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Gauffenic A, Ratsimbazafy V, Ostertag A, Linglart A, Bourrat E, Leroy C, Lioté F, Latourte A, Richette P, Ea HK, Guigonis V. Effectiveness of topical sodium thiosulfate for ectopic calcifications and ossifications. Results of the CATSS-O study. Semin Arthritis Rheum 2023; 63:152306. [PMID: 37976811 DOI: 10.1016/j.semarthrit.2023.152306] [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: 08/07/2023] [Revised: 10/02/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Ectopic calcifications (ECs) and heterotopic ossifications (HOs) form in non-mineralized tissues, most often in subcutaneous and muscular areas. Local and systemic complications can cause severe disability. Systemic administration of sodium thiosulfate (STS) gives promising results but is difficult to use in clinical practice. OBJECTIVE Evaluation of the efficacy and safety of topical STS in ECs and HOs. METHODS Retrospective analysis of the CATSS-O registry that included patients receiving topical STS 25 % prepared by the pharmacy of Limoges hospital during 2014-2020. The efficacy of STS was assessed by imaging (radiography or CT) after at least 6 months' treatment. RESULTS Among 126 patients who received STS 25 %, 35 had complete clinical and radiographic data for analysis (28 with ECs and 7 with HOs; 18 children [mean age 8.9 years, range 1.5-16], 17 adults [mean age 52.4 years, range 24-90]). Calcifications or ossifications were due to dermatomyositis (8 children, 6 adults), systemic scleroderma (6 adults) or pseudo-hypoparathyroidism 1A (7 children). They were single (37.1 %) or multiple (62.9 %). Treated regions were in the lower limbs (31.4 %), upper limbs (37.1 %) or both (28.6 %) and the axial region (2.9 %). Topical STS was clinically effective in 9/28 (32.1 %) patients with ECs and 2/7 (28.6 %) children with HOs. Three patients experienced complete disappearance of their calcifications. Response for ECs was better in children than adults (54.5% vs 17.6 %, p = 0.035). Topical STS was well tolerated. CONCLUSION Local STS seems effective for ossifications, particularly pediatric calcifications or ossifications. Randomized and experimental studies are needed to confirm this observation and to identify the underlying mechanisms.
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Affiliation(s)
- Alan Gauffenic
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Voa Ratsimbazafy
- University of Limoges, EpiMaCT Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France; Inserm, U1094, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Limoges, France; IRD, U270, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Limoges, France; CHU Limoges, Department of Pharmacy, Limoges, France
| | - Agnès Ostertag
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France
| | - Agnès Linglart
- INSERM-U1185, Paris Sud Paris-Saclay University, 75005 Paris, France; APHP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Network OSCAR and 'Platform of Expertise Paris Sud for Rare Diseases, 75005 Paris, France; APHP, Endocrinology and Diabetes for Children, 75005 Paris, France
| | - Emmanuelle Bourrat
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Paris, France
| | - Charles Leroy
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France
| | - Frédéric Lioté
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Augustin Latourte
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Pascal Richette
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Hang Korng Ea
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France.
| | - Vincent Guigonis
- Service de Pédiatrie, CHU de Limoges, Limoges, France; CIC 1435, CHU de Limoges, Limoges, France; UMR CNRS 7276, Limoges, France
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Takatani R, Kubota T, Minagawa M, Inoue D, Fukumoto S, Ozono K, Nakamura Y. Prevalence of Pseudohypoparathyroidism and Nonsurgical Hypoparathyroidism in Japan in 2017: A Nationwide Survey. J Epidemiol 2023; 33:569-573. [PMID: 36123043 PMCID: PMC10518380 DOI: 10.2188/jea.je20220152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/29/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pseudohypoparathyroidism (PHP) and nonsurgical hypoparathyroidism (NS-HypoPT) are rare diseases with hypocalcemia, hyperphosphatemia, and high and low parathyroid hormone levels, respectively. In Japan, over 20 years have passed since the last survey on these diseases. We carried out a nationwide cross-sectional survey to estimate the prevalence of these diseases in 2018. METHODS We conducted a nationwide mail-based survey targeting hospitals in 2018. From a total of 13,156 departments throughout Japan, including internal medicine, pediatrics, neurology, and psychiatry, 3,501 (27%) departments were selected using a stratified random sampling method. We asked each included department to report the number of patients with PHP and NS-HypoPT in 2017. RESULTS The overall survey response rate was 52.0% (1,807 departments). The estimated number of patients with PHP and NS-HypoPT was 1,484 (95% confidence interval [CI], 1,143-1,825) and 2,304 (95% CI, 1,189-3,419), respectively; the prevalence per 100,000 population was 1.2 and 1.8, respectively. CONCLUSION In this study, we generated estimates of the national prevalence of PHP and NS-HypoPT in Japan during 2017, which were found to be higher than those previously reported.
