frontal Interna , Hiperparatireoidismo , Osteíte Fibrosa Cística , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico , Distúrbio Mineral e Ósseo na Doença Renal Crônica/terapia , Feminino , Humanos , Hiperostose Frontal Interna/patologia , Hiperparatireoidismo/complicações , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/patologia , Arcada Osseodentária/patologia , Masculino , Osteíte Fibrosa Cística/diagnóstico , Osteíte Fibrosa Cística/etiologia , Osteíte Fibrosa Cística/patologiaRESUMO
OBJECTIVE: We investigated the efficacy of non-contrast 3-Tesla MR imaging added to the combination of sestamibi with99mTc (MIBI) scintigraphy and Ultrasonography (US) for the pre-operative localization of Primary Hyperparathyroidism (PHPT) lesions. METHODS: A total of 34 parathyroid glands, including nine normal glands, were examined with MIBI, US, and non-contrast 3-Tesla MRI. MRI was performed with the acquisition of T1- and T2-weighted images and fat-suppressed T2-weighted images. We calculated the sensitivities of MIBI, US, and the 'additional' MRI, with knowledge of the former two modalities' results. RESULTS: For the diagnosis of PHPT lesions, the sensitivity values of MIBI, US, and additional MRI were 88.0% (22/25), 84.0% (21/25), and 92.0% (23/25), respectively. Normal glands were not visualized with any modality (0/9). One lesion was detected neither with US nor MRI, but only with MIBI, with the limitation that MIBI represented no more than laterality. The two glands not identified in MRI were 4â¯mm and 6â¯mm in their size, which are within the range of normal gland's size. Two lesions were not detected with US or MIBI but were visualized with the additional MRI, which indicated that the MRI contributed an 8.0% (2/25) improvement of sensitivity, compared from that of US. Fat-suppressed T2-weighted images were useful in the identification of parathyroid lesions, as these images helped to differentiate between the lesion and the adjacent tissue. CONCLUSION: Additional non-contrast 3-Tesla MRI was a useful adjunctive tool for localization of PHPT, which improved the sensitivity of the pre-operative localization of PHPT lesions. Fat-suppressed T2-weighted images contributed to their identification. LEVEL VI: Evidence from a single descriptive or qualitative study.
Assuntos
Hiperparatireoidismo , Humanos , Hiperparatireoidismo/diagnóstico por imagem , Hiperparatireoidismo/patologia , Tecnécio Tc 99m Sestamibi , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Cintilografia , Compostos Radiofarmacêuticos , Imageamento por Ressonância Magnética , Ultrassonografia , Sensibilidade e EspecificidadeAssuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Hiperparatireoidismo/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Humanos , Hiperparatireoidismo/patologia , Pneumonia Viral/epidemiologia , SARS-CoV-2RESUMO
The ectopic parathyroid tissue is a frequent cause of recurrent hyperparathyroidism (HPT), accounting 16% in primary HPT and 14% in secondary cases. Although intrathoracic ectopic glands represent 25-35% of all ectopic cases, only 2% requires thoracic surgery. The aim of this study is to report a case series of patients with ectopic mediastinal HPT treated by thoracic approach in a private institution in Argentina. This is a retrospective analysis from January 2006 to June 2019. All patients diagnosed with ectopic hyperparathyroidism who required a thoracic surgical approach were included. During this period, 728 patients with primary HPT and secondary HPT were treated. Six with primary HPT and 3 with secondary HPT required a thoracic approach. Six video-assisted thoracoscopy surgeries (VATS) and 3 sternotomies were performed. None of them presented serious posoperative complications. Frozen section biopsy was used in all cases. iPTH was measured in 8 cases, with a mean drop of 65% after 15 minutes. Final pathology reports confirmed 5 adenomas and 4 hyperplasias. Our case series reported an incidence of 1.65% (12/728) mediastinal parathyroids, while 1.24% (9/728) received surgical treatment at our institution. Intraoperative frozen section and PTHi are useful to confirm the diagnosis and to avoid recurrences. Although VATS is a safe and efficient treatment option, it depends on surgical training and availability. In terms of diagnostic imaging resources, sestamibi remains the current gold standard. However, 18F-choline PET/CT may arise as a new diagnostic tool. The possibility of obtaining evidence-based conclusions requires studies with higher number of patients.
