Preeclampsia as an inaugural manifestation of primary hyperparathyroidism: A case report / Pré-eclâmpsia como manifestação inaugural de hiperparatiroidismo primário: Um caso clínico

Abstract Primary hyperparathyroidism is an endocrine disorder characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone. The diagnosis is based on a biochemical evaluation, and a neck ultrasound is the first choice during pregnancy to access the parathyroid glands. Manifestations during pregnancy are rare and can be present with life-threatening complications, so the diagnosis is challenging. The conservative treatment is limited, and there is not enough data about its safety and efficacy during pregnancy. Surgery is the only curative treatment, and a parathyroidectomy performed during the second or third trimesters is considered safe. Recently, some authors suggested an association between primary hyperparathyroidism and preeclampsia. We describe a case of preeclampsia with severe features at 27 weeks of gestational age. The severity of the preeclampsiamotivated an early termination of the pregnancy by cesarean section. During the postpartum period, the patient presented life-threatening complications, such as severe hypercalcemia and acute pancreatitis. An ultrasound exam found two parathyroid nodules, suggestive of parathyroid adenomas. The patient recovered after the pharmacological correction of the calcemia levels.

Resumo O hiperparatiroidismo primário é umdistúrbio endócrino caraterizado pela elevação do cálcio sérico associada a níveis de paratormona elevados ou inapropriadamente normais. O diagnóstico é baseado em análises bioquímicas, e, na gravidez, o exame de imagem de primeira linha é a ecografia cervical. É uma doença rara na gravidez, e pode se apresentar com complicações ameaçadoras de vida, pelo que o seu diagnóstico é desafiante. O tratamento médico disponível é limitado, havendo poucos dados relativos à sua eficácia e segurança na gravidez. A cirurgia é o único tratamento curativo, e pode ser realizada no segundo ou terceiro trimestres. Tem sido descrita uma relação entre hiperparatiroidismo primário e pré-eclâmpsia. Apresenta-se um caso de uma grávida de 27 semanas com pré-eclâmpsia com critérios de gravidade, o que obrigou ao término da gravidez por cesariana. Verificou-se agravamento clínico no período pós-parto, com aparecimento de complicações graves, tais como hipercalcemia grave e pancreatite aguda. Ecograficamente, constataram-se duas massas paratiróideias sugestivas de adenomas da paratiroide. A doente recebeu tratamento médico, e teve melhora apenas após a correção dos níveis de cálcio sérico.

Expression of β-catenin and cyclin-D1 in sporadic parathyroid adenomas / 中华内分泌外科杂志

Objective To study the expression of β-catenin and cyclin-D1 in sporadic parathyroid adenomas and the clinical significance.Methods Immunohistochemistry and RT-PCR were used to examine the expression of β-catenin and cyclin-Dl in 20 cases of sporadic parathyroid adenomas,10 cases of parathyroid hyperplasia tissues and 8 cases of normal parathyroid tissues respectively.Results The results of immunohistochemistry showed that the expression of β-catenin was decreased on cell membrane of normal parathyroid tissues,parathyroid hyperplasia tissues and sporadic parathyroid adenomas,and was increased in the cytoplasm and the nucleus.The expression of cyclin-Dl was significantly higher in the adenoma group and hyperplasia group than in the normal group( P ＜ 0.05 ).The difference had no statistical significance in terms of cyclin-Dl expression between the adenoma group and the hyperplasia group( P ＞0.05 ).The abnormal expression of β-catenin was significantly correlated with the overexpression of cyclin-D1 in sporadic parathyroid adenomas( P ＜ 0.05 ).RT-PCR analysis showed that the expression of cyclin-D1 mRNA was 2.36 ± 1.12 vs 1.50 ± 1.03 ( P ＜ 0.05 ),and the expression of β-catenin mRNA was 1.02 ± 0.45 vs 0.88 ± 0.56( P ＞ 0.05 ) in adenomas and normal parathyroid tissues respectively.Conclusion The abnormal expression of β-catenin activates cyclin-Dl and thus leads to the uncontrolled cell proliferation and differentiation,which may be one of the mechanisms of the occurrence of sporadic parathyroid tumors.

Preliminary study on gene expression profiles of sporadic parathyroid adenoma with application of gene-chip technology / 中华内分泌外科杂志

Objective To investigate the differentially expressed genes in sporadic parathyroid adenomas using genechip and provide basis for further studying the mechanism and diagnosis of sporadic parathyroid adeno-mas. Methods Total RNA was extracted from normal parathyroid tissues and adenomas tissues. The mRNA was used to prepare probes. The mixed probes were hybridized to the cDNA microarray. After washing, the DNA chips were scanned by laser scanner. The acquired image was analyzed. Results Among the 47 000 target genes, 2302 genes were identified in sporadic parathyroid adenomas tissues that had at least two-fold changes compared to normal parathyroid tissues, and 1012 genes up-regulated and 1290 down-regulated were found in this study. Of 10 genes up-regulated and 27 down-regulated, the changes were over five-fold. The function of these changed genes was involved in transport, cell adhesion, signal transduetion, transcription, ion binding and so on. Conclusions Many parathyroid adenomas associated genes have been screened by high-throughout gene chip method, Which may help to identify the mechanism and diagnosis of sporadic parathyroid adenomas.