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Affiliation(s)
- Rieko Takatani
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Daisuke Inoue
- Third Department of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Seiji Fukumoto
- Department of Molecular Endocrinology, Fujii Memorial Institute of Medical Sciences, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
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Ertl DA, de Nanclares GP, Jüppner H, Hanna P, Pagnano A, Pereda A, Rothenbuhler A, Del Sindaco G, Ruiz-Cuevas P, Audrain C, Escribano A, Berkenou J, Gleiss A, Mantovani G, Linglart A. Recombinant growth hormone improves growth and adult height in patients with maternal inactivating GNAS mutations. Eur J Endocrinol 2023; 189:123-131. [PMID: 37440712 PMCID: PMC11077274 DOI: 10.1093/ejendo/lvad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Maternal inactivating GNAS mutations lead to pseudohypoparathyroidism 1A (PHP1A), newly classified as inactivating parathyroid hormone (PTH)/PTHrP-signaling disorder type 2 of maternal inheritance (iPPSD2). Patients present with resistance to PTH and other hormones, subcutaneous ossifications, brachydactyly, short stature, and early-onset obesity. They can be born small for gestational age (SGA) and may present with growth hormone (GH) deficiency. The use of recombinant human GH (rhGH) therapy has been sporadically reported, yet we lack data on the long-term efficacy and safety of rhGH, as well as on adult height. OBJECTIVE Our multicenter, retrospective, observational study describes growth in patients treated with rhGH in comparison with untreated iPPSD2/PHP1A controls. METHODS We included 190 patients, of whom 26 received rhGH. Height, weight, body mass index at various time points, and adult height were documented. We analyzed the effect of rhGH on adult height by using linear mixed models. RESULTS Adult height was available for 11/26 rhGH-treated individuals and for 69/164 controls. Patients treated with rhGH showed a gain in height of 0.7 standard deviation scores (SDS) after 1 year (CI +0.5 to +0.8, P < .001) and of 1.5 SDS after 3 years (CI +1.0 to +2.0, P < .001). Additionally, there was a clear beneficial impact of rhGH on adult height when compared with untreated controls, with a difference of 1.9 SDS (CI +1.1 to +2.7, P < .001). Body mass index SDS did not vary significantly upon rhGH therapy. CONCLUSION Recombinant human growth hormone treatment of iPPSD2/PHP1A patients with short stature improves growth and adult height. More studies are needed to confirm long-term efficacy and safety.