El tejido paratiroideo ectópico es una causa frecuente de recurrencia del hiperparatiroidismo (HPT) siendo de 16% en primarios y 14% en secundarios. La localización intratorácica representa el 20-35%, pero solo un 2% requiere una cirugía torácica. El objetivo fue analizar una cohorte de pacientes con diagnóstico de HPT mediastinal operados en un hospital de alta complejidad de Argentina. Se realizó un estudio retrospectivo de todos los operados por HPT entre enero de 2006 y julio 2019 en ese hospital. Se incluyeron aquellos que requirieron acceso torácico por HPT ectópico. En este período se trataron 728 pacientes con HPT primario y secundario. Seis con primario y 3 con secundario requirieron cirugía torácica. Se realizaron 6 videotoracoscopias (VATS) y 3 esternotomías, sin complicaciones graves. Se utilizó biopsia por congelación en todos y dosaje de paratohormona intraoperatoria (PTHi) en 8 casos, que descendió en promedio 65% respecto al valor basal. Se confirmaron 5 adenomas y 4 hiperplasias. La enfermedad paratiroi dea mediastinal representó el 1.65% (12/728), mientras que recibieron tratamiento quirúrgico en nuestra institución 1.24% (9/728). La biopsia por congelación y el descenso de PTHi resultan útiles para confirmar el foco y eventualmente disminuir el riesgo de recurrencia. La VATS es segura pero depende del entrenamiento y de la disponibilidad en el medio asistencial. Si bien el sestamibi es el método con mayor sensibilidad, se propone el uso de 18F-colina PET/TC ante la sospecha de HPT ectópico. La posibilidad de obtener conclusiones basadas en la evidencia requiere de estudios con mayor número de pacientes.
Assuntos
Hiperparatireoidismo/patologia , Glândulas Paratireoides/patologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Biópsia , Feminino , Humanos , Hiperparatireoidismo/epidemiologia , Hiperparatireoidismo/terapia , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Recidiva , Estudos Retrospectivos , Distribuição por Sexo , Adulto JovemRESUMO
El tejido paratiroideo ectópico es una causa frecuente de recurrencia del hiperparatiroidismo (HPT) siendo de 16% en primarios y 14% en secundarios. La localización intratorácica representa el 20-35%, pero solo un 2% requiere una cirugía torácica. El objetivo fue analizar una cohorte de pacientes con diagnóstico de HPT mediastinal operados en un hospital de alta complejidad de Argentina. Se realizó un estudio retrospectivo de todos los operados por HPT entre enero de 2006 y julio 2019 en ese hospital. Se incluyeron aquellos que requirieron acceso torácico por HPT ectópico. En este período se trataron 728 pacientes con HPT primario y secundario. Seis con primario y 3 con secundario requirieron cirugía torácica. Se realizaron 6 videotoracoscopias (VATS) y 3 esternotomías, sin complicaciones graves. Se utilizó biopsia por congelación en todos y dosaje de paratohormona intraoperatoria (PTHi) en 8 casos, que descendió en promedio 65% respecto al valor basal. Se confirmaron 5 adenomas y 4 hiperplasias. La enfermedad paratiroi dea mediastinal representó el 1.65% (12/728), mientras que recibieron tratamiento quirúrgico en nuestra institución 1.24% (9/728). La biopsia por congelación y el descenso de PTHi resultan útiles para confirmar el foco y eventualmente disminuir el riesgo de recurrencia. La VATS es segura pero depende del entrenamiento y de la disponibilidad en el medio asistencial. Si bien el sestamibi es el método con mayor sensibilidad, se propone el uso de 18F-colina PET/TC ante la sospecha de HPT ectópico. La posibilidad de obtener conclusiones basadas en la evidencia requiere de estudios con mayor número de pacientes.
