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Cetani F, Dinoi E, Pierotti L, Pardi E. Familial states of primary hyperparathyroidism: an update. J Endocrinol Invest 2024:10.1007/s40618-024-02366-7. [PMID: 38635114 DOI: 10.1007/s40618-024-02366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Familial primary hyperparathyroidism (PHPT) includes syndromic and non-syndromic disorders. The former are characterized by the occurrence of PHPT in association with extra-parathyroid manifestations and includes multiple endocrine neoplasia (MEN) types 1, 2, and 4 syndromes, and hyperparathyroidism-jaw tumor (HPT-JT). The latter consists of familial hypocalciuric hypercalcemia (FHH) types 1, 2 and 3, neonatal severe primary hyperparathyroidism (NSHPT), and familial isolated primary hyperparathyroidism (FIHP). The familial forms of PHPT show different levels of PHPT penetrance, developing earlier and with multiglandular involvement compared to sporadic counterpart. All these diseases exhibit Mendelian inheritance patterns, and for most of them, the genes responsible have been identified. DNA testing for predisposing mutations is helpful in index cases or in individuals with a high suspicion of the disease. Early recognition of hereditary disorders of PHPT is of great importance for the best clinical and surgical approach. Genetic testing is useful in routine clinical practice because it will also involve appropriate screening for extra-parathyroidal manifestations related to the syndrome as well as the identification of asymptomatic carriers of the mutation. PURPOSE The aim of the review is to discuss the current knowledge on the clinical and genetic profile of these disorders along with the importance of genetic testing in clinical practice.
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Affiliation(s)
- F Cetani
- Endocrine Unit 2, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - E Dinoi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Pierotti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Pardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Cetani F, Pardi E, Torregrossa L, Borsari S, Pierotti L, Dinoi E, Marcocci C. Approach to the Patient With Parathyroid Carcinoma. J Clin Endocrinol Metab 2023; 109:256-268. [PMID: 37531615 DOI: 10.1210/clinem/dgad455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
Parathyroid carcinoma (PC) is usually associated with severe symptomatic primary hyperparathyroidism (PHPT) and accounts for less than 1% of all cases of PHPT and approximately 0.005% of all cancers. PC most commonly occurs as a sporadic disease and somatic CDC73 mutations can be detected in up to 80% of cases. Approximately 30% of patients harbor a germline mutation of the CDC73 gene. Preoperative diagnosis of PC is difficult because no disease-specific markers are available, and PC should be suspected in patients with severe hypercalcemia and end-organ complications. The diagnosis is based on the evidence of invasive tumor growth at histology and/or metastases. En bloc resection of the tumor, together with the ipsilateral thyroid lobe and adjacent structures, should be performed by an experienced surgeon when PC is suspected. This surgical approach reduces the risk of recurrence and metastasis and offers the highest chance of cure. Nonetheless, PC has a recurrence rate of 40% to 60% and, if feasible, multiple surgical procedures should be performed. When surgery is no longer an option, medical treatment is aimed to reduce hypercalcemia and target organ complications. Targeted agents have been effectively used in a few cases. We describe herein a patient with severe PHPT due to PC and provide a systematic diagnostic and treatment approach. A thorough review of the medical history, a typical clinical and biochemical phenotype and, in some cases, the revision of the histological examination provide the clues for the diagnosis of PC.
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Affiliation(s)
- Filomena Cetani
- Unit of Endocrinology, University Hospital of Pisa, 56124 Pisa, Italy
| | - Elena Pardi
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
| | - Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Clinical Area, University of Pisa, 56126 Pisa, Italy
| | - Simona Borsari
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
| | - Laura Pierotti
- Unit of Endocrinology, University Hospital of Pisa, 56124 Pisa, Italy
| | - Elisa Dinoi
- Unit of Endocrinology, University Hospital of Pisa, 56124 Pisa, Italy
| | - Claudio Marcocci
- Unit of Endocrinology, University Hospital of Pisa, 56124 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
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Abstract
The most common causes of hypercalcemia are primary hyperparathyroidism (PHPT) and malignancy. Parathyroid carcinoma (PC), causing a severe PHPT, is the rarest parathyroid tumor. A diagnosis of PC is challenging because the clinical profile overlaps with that of benign counterpart. Surgery is the mainstay treatment. CDC73 mutations have been detected in up to 80% of sporadic PCs. Ectopic production of parathyroid hormone (PTH) by malignant nonparathyroid tumors is a rare condition accounting for less than 1% of hypercalcemia of malignancy. PTH secretion can be considered an aberration in the tissue specificity of gene expression and may involve heterogeneous molecular mechanisms.
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Affiliation(s)
- Filomena Cetani
- University Hospital of Pisa, Endocrine Unit 2, Via Paradisa, 2, Pisa 56124, Italy.
| | - Elena Pardi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, Pisa 56124, Italy
| | - Claudio Marcocci
- University Hospital of Pisa, Endocrine Unit 2, Via Paradisa, 2, Pisa 56124, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, Pisa 56124, Italy
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Grigorie D, Sucaliuc A, Ciuffi S, Franceschelli F, Marini F, Ioachim D, Terzea D, Brandi MLL. HIGH RISK OF PARATHYROID CARCINOMA AND GENETIC SCREENING IN THE FIRST DIAGNOSED ROMANIAN FAMILY WITH HYPERPARATHYROIDISM-JAW TUMOR SYNDROME AND A GERMLINE MUTATION OF THE CDC73 GENE. Acta Endocrinol (Buchar) 2019; 15:398-403. [PMID: 32010362 DOI: 10.4183/aeb.2019.398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Context Hyperparathyroidism-jaw tumour (HPT-JT) syndrome is a rare autosomal dominant cause of familial hyperparathyroidism associated with ossifying fibromas (OF) of the maxillofacial bones and increased risk of parathyroid carcinoma, caused by inactivating germline mutation of the cell division cycle 73 (CDC73) gene. Objective To report the first Romanian family with HPT-JT and genetic screening of CDC73 gene. Subjects and Methods Mutational analysis of the CDC73 gene and genetic screening of the family of a proband with HPT-JT. Histological diagnosis of parathyroid tumors (WHO criteria) and immunohistochemistry (parafibromin) were performed. Results Three of the six screened family members had evidence of PHPT and surgically proven parathyroid tumours. Two of the three affected members had parathyroid carcinomas and one had two parathyroid adenomas. Genetic screening of CDC73 gene revealed that 4 of 6 patients showed a heterozygous germline deletion of one nucleotide: c.128-IVS1+1 delG. All the three affected patients, resulted to be carriers of the CDC73 mutation, but each one bearing a different CDC73 polymorphism. Conclusions We identified a new CDC73 germline mutation in a Romanian family of HPT-JT. Analysis of clinical phenotypes in the four mutated individuals confirmed the incomplete penetrance and the variable clinical expression of the disease.
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Affiliation(s)
- D Grigorie
- Dept. Endocrinology and Metabolism, National Institute of Endocrinology, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - A Sucaliