Challenges in differential diagnosis between primary and secondary forms of hyperparathyroidism
https://doi.org/10.14341/omet2017348-53
Abstract
Hyperparathyroidism is a disease characterized by excessive secretion of parathyroid hormone (PTH) in the chief cells of parathyroid glands. There are three types of hyperparathyroidism: primary, secondary, and tertiary depending on the cause of this disease. By the secondary hyperparathyroidism calcium-sensing receptors (CaSR) and vitamin D receptors (VDR) lead to disturbance of phosphorus-calcium exchange and to development of a parathyroid glands hyperplasia. Treatment of secondary hyperparathyroidism with vitamin D showed the efficiency not only in normalization of clinical laboratory indicators but also in involution of changes in parathyroid glands. We represent the clinical case of a patient with secondary hyperparathyroidism caused by hypovitaminosis D, parathyroid hyperplasia more than 1 cm. The long-term oral therapy with active vitamin D led to the positive dynamics of PTH levels, as well as complete reduction of parathyroid lesion.
About the Authors
Natalia G. MokryshevaEndocrinology Research Centre
Russian Federation
Sc.D.
Anna K. Eremkina
Endocrinology Research Centre
Russian Federation
PhD
Svetlana S. Mirnaya
Endocrinology Research Centre
Russian Federation
postgraduate student
Elena V. Kovaleva
Endocrinology Research Centre
Russian Federation
postgraduate student
References
1. Slatopolsky E, Finch J, Denda M, et al. Phosphorus restriction prevents parathyroid gland growth. High phosphorus directly stimulates PTH secretion in vitro. J Clin Invest. 1996;97(11):2534-2540. doi: 10.1172/jci118701.
2. Drüeke TB. Cell biology of parathyroid gland hyperplasia in chronic renal failure. J Am Soc Nephrol. 2000;11(6):1141-1152.
3. Demiralay E. Comparison of Proliferative Activity in Parathyroid Glands in Primary and Secondary Hyperparahyroidism. Acta Endocrinologica (Bucharest). 2011;7(4):513-522. doi: 10.4183/aeb.2011.513.
4. Latus J, Lehmann R, Roesel M, et al. Analysis of a-Klotho, Fibroblast Growth Factor-, Vitamin-D and Calcium-Sensing Receptor in 70 Patients with Secondary Hyperparathyroidism. Kidney Blood Press Res. 2013;37(1):84-94. doi: 10.1159/000343403.
5. Kifor O, Diaz R, Butters R, et al. The Calcium-sensing Receptor Is Localized in Caveolin-rich Plasma Membrane Domains of Bovine Parathyroid Cells. J Biol Chem. 1998;273(34):21708-21713. doi: 10.1074/jbc.273.34.21708.
6. Silver J, Naveh-Many T, Mayer H, et al. Regulation by vitamin D metabolites of parathyroid hormone gene transcription in vivo in the rat. J Clin Invest. 1986;78(5):1296-1301. doi: 10.1172/jci112714.
7. Canaff L, Hendy GN. Human Calcium-sensing Receptor Gene. J Biol Chem. 2002;277(33):30337-30350. doi: 10.1074/jbc.M201804200.
8. Gogusev J, Duchambon P, Hory B, et al. Depressed expression of calcium receptor in parathyroid gland tissue of patients with hyperparathyroidism. Kidney Int. 1997;51(1):328-336. doi: 10.1038/ki.1997.41.
9. Yano S, Sugimoto T, Tsukamoto T, et al. Association of decreased calcium-sensing receptor expression with proliferation of parathyroid cells in secondary hyperparathyroidism. Kidney Int. 2000;58(5):1980-1986. doi: 10.1111/j.1523-1755.2000.00370.x.
10. Canadillas S. Calcium-Sensing Receptor Expression and Parathyroid Hormone Secretion in Hyperplastic Parathyroid Glands from Humans. J Am Soc Nephrol. 2005;16(7):2190-2197. doi: 10.1681/asn.2004080657.