The ectopic parathyroid tissue is a frequent cause of recurrent hyperparathyroidism (HPT), accounting 16% in primary HPT and 14% in secondary cases. Although intrathoracic ectopic glands represent 25-35% of all ectopic cases, only 2% requires thoracic surgery. The aim of this study is to report a case series of patients with ectopic mediastinal HPT treated by thoracic approach in a private institution in Argentina. This is a retrospective analysis from January 2006 to June 2019. All patients diagnosed with ectopic hyperparathyroidism who required a thoracic surgical approach were included. During this period, 728 patients with primary HPT and secondary HPT were treated. Six with primary HPT and 3 with secondary HPT required a thoracic approach. Six video-assisted thoracoscopy surgeries (VATS) and 3 sternotomies were performed. None of them presented serious posoperative complications. Frozen section biopsy was used in all cases. iPTH was measured in 8 cases, with a mean drop of 65% after 15 minutes. Final pathology reports confirmed 5 adenomas and 4 hyperplasias. Our case series reported an incidence of 1.65% (12/728) mediastinal parathyroids, while 1.24% (9/728) received surgical treatment at our institution. Intraoperative frozen section and PTHi are useful to confirm the diagnosis and to avoid recurrences. Although VATS is a safe and efficient treatment option, it depends on surgical training and availability. In terms of diagnostic imaging resources, sestamibi remains the current gold standard. However, 18F-choline PET/CT may arise as a new diagnostic tool. The possibility of obtaining evidence-based conclusions requires studies with higher number of patients.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Glândulas Paratireoides/patologia , Hiperparatireoidismo/patologia , Argentina/epidemiologia , Recidiva , Biópsia , Estudos Retrospectivos , Distribuição por Sexo , Distribuição por Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Hiperparatireoidismo/terapia , Hiperparatireoidismo/epidemiologiaAssuntos
Humanos , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Betacoronavirus , Hiperparatireoidismo/cirurgia , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/epidemiologia , SARS-CoV-2 , COVID-19 , Hiperparatireoidismo/patologiaRESUMO
OBJECTIVE: To evaluate frequency, anatomic presentation, and quantities of supernumerary parathyroids glands in patients with primary hyperparathyroidism (HPT1) associated with multiple endocrine neoplasia type 1 (MEN1), as well as the importance of thymectomy, and the benefits of localizing examinations for those glands. METHODS: Forty-one patients with hyperparathyroidism associated with MEN1 who underwent parathyroidectomy between 1997 and 2007 were retrospectively studied. The location and number of supernumerary parathyroids were reviewed, as well as whether cervical ultrasound and parathyroid SESTAMIBI scan (MIBI) were useful diagnostic tools. RESULTS: In five patients (12.2%) a supernumerary gland was identified. In three of these cases (40%), the glands were near the thyroid gland and were found during the procedure. None of the imaging examinations were able to detect supernumerary parathyroids. In one case, only the pathologic examination could find a microscopic fifth gland in the thymus. In the last case, the supernumerary gland was resected through a sternotomy after a recurrence of hyperparathyroidism, ten years after the initial four-gland parathyroidectomy without thymectomy. MIBI was capable of detecting this gland, but only in the recurrent setting. Cervical ultrasound did not detect any supernumerary glands. CONCLUSION: The frequency of supernumerary parathyroid gland in the HPT1/MEN1 patients studied (12.2%) was significant. Surgeons should be aware of the need to search for supernumerary glands during neck exploration, besides the thymus. Imaging examinations were not useful in the pre-surgical location of these glands, and one case presented a recurrence of hyperparathyroidism.