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Affiliation(s)
- Diana-Alexandra Ertl
- Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, AP-HP, Bicetre Paris-Saclay University Hospital, 94270 Le Kremlin-Bicetre, France
- Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, AP-HP, Filière OSCAR and Platform of expertise for rare diseases Paris-Saclay, Bicêtre Paris-Saclay Hospital, 94270 Le Kremlin-Bicêtre, France
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Reference Center for Rare Bone and Growth Disorders, Vienna Bone and Growth Center (ERN-BOND), 1090 Vienna, Austria
| | - Guiomar Perez de Nanclares
- Molecular (Epi) Genetics Laboratory, Bioaraba Health Research Institute, Araba University Hospital, 01009 Vitoria-Gasteiz, Spain
| | - Harald Jüppner
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Patrick Hanna
- Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, AP-HP, Bicetre Paris-Saclay University Hospital, 94270 Le Kremlin-Bicetre, France
- Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, AP-HP, Filière OSCAR and Platform of expertise for rare diseases Paris-Saclay, Bicêtre Paris-Saclay Hospital, 94270 Le Kremlin-Bicêtre, France
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Angela Pagnano
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Arrate Pereda
- Molecular (Epi) Genetics Laboratory, Bioaraba Health Research Institute, Araba University Hospital, 01009 Vitoria-Gasteiz, Spain
| | - Anya Rothenbuhler
- Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, AP-HP, Bicetre Paris-Saclay University Hospital, 94270 Le Kremlin-Bicetre, France
- Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, AP-HP, Filière OSCAR and Platform of expertise for rare diseases Paris-Saclay, Bicêtre Paris-Saclay Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Giulia Del Sindaco
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Pilar Ruiz-Cuevas
- Department of Pediatric Endocrinology, Josep Trueta University Hospital, 17007 Girona, Spain
| | - Christelle Audrain
- Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, AP-HP, Filière OSCAR and Platform of expertise for rare diseases Paris-Saclay, Bicêtre Paris-Saclay Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Arancha Escribano
- Department of Pediatric Endocrinology, University Hospital Virgen de la Arrixaca, 30120 El Palmar, Murcia, Spain
| | - Jugurtha Berkenou
- Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, AP-HP, Filière OSCAR and Platform of expertise for rare diseases Paris-Saclay, Bicêtre Paris-Saclay Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Andreas Gleiss
- Center for Medical Data Science, Medical University of Vienna, 1090 Vienna, Austria
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Agnès Linglart
- Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, AP-HP, Bicetre Paris-Saclay University Hospital, 94270 Le Kremlin-Bicetre, France
- Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, AP-HP, Filière OSCAR and Platform of expertise for rare diseases Paris-Saclay, Bicêtre Paris-Saclay Hospital, 94270 Le Kremlin-Bicêtre, France
- INSERM, Physiologie et physiopathologie endocrinienne, Université Paris Saclay, 94276 Paris, France
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Shen L, He Y, Chen S, He L, Zhang Y. PTHrP Modulates the Proliferation and Osteogenic Differentiation of Craniofacial Fibrous Dysplasia-Derived BMSCs. Int J Mol Sci 2023; 24:ijms24087616. [PMID: 37108778 PMCID: PMC10146947 DOI: 10.3390/ijms24087616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Fibrous dysplasia (FD) is a skeletal stem cell disease caused by mutations in the guanine nucleotide-binding protein, alpha-stimulating activity polypeptide (GNAS) gene, which results in the abnormal accumulation of cyclic adenosine monophosphate (cAMP) and hyperactivation of downstream signaling pathways. Parathyroid hormone-related protein (PTHrP) is secreted by the osteoblast lineage and is involved in various physiological and pathological activities of bone. However, the association between the abnormal expression of PTHrP and FD, as well as its underlying mechanism, remains unclear. In this study, we discovered that FD patient-derived bone marrow stromal cells (FD BMSCs) expressed significantly higher levels of PTHrP during osteogenic differentiation and exhibited greater proliferation capacity but impaired osteogenic ability compared to normal control patient-derived BMSCs (NC BMSCs). Continuous exogenous PTHrP exposure on the NC BMSCs promoted the FD phenotype in both in vitro and in vivo experiments. Through the PTHrP/cAMP/PKA axis, PTHrP could partially influence the proliferation and osteogenesis capacity of FD BMSCs via the overactivation of the Wnt/β-Catenin signaling pathway. Furthermore, PTHrP not only directly modulated cAMP/PKA/CREB transduction but was also demonstrated as a transcriptional target of CREB. This study provides novel insight into the possible pathogenesis involved in the FD phenotype and enhances the understanding of its molecular signaling pathways, offering theoretical evidence for the feasibility of potential therapeutic targets for FD.
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Affiliation(s)
- Lihang Shen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Yang He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Shuo Chen
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Linhai He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing 100034, China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
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Structural and Functional Implication of Natural Variants of Gαs. Int J Mol Sci 2023; 24:ijms24044064. [PMID: 36835474 PMCID: PMC9959179 DOI: 10.3390/ijms24044064] [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] [Received: 01/16/2023] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Heterotrimeric guanine nucleotide-binding proteins (G proteins) are among the most important cellular signaling components, especially G protein-coupled receptors (GPCRs). G proteins comprise three subunits, Gα, Gβ, and Gγ. Gα is the key subunit, and its structural state regulates the active status of G proteins. Interaction of guanosine diphosphate (GDP) or guanosine triphosphate (GTP) with Gα switches G protein into basal or active states, respectively. Genetic alteration in Gα could be responsible for the development of various diseases due to its critical role in cell signaling. Specifically, loss-of-function mutations of Gαs are associated with parathyroid hormone-resistant syndrome such as inactivating parathyroid hormone/parathyroid hormone-related peptide (PTH/PTHrP) signaling disorders (iPPSDs), whereas gain-of-function mutations of Gαs are associated with McCune-Albright syndrome and tumor development. In the present study, we analyzed the structural and functional implications of natural variants of the Gαs subtype observed in iPPSDs. Although a few tested natural variants did not alter the structure and function of Gαs, others induced drastic conformational changes in Gαs, resulting in improper folding and aggregation of the proteins. Other natural variants induced only mild conformational changes but altered the GDP/GTP exchange kinetics. Therefore, the results shed light on the relationship between natural variants of Gα and iPPSDs.
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Vado Y, Pereda A, Manero-Azua A, Perez de Nanclares G. Frequency of de novo variants and parental mosaicism in families with inactivating PTH/PTHrP signaling disorder type 2. Front Endocrinol (Lausanne) 2023; 13:1055431. [PMID: 36686455 PMCID: PMC9846528 DOI: 10.3389/fendo.2022.1055431] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Objective iPPSD2 (which includes PHP1A and PPHP/POH) is a rare inherited autosomal dominant endocrine disorder caused by inactivating GNAS pathogenic variants. A high percentage of de novo cases has been suggested. In rare cases, parental mosaicism has been described, but its real frequency is unknown. Design A retrospective study including a series of 95 genetically confirmed iPPSD2 probands. Methods The frequency of de novo cases was evaluated and the distribution of the type of variants was compared according to the type of inheritance. The putative involved allele was determined by reverse transcriptase PCR (RT-PCR) or allele specific oligonucleotide RT-PCR (ASO-RT-PCR). The possibility of GNAS mosaicism was studied by next-generation sequencing (NGS) on the corresponding parental DNA. Results In 41 patients the variant was of de novo origin and in 24 the origin could not be established. In both cases 66.67% of variants generated a truncated or absent protein whereas the rest of the variants were missense or in-frame deletion/duplication. Parental origin was studied in 45 of those patients and determined in 35. Curiously, the percentage of de novo variants at the paternal allele was higher than when paternally inherited (31.1% vs 6.67%). NGS detected mosaicism in three independent families: one from paternal DNA (allelic ratio 10%) and two from maternal DNA (allelic ratio 10% and 2%). Conclusion De novo pathogenic variants are frequent in iPPSD2 (around 45%). Parental mosaicism is infrequent (8.11%) but should be analyzed with NGS, taking into account its importance in genetic counselling.
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Affiliation(s)
| | | | | | | | - Guiomar Perez de Nanclares
- Rare Diseases Research Group, Molecular (Epi)Genetics Laboratory, Bioaraba Health Research Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Araba, Spain
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Zgheib O, Trombetti A, Juillerat A, Fokstuen S. Odyssey of a Misclassified Genomic Variant: Insight from an Incidental Finding Assessment. Child Neurol Open 2023; 10:2329048X231199327. [PMID: 37664540 PMCID: PMC10472820 DOI: 10.1177/2329048x231199327] [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: 07/23/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
Genetic evaluation of a teenager with seizure found no pathogenic variant in a large gene panel, but an incidental likely pathogenic HNF4A variant, deemed to cause MODY1 diabetes. Diabetes history was absent and glycated hemoglobin normal, but serum calcium was severely low, with abnormally high parathyroid hormone. Thus, pseudohypoparathyroidism was suspected and confirmed by molecular genetic testing. Calcium and calcitriol supplementation led to calcium normalization and neurological symptom improvement. Given the absence of personal or family diabetes history, the HNF4A variant was reassessed and found to encode an alternative transcript with poor expression and activity levels, hence downgraded on expert advice from 'likely pathogenic' to 'likely benign'. Besides illustrating the importance of structured medical workup before launching extensive targeted exome sequencing, this case highlights the need for caution in incidental finding interpretation in patients lacking compatible phenotype or family history, and the value of expert advice in such variant interpretation.