11. McCann LM, Beto J. Roles of Calcium-Sensing Receptor and Vitamin D Receptor in the Pathophysiology of Secondary Hyperparathyroidism. J Ren Nutr. 2010;20(3):141-150. doi: 10.1053/j.jrn.2010.01.004.
12. Tominaga Y, Takagi H. Molecular genetics of hyperparathyroid disease. Curr Opin Nephrol Hypertens. 1996;5(4):336-341. doi: 10.1097/00041552-199607000-00008.
13. Dusso AS, Sato T, Arcidiacono MV, et al. Pathogenic mechanisms for parathyroid hyperplasia. Kidney Int. 2006;70:S8-S11. doi: 10.1038/sj.ki.5001595.
14. Артемова А.М., Сморщок В.Н., Кузнецов Н.С., Бельцевич Д.Г. Возможности УЗ-томографии в диагностике вторичного гиперпаратиреоза при хронической почечной недостаточности.// Нефрология и диализ. – 2001. – Т.3. – № 2. – C. 147-161. [Artemova AM, Smorshchok VN, Kuznetsov NS, Bel'tsevich DG. Vozmozhnosti UZ-tomografii v diagnostike vtorichnogo giperparatireoza pri khronicheskoy pochechnoy nedostatochnosti. Nefrologiya i dializ 2001;3(2):147-161. (In Russ.)]
15. Мокрышева Н.Г., Рожинская Л.Я., Кузнецов Н.С., и др. Клинические рекомендации Первичный гиперпаратиреоз: клиника, диагностика, дифференциальная диагностика, методы лечения. //Проблемы Эндокринологии. – 2016. – Т. 62. – №6. – C. 40-77. [Dedov II, Melnichenko GA, Mokrysheva NG, et al. Primary hyperparathyroidism: the clinical picture, diagnostics, differential diagnostics, and methods of treatment. Problems of Endocrinology. 2017;62(6):40-77. (In Russ)] doi: 10.14341/probl201662640-77
16. Мокрышева Н.Г. Первичный гиперпаратиреоз (эпидемиология, клиника, современные принципы диагностики и лечения): Дис. … док. мед. наук. –Москва; 2011. [Mokrysheva NG. Pervichnyi giperparatireoz (epidemiologiya, klinika, sovremennye printsipy diagnostiki i lecheniya) [dissertation]. Moscow; 2011. (In Russ).]
17. Kremer R, Bolivar I, Goltzman D, Hendy GN. Influence of Calcium and 1,25-Dihydroxycholecalciferol on Proliferation and Proto-Oncogene Expression in Primary Cultures of Bovine Parathyroid Cells*. Endocrinology. 1989;125(2):935-941. doi: 10.1210/endo-125-2-935.
18. Regression of Parathyroid Hyperplasia by Calcitriol-Pulse Therapy in Patients on Long-Term Dialysis. N Engl J Med. 1990;323(6):421-422. doi: 10.1056/nejm199008093230617.
19. Fukagawa M, Kitaoka M, Yi H, et al. Serial Evaluation of Parathyroid Size by Ultrasonography Is Another Useful Marker for the Long-Term Prognosis of Calcitriol Pulse Therapy in Chronic Dialysis Patients. Nephron. 2008;68(2):221-228. doi: 10.1159/000188261.
Supplementary files
|
|
1. Рис. 1. Развитие диффузной и узелковой гиперплазии ОЩЖ (по материалам [12]) | |
| Subject | ||
| Type | Исследовательские инструменты | |
View
(114KB)
|
Indexing metadata ▾ | |
Review
For citations:
Mokrysheva N.G., Eremkina A.K., Mirnaya S.S., Kovaleva E.V. Challenges in differential diagnosis between primary and secondary forms of hyperparathyroidism. Obesity and metabolism. 2017;14(3):48-53. (In Russ.) https://doi.org/10.14341/omet2017348-53
Views:
10149
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
Email this article 