Assuntos
Hiperparatireoidismo/patologia , Neoplasia Endócrina Múltipla Tipo 1/patologia , Glândulas Paratireoides/anormalidades , Adulto , Idoso , Feminino , Humanos , Hiperparatireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla Tipo 1/complicações , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Estudos Retrospectivos , Timectomia , Adulto JovemRESUMO
OBJECTIVE: To evaluate frequency, anatomic presentation, and quantities of supernumerary parathyroids glands in patients with primary hyperparathyroidism (HPT1) associated with multiple endocrine neoplasia type 1 (MEN1), as well as the importance of thymectomy, and the benefits of localizing examinations for those glands. METHODS: Forty-one patients with hyperparathyroidism associated with MEN1 who underwent parathyroidectomy between 1997 and 2007 were retrospectively studied. The location and number of supernumerary parathyroids were reviewed, as well as whether cervical ultrasound and parathyroid SESTAMIBI scan (MIBI) were useful diagnostic tools. RESULTS: In five patients (12.2%) a supernumerary gland was identified. In three of these cases (40%), the glands were near the thyroid gland and were found during the procedure. None of the imaging examinations were able to detect supernumerary parathyroids. In one case, only the pathologic examination could find a microscopic fifth gland in the thymus. In the last case, the supernumerary gland was resected through a sternotomy after a recurrence of hyperparathyroidism, ten years after the initial four-gland parathyroidectomy without thymectomy. MIBI was capable of detecting this gland, but only in the recurrent setting. Cervical ultrasound did not detect any supernumerary glands. CONCLUSION: The frequency of supernumerary parathyroid gland in the HPT1/MEN1 patients studied (12.2%) was significant. Surgeons should be aware of the need to search for supernumerary glands during neck exploration, besides the thymus. Imaging examinations were not useful in the pre-surgical location of these glands, and one case presented a recurrence of hyperparathyroidism.
OBJETIVO: Avaliação da frequência, da localização anatômica e do número de paratireoides extranumerárias em pacientes com hiperparatireoidismo primário (HPT1) associado a neoplasia endócrina múltipla tipo 1(NEM1), além da avaliação da importância da timectomia e da utilidade dos exames radiológicos para localização destes. MÉTODOS: Foram avaliados de forma retrospectiva 41 pacientes portadores de NEM1 com HPT1 submetidos a paratireoidectomia entre 1997 e 2007. O número de glândulas supranumerárias encontradas e a sua localização foram revisados, assim como a utilidade do ultrassom cervical e do SESTAMIBI (MIBI) de paratireoide como ferramentas diagnósticas. RESULTADOS: Em cinco pacientes (12,2%) foram identificadas glândulas supranumerárias. Em três destes (40%), as glândulas estavam próximas à glândula tireoide e foram encontradas durante a exploração cirúrgica. Os exames de imagem não foram úteis para a localização destas glândulas. Em um caso, apenas o exame anatomopatológico foi capaz de encontrar uma glândula extranumerária microscópica localizada no timo. No último caso, uma quinta glândula foi ressecada por meio de esternotomia após a recidiva do hiperparatireoidismo, cerca de 10 anos após a paratireoidectomia realizada sem timectomia na ocasião. Neste caso o MIBI detectou esta paratireoide apenas após a recidiva da doença. Em nenhum dos casos o ultrassom cervical foi capaz de detectar glândulas extranumerárias. CONCLUSÃO: A frequência de paratireoides supranumerárias em nossa casuística foi significativa (12,2%). Durante a exploração cervical, o cirurgião deve estar atento para localizar glândulas extranumerárias além do timo. Exames de imagem não foram úteis na localização préoperatória dessas glândulas, e em um caso houve recidiva do hiperparatireoidismo.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Hiperparatireoidismo/patologia , Neoplasia Endócrina Múltipla Tipo 1/patologia , Glândulas Paratireoides/anormalidades , Hiperparatireoidismo/etiologia , Neoplasia Endócrina Múltipla Tipo 1/complicações , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Estudos Retrospectivos , TimectomiaAssuntos
Assimetria Facial/patologia , Fibroma Ossificante/patologia , Neoplasias Mandibulares/patologia , Neoplasias Primárias Múltiplas/patologia , Adulto , Assimetria Facial/etiologia , Assimetria Facial/cirurgia , Feminino , Fibroma Ossificante/complicações , Fibroma Ossificante/cirurgia , Humanos , Hiperparatireoidismo/complicações , Hiperparatireoidismo/patologia , Neoplasias Mandibulares/complicações , Neoplasias Mandibulares/cirurgia , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/cirurgia , Síndrome , Resultado do TratamentoRESUMO