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Affiliation(s)
- Omar Zgheib
- Division of Genetic Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - André Juillerat
- Division of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Siv Fokstuen
- Division of Genetic Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
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Muacevic A, Adler JR. Parathyroid Hormone Secretion and Related Syndromes. Cureus 2022; 14:e30251. [PMID: 36381723 PMCID: PMC9650928 DOI: 10.7759/cureus.30251] [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: 08/27/2022] [Accepted: 10/13/2022] [Indexed: 01/24/2023] Open
Abstract
In this article, we will get to know about the parathyroid hormone and the parathyroid gland. Its anatomy, physiology, and pathology will be delved into. There will be a brief discussion about its secretion and also about various clinical syndromes related to it. Parathormone, the parathyroid glands, regulate normal calcium and phosphorus levels in the body. An increase in the secretion of parathormone results in increased calcium uptake from the kidney, intestine, and bones, hence elevating the blood calcium level. A few mechanisms of action of this hormone are increased by the presence of vitamin D. The increase in the secretion of this hormone as compared to the normal levels is termed hyperparathyroidism. Incidence is maximum after 60 years of age. The ratio of females to males is 2:1. There are three types of hyperparathyroidism which will be described in this article. Clinical manifestations of hyperparathyroidism include skeletal disease, renal involvement, GI manifestations, psychiatric diseases, decreased neuro-muscular irritability, decreased deep tendon reflexes, muscular weakness, and atrophy. Assessment for hyperparathyroidism can be done by various diagnostic tests which are described further in this article. Medical/surgical management to cure this is also well-established nowadays. The decrease in the secretion of this hormone as compared to normal levels is termed hypoparathyroidism. Serum calcium levels are very low, serum phosphate levels are very high, and tetany can develop. The incidence is that females are more prone than males. Assessment for acute hypoparathyroidism will show positive Chvostek sign and trousseau sign, hyperactive deep tendon reflexes, and paresthesia. Assessment of chronic hypoparathyroidism will show lethargy, weakness, fatigue, cataracts, brittle nails, dry scaly skin, personality changes, and can even cause permanent brain damage. The normal secretion process of this hormone and diseases when its secretion becomes abnormal and why that happens are briefed in this article.
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Mahmodlou R, Sedokani A, Pezeshk A, Najafinejad B. Giant parathyroid adenoma: a case report. J Med Case Rep 2022; 16:150. [PMID: 35414046 PMCID: PMC9006466 DOI: 10.1186/s13256-022-03401-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Giant parathyroid adenoma is a type of parathyroid adenoma weighing > 3.5 g and having a size of more than 2 cm. CASE PRESENTATION This report describes giant primary parathyroid adenoma with reference to the literature. We report the case of a 48-year-old Persian man referred to the clinic with knee and lower back pain. He had a history of mitral valve replacement and several episodes of bilateral nephrolithiasis. After a thorough assessment, a neck mass with a possible thyroid origin was detected, but further assessment showed it was of parathyroid origin. The resected mass was 9 × 6× 4 cm and weighed 122 g, and histopathology showed a giant parathyroid adenoma. CONCLUSION Giant parathyroid adenomas that weigh more than 110 g and are larger than 8 cm can lead to significant hypercalcemia. Despite giant parathyroid adenomas and high parathyroid hormone levels, a calcium crisis may not always occur in these patients, and the masses may be initially misdiagnosed as a thyroid mass.