Differences in bone mineral density (BMD) patterns have been recently reported between multiple endocrine neoplasia type 1-related primary hyperparathyroidism (HPT/MEN1) and sporadic primary HPT. However, studies on the early and later outcomes of bone/renal complications in HPT/MEN1 are lacking. In this cross-sectional study, performed in a tertiary academic hospital, 36 patients cases with uncontrolled HPT from 8 unrelated MEN1 families underwent dual-energy X-ray absorptiometry (DXA) scanning of the proximal one-third of the distal radius (1/3DR), femoral neck, total hip, and lumbar spine (LS). The mean age of the patients was 38.9 ± 14.5 years. Parathyroid hormone (PTH)/calcium values were mildly elevated despite an overall high percentage of bone demineralization (77.8%). In the younger group (<50 years of age), demineralization in the 1/3DR was more frequent, more severe, and occurred earlier (40%; Z-score -1.81 ± 0.26). The older group (>50 years of age) had a higher frequency of bone demineralization at all sites (p < .005) and a larger number of affected bone sites (p < .0001), and BMD was more severely compromised in the 1/3DR (p = .007) and LS (p = .002). BMD values were lower in symptomatic (88.9%) than in asymptomatic HPT patients (p < .006). Patients with long-standing HPT (>10 years) and gastrinoma/HPT presented significantly lower 1/3DR BMD values. Urolithiasis occurred earlier (<30 years) and more frequently (75%) and was associated with related renal comorbidities (50%) and renal insufficiency in the older group (33%). Bone mineral- and urolithiasis-related renal complications in HPT/MEN1 are early-onset, frequent, extensive, severe, and progressive. These data should be considered in the individualized clinical/surgical management of patients with MEN1-associated HPT.
Assuntos
Densidade Óssea/fisiologia , Hiperparatireoidismo/complicações , Hiperparatireoidismo/patologia , Nefropatias/complicações , Neoplasia Endócrina Múltipla Tipo 1/complicações , Neoplasia Endócrina Múltipla Tipo 1/patologia , Adulto , Idade de Início , Idoso , Brasil/epidemiologia , Calcificação Fisiológica/fisiologia , Densitometria , Feminino , Fraturas Ósseas/sangue , Fraturas Ósseas/complicações , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/fisiopatologia , Humanos , Hiperparatireoidismo/epidemiologia , Hiperparatireoidismo/fisiopatologia , Nefropatias/sangue , Nefropatias/epidemiologia , Nefropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla Tipo 1/epidemiologia , Neoplasia Endócrina Múltipla Tipo 1/fisiopatologia , Prevalência , Adulto JovemRESUMO
El calcio es esencial para varias funciones del cuerpo, incluyendo la contracción muscular, la conducción nerviosa y el funcionamiento apropiado de muchas enzimas. La mayor parte del calcio del cuerpo se almacena en los huesos, pero también se encuentra en las células y en la sangre. El organismo controla con "toda precisión" la cantidad de calcio tanto en la célula como en la sangre. Para mantener este equilibrio entra en competencia la hormona para tiroidea, secretada por las glándulas paratiroidea. La actividad de las glándulas paratiroideas está controlada por el nivel de calcio libre (ionizado) de la sangre. El descenso de los niveles de este calcio estimula la síntesis y secreción de hormonas paratiroideas, si la cantidad de calcio libre en sangre aumenta, estamos frente a una alteración metabólica "La Hipercalcemia" la cual consiste en una concentración elevada de calcio en sangre superior a 10.5 miligramos por decilitro de sangre, la que puede ser causada por aumento en la ingestión de calcio, pero la causa más común de la hipercalcemia es el "Hiperparatiroidismo", el cual se debe a la hipersecreción de hormonas paratiroideas. Esta alteración puede deberse a un adenoma paratiroide (80%). Hiperplasia primaria (15%). Carcinoma paratiroide (5%). Fenómeno secundario típico de los pacientes con insuficiencia renal crónica. El hiperparatiroidismo puede manifestarse en la cavidad bucal en forma de hiperplasia gingival y lesiones osteolíticas de los maxilares (Tumores pardos) que son asintomáticas. El objetivo de este trabajo es realizar una revisión bibliográfica actualizada sobre esta patología y resaltar la importancia que representan las manifestaciones orales de esta patología sistémica para el odontólogo en general, especialmente para el cirujano oral y maxilofacial.
Assuntos
Humanos , Hipercalcemia , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/patologia , Odontologia , Patologia , NeoplasiasRESUMO
Os autores relatam o caso de uma paciente com hiperparatireoidismo primário causado por adenoma de paratireóide diagnosticado através de punção aspirativa por agulha fina (PAAF) no pré-operatório. A paratireóide aumentada foi visualizada pela ultra-sonografia (US) e submetida à PAAF, que foi compatível com adenoma de paratireóide. Realizou-se a remoção cirúrgica do adenoma e o histopatológico resultou concordante com a citologia. Este relato destaca a importância da localização e do diagnóstico citológico pré-operatório das lesões de paratireóide para proporcionar uma abordagem cirúrgica menos agressiva.
The authors report a patients case with primary hyperparathyroidism caused by parathyroid adenoma that was diagnosed by fine needle aspiration cytology (FNAC) in the preoperative. The increased parathyroid was visualized by the ultrasonography and submitted to FNAC that was compatible with parathyroid adenoma. The surgical removal of adenoma was accomplished and the histopathologic was concordant with the cytology. This report detaches the importance of the location and preoperative cytological diagnosis of the parathyroid lesions in providing a less aggressive surgical approach.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Adenoma/complicações , Adenoma/patologia , Glândulas Paratireoides/patologia , Hiperparatireoidismo/complicações , Hiperparatireoidismo/patologia , Biópsia por Agulha FinaRESUMO
INTRODUCTION: Hyperparathyroidism (HPT) is a highly prevalent pathology in the chronic renal disease population, which is associated with considerable morbidity, and mortality. The histopathological findings most often reported are solitary adenoma, diffuse hyperplasia, and autonomous hyperplasia. Carcinoma is an unusual cause of primary parathyroid hyperfunction (0.5% to 4% according to data); in renal transplanted patients it is exceptional. We sought to analyze parathyroid gland histology from renal transplant patients in comparison with nontransplanted patients and to report a parathyroid carcinoma case in a renal transplant patient. METHODS: We retrospectively analyzed parathyroidectomies (PTX) and histopathological reports between March 1989 and December 2003. RESULTS: Among 72 PTXs 41 were performed because of primary HPT; 26, secondary HPT; and five, tertiary HPT. Among the 41 primary HPT cases there were two carcinomas (4.88% primary HPT operated patients), one of whom was in a kidney transplant recipient. Among the total number of surgeries, seven were performed in six renal transplant patients, including five diffuse hyperplasia cases; one, nodular hyperplasia with an adenoma focus; and one, parathyroid carcinoma. CONCLUSIONS: Parathyroidectomy indications in the renal transplant population are usually associated with the clinical picture of tertiary HPT, which does not resolve after a functional renal transplant. In spite of this, diffuse hyperplasia, which is associated with secondary HPT, was the most frequent hystological finding. Two carcinomas were observed: one in a renal transplant patient (16.6% parathyroidectomies) and the other in a patient who did not show renal failure. These data coincide with international records.
Assuntos
Hiperparatireoidismo/patologia , Transplante de Rim , Neoplasias das Paratireoides/cirurgia , Complicações Pós-Operatórias/cirurgia , Feminino , Humanos , Hiperparatireoidismo/complicações , Pessoa de Meia-Idade , Neoplasias das Paratireoides/patologia , Paratireoidectomia , Complicações Pós-Operatórias/patologia , Estudos RetrospectivosRESUMO
BACKGROUND: The prevalence of the types of renal osteodystrophy (ROD) has changed in the last two decades. This study evaluates the prevalence and determining factors of the types of ROD in two countries in South America. METHODS: Symptomatic patients who underwent bone biopsies for diagnostic purposes (1985 through 2001) were included in the study. In Brazil, a total of 2340 patients were reviewed, 93.1% on hemodialysis (HD), and 6.9% on continuous ambulatory peritoneal dialysis (CAPD). In Uruguay, 167 patients on hemodialysis were included. Uncalcified bone samples were analyzed in order to diagnose the different types of ROD. RESULTS: Comparing the 1980s to the 1990s, the prevalence of Brazilian patients with hyperparathyroid bone disease (HP) increased from 32.3% to 44.0%, while Al overload decreased from 61.3% to 42.4%. A logistic regression analysis showed that the main factors associated with HP included female gender, age of less than 40 years, black patients, longer time on dialysis, and absence of Al overload. In Uruguay, HP also increased over time from 31.8% to 70.5% (P < 0.05), while Al overload decreased from 42% to 27% (P < 0.05). CONCLUSION: A better control of Al overload may lead to a change in histologic pattern, as evidenced by the increasing prevalence of HP.