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Affiliation(s)
- Rahim Mahmodlou
- Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Amin Sedokani
- Department of Cardiology, Urmia University of Medical Sciences, 17 Shahrivar St., 571478334, Urmia, Iran.
| | - Apameh Pezeshk
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Biological Sciences, Chicago, IL, USA
| | - Bita Najafinejad
- Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran
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Stembridge N, Durack A, Gass JK, Firth HV, Park SM, McDonald S, Thankamony A, Burrows NP. Infantile-onset osteoma cutis with pseudopseudohypoparathyroidism. Clin Exp Dermatol 2021; 46:1384-1386. [PMID: 34418133 DOI: 10.1111/ced.14700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/07/2021] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Affiliation(s)
- N Stembridge
- Departments of, Dermatology, Addenbrooke's Hospital, Cambridge, UK
| | - A Durack
- Departments of, Dermatology, Addenbrooke's Hospital, Cambridge, UK
| | - J K Gass
- Departments of, Dermatology, Addenbrooke's Hospital, Cambridge, UK
| | - H V Firth
- Genetics, Addenbrooke's Hospital, Cambridge, UK
| | - S-M Park
- Genetics, Addenbrooke's Hospital, Cambridge, UK
| | - S McDonald
- Histopathology, Addenbrooke's Hospital, Cambridge, UK
| | - A Thankamony
- Endocrinology, Addenbrooke's Hospital, Cambridge, UK
| | - N P Burrows
- Departments of, Dermatology, Addenbrooke's Hospital, Cambridge, UK
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Magnadóttir B, Uysal-Onganer P, Kraev I, Svansson V, Skírnisson K, Lange S. Deiminated proteins and extracellular vesicles as novel biomarkers in pinnipeds: Grey seal (Halichoerus gryptus) and harbour seal (Phoca vitulina). Biochimie 2020; 171-172:79-90. [PMID: 32105816 DOI: 10.1016/j.biochi.2020.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/21/2020] [Indexed: 12/16/2022]
Abstract
Peptidylarginine deiminases (PADs) are phylogenetically conserved calcium-dependent enzymes which post-translationally convert arginine into citrulline in target proteins in an irreversible manner, leading to functional and structural changes in target proteins. Protein deimination can cause the generation of neo-epitopes, affect gene regulation and also allow for protein moonlighting and therefore facilitate multifaceted functions of the same protein. PADs are furthermore a key regulator of cellular release of extracellular vesicle (EVs), which are found in most body fluids and participate in cellular communication via transfer of cargo proteins and genetic material. In this study, post-translationally deiminated proteins and EVs were assessed in sera of two seal species, grey seal and harbour seal. We report a poly-dispersed population of serum-EVs, which were positive for phylogenetically conserved EV-specific markers and characterised by transmission electron microscopy. A number of deiminated proteins critical for immune and metabolic functions were identified in the seal sera and varied somewhat between the two species under study, while some targets were in common. EV profiles of the seal sera further revealed that key microRNAs for inflammation, immunity and hypoxia also vary between the two species. Protein deimination and EVs profiles may be useful biomarkers for assessing health status of sea mammals, which face environmental challenges, including opportunistic infection, pollution and shifting habitat due to global warming.
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Affiliation(s)
- Bergljót Magnadóttir
- Institute for Experimental Pathology, University of Iceland, Keldur V. Vesturlandsveg, 112 Reykjavik, Iceland.
| | - Pinar Uysal-Onganer
- Cancer Research Group, School of Life Sciences, University of Westminster, London, W1W 6UW, UK.
| | - Igor Kraev
- Electron Microscopy Suite, Faculty of Science, Technology, Engineering and Mathematics, Open University, Milton Keynes, MK7 6AA, UK.
| | - Vilhjálmur Svansson
- Institute for Experimental Pathology, University of Iceland, Keldur V. Vesturlandsveg, 112 Reykjavik, Iceland.
| | - Karl Skírnisson
- Institute for Experimental Pathology, University of Iceland, Keldur V. Vesturlandsveg, 112 Reykjavik, Iceland.
| | - Sigrun Lange
- Tissue Architecture and Regeneration Research Group, School of Life Sciences, University of Westminster, London, W1W 6UW, UK.