Assuntos
Distúrbio Mineral e Ósseo na Doença Renal Crônica/epidemiologia , Adulto , Idoso , Osso e Ossos/patologia , Brasil/epidemiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/patologia , Feminino , Humanos , Hiperparatireoidismo/complicações , Hiperparatireoidismo/patologia , Ílio/patologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Fatores de Risco , Uruguai/epidemiologiaRESUMO
OBJECTIVE: To compare vitamin D status represented by serum 25-hydroxyvitamin D (25-OHD) levels in a group of patients with primary hyperparathyroidism, stratified by clinical manifestations. METHODS: We studied 22 patients (18 women and 4 men) with primary hyperparathyroidism--5 patients with severe osteitis fibrosa cystica, 10 symptomatic patients with active renal stone disease without overt bone disease, and 7 asymptomatic patients. Bone mineral density (BMD) measurements (T-scores) were done at the lumbar spine, femoral neck, and distal radius, and laboratory data for the three subgroups were analyzed. RESULTS: Although considerably younger than the asymptomatic group, patients with osteitis fibrosa had significantly lower mean serum 25-OHD levels (16.7 +/- 1.1 ng/mL versus 29.9 +/- 2.9 ng/mL; P = 0.003). Moreover, patients with osteitis fibrosa had significantly lower BMD in comparison with patients who had renal stone disease as well as asymptomatic patients for all sites measured. Serum parathyroid hormone levels were significantly higher in patients with osteitis fibrosa than in asymptomatic patients (1,352.8 +/- 297.2 pg/mL versus 145.0 +/- 43.7 pg/mL; P<0.02) as well as in comparison with patients who had renal stone disease (P<0.02). Patients with osteitis fibrosa had urinary N-telopeptide levels that were significantly higher than those in asymptomatic patients (501.5 +/- 201.7 versus 51.3 +/- 6.4 nmol/mmol creatinine; P = 0.02) and those in patients with renal stone disease (P = 0.01). CONCLUSION: The findings in this study demonstrate that vitamin D deficiency or insufficiency may contribute to disease severity in primary hyperparathyroidism.
Assuntos
Calcifediol/sangue , Hiperparatireoidismo/complicações , Hiperparatireoidismo/fisiopatologia , Adulto , Idoso , Densidade Óssea , Colágeno/urina , Colágeno Tipo I , Feminino , Humanos , Hiperparatireoidismo/patologia , Cálculos Renais/complicações , Masculino , Pessoa de Meia-Idade , Osteíte Fibrosa Cística/complicações , Hormônio Paratireóideo/sangue , Peptídeos/urinaRESUMO
El hiperparatiroidismo primario es una enfermedad que afecta a una o varias glándulas paratiroides, produciendo las manifestaciones clínicas características por el disbalance de la parathormona, el calcio, el fósforo y la vitamina D, y su definición obedece a que no es posible identificar el agente desencadenante, como sucede en las formas secundarias y terciarias de la enfermedad. Las glándulas paratiroides son cuatro y se encuentan ubicadas detrás de la glándula tiroides, pesando cada una 30 a 40 mg, con un diámetro mayor de 0.5 cm y tienen una característico color amarillo que las identifica con suma facilidad. Desde el punto de vista embrionario, las paratiroides superiores descienden junto con la glándula tiroides y la paratiroides inferiores están en relación al timo. Este detalle es importante cuando existe tiroides lingual, por lo que debemos encontrar las paratiroides superiores y las inferiores estarán en su ubicación normal en cuello.
Assuntos
Masculino , Feminino , Humanos , Glândulas Paratireoides , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/patologia , Hiperparatireoidismo/terapiaRESUMO
The various forms of renal osteodystrophy are predominant hyperparathyroid bone disease, mixed uremic osteodystrophy, low turnover osteomalacia, and adynamic bone disease. The present study analyses a total number of 1,209 bone biopsies from 5 different countries (Brazil, Uruguay, Argentina, Portugal, and Spain). Low turnover osteomalacia and mixed uremic osteodystrophy were more common in Brazil, Uruguay, and Argentina than in Portugal and Spain whereas predominant hyperparathyroid bone disease was seen more often in Portugal and Spain. In all centers, independent of the aluminum staining technique used, the extent of aluminum deposited in bone was greater in patients presenting with low bone turnover, whether from low turnover osteomalacia or adynamic bone disease, than in the predominant hyperparathyroid bone disease. In summary, even though recent reports have indicated that, over the last decade, the incidence of aluminum-induced toxicity was reduced, aluminum still seems to be implicated in a great percentage of symptomatic low bone remodelling lesions in Iberoamerica.
Assuntos
Alumínio/análise , Osso e Ossos/química , Distúrbio Mineral e Ósseo na Doença Renal Crônica/epidemiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/patologia , Hormônio Paratireóideo/sangue , Argentina/epidemiologia , Biópsia/estatística & dados numéricos , Doenças Ósseas/sangue , Doenças Ósseas/epidemiologia , Doenças Ósseas/patologia , Osso e Ossos/metabolismo , Osso e Ossos/patologia , Brasil/epidemiologia , Distúrbio Mineral e Ósseo na Doença Renal Crônica/sangue , Distúrbio Mineral e Ósseo na Doença Renal Crônica/classificação , Comorbidade , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/epidemiologia , Hiperparatireoidismo/patologia , Falência Renal Crônica/sangue , Falência Renal Crônica/patologia , Osteomalacia/sangue , Osteomalacia/epidemiologia , Osteomalacia/patologia , Portugal/epidemiologia , Prevalência , Espanha/epidemiologia , Uruguai/epidemiologiaRESUMO
Parathyroid carcinoma is a rare cause of primary hyperparathyroidism with a prevalence ranging between 0.5 and 4%. Because of their aggressiveness, prompt diagnosis and treatment are mandatory. A parathyroid carcinoma was found in four patients (4.5%) of 88 patients who underwent surgical cervical exploration for primary hyperparathyroidism at the Institute Nacional de la Nutrición in a period of seven years. Our paper gives the clinical characteristics, diagnosis, treatment and outcome of the four patients.
Assuntos
Hiperparatireoidismo/etiologia , Neoplasias das Paratireoides/complicações , Adulto , Feminino , Humanos , Hiperparatireoidismo/patologia , Hiperparatireoidismo/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Resultado do TratamentoRESUMO
AIMS: Refractory hyperparathyroidism is a state of parathyroid hyperfunction and hypercalcaemia in uraemic patients with previous secondary hyperplasia. We studied histopathological features and p53 expression in 49 parathyroid glands of uraemic patients (n = 21) with refractory hyperparathyroidism in order to investigate whether p53 abnormalities could be present in parathyroid hyperplasias of chronic renal failure. METHODS AND RESULTS: Nodular hyperplasia was found in 77.5% of the glands (n = 38). The proportion of oxyphil cells and acinar cell arrangements was higher in nodular hyperplasia than in diffuse hyperplastic glands P < 0.001). Duration of renal disease and haemodialysis treatment tended to be longer in patients with nodular hyperplasia. There was no correlation between serum intact PTH (iPTH), calcium and hyperplasia pattern. A trend for a higher glandular mass was found in nodular type hyperplasia (1.88 +/- 2.13 g) than in diffuse type hyperplasia (0.87 +/- 1.28 g; P = 0.06). Nuclear p53 immunoreactivity was shown in 55% of the hyperplastic glands, whereas it was not detected in 12 normal parathyroid glands used as controls. p53 staining was present in c. 82% of the diffuse hyperplastic glands and in 47% of the nodular hyperplastic glands (P = 0.08). CONCLUSIONS: Nodular type hyperplasia was the predominant histopathological pattern in uraemic patients with refractory hyperparathyroidism in our study. Nodular hyperplastic glands characteristically had higher percentage of oxyphil cells, acinar cell arrangements and mass than diffuse hyperplastic glands. A high prevalence of p53 protein expression was found in hyperplastic glands of uraemic patients. Our results suggest that p53 abnormalities might be involved in the pathogenesis of parathyroid hyperplasia in chronic renal failure.