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Brancatella A, Mantovani G, Elli FM, Borsari S, Marcocci C, Cetani F. A severe inactivating PTH/PTHrP signaling disorder type 2 in a patient carrying a novel large deletion of the GNAS gene: a case report and review of the literature. Endocrine 2020; 67:466-472. [PMID: 31939093 DOI: 10.1007/s12020-020-02195-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/05/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Pseudohypoparathyroidism (PHP), characterized by multihormone resistance and Albright's hereditary osteodystrophy (AHO), is caused by GNAS mutations. Whole or partial gene deletions are rare. All disorders due to inactivating mutations of the GNAS gene are now classified as "inactivating PTH/PTHrP signaling disorder type 2" (iPPSD2). This study reports a family harboring a large GNAS gene deletion in order to improve the knowledge of genotype-phenotype correlation of this disease. METHODS An 18-year-old man with severe diffuse soft ossifications and multihormone resistance underwent to clinical, biochemical, radiological, and genetic studies. A review of the literature of other cases of iPPSD2 due to GNAS large deletions was performed focusing on clinical and biochemical features. RESULTS The proband presented signs of hypocalcemia and marked AHO features. Laboratory tests revealed hypocalcemia, high levels of serum phosphate, PTH, TSH, and calcitonin despite therapy with calcium carbonate, calcitriol, and levothyroxine. Diffuse soft tissue ossifications and brain calcifications were shown by radiological exams. Family history was remarkable for hypocalcemia, neurocognitive impairment, and cerebral calcifications in his brother and AHO features in the maternal grandfather. The proband's mother showed short stature, whereas physical examination of the father was unremarkable. Genetic analysis of the GNAS gene revealed an unreported large deletion encompassing exons 1-7 in the proband, brother, and mother. By reviewing the literature, only six other cases were described. CONCLUSIONS We report a kindred harboring a large GNAS deletion. A genotype-phenotype correlation was observed in term of severity of tissue ossifications in the siblings but not in the mother.
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Affiliation(s)
| | - Giovanna Mantovani
- Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Endocrinology Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca M Elli
- Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Endocrinology Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Simona Borsari
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Azzam E, Elsabbagh N, Elgayar N, Younan D. Relation between vitamin D and geriatric syndrome. Clin Nutr ESPEN 2019; 35:123-127. [PMID: 31987105 DOI: 10.1016/j.clnesp.2019.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/19/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Vitamin D level is a common health problem for elderly persons and it is associated with a decrease in physical performance, furthermore, it has been demonstrated that those with low serum vitamin D level has more risk of cognitive impairment, depression and anxiety. AIM The aim of the study was to estimate relation of vitamin D and geriatric syndrome. METHODS A prospective study was done on 50 subjects who were normal elderly persons above 65 years. All the participants were subjected to full history taking, complete physical examination, laboratory assessment including serum 25-hydroxyvitamin D (OH)D by enzyme linked immunosorbent assay (ELISA) and geriatric syndrome assessment using 5 methods namely fall risk assessment using timed up &go test, mini-mental state examination (MMSE), geriatric depressive scale, mini nutritional assessment and Tinetti performance - oriented mobility assessment (POMA). RESULTS The number of patients who were vitamin D deficient (<12 ng/ml), insufficient (12-20 ng/ml) and sufficient (>20 ng/ml) were 11, 24 and 15 respectively. There was significant p association between low vitamin D level and female gender (p = 0.024), advanced age (p = 0.026), no-sun exposure jobs (p = 0.001) and nursing home residency. Mini mental state examination (p = 0.006) and geriatric depressive scale (p = 0.002) had a significant positive correlation with low vitamin D level while mini nutritional assessment (p = 1.000), timed up and go test (p = 0.225) and POMA score (p = 0.133) had no significant correlation with low vitamin D level. CONCLUSION There is correlation finding between vitamin D deficiency and advanced age, cognitive dysfunction, and depression.
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Affiliation(s)
- Eman Azzam
- Internal Medicine, Faculty of Medicine, Alexandria, University, Egypt.
| | - Noha Elsabbagh
- Internal Medicine, Faculty of Medicine, Alexandria, University, Egypt
| | - Nany Elgayar
- Internal Medicine, Faculty of Medicine, Alexandria, University, Egypt
| | - Doreen Younan
- Clinical Pathology, Faculty of Medicine, Alexandria University, Egypt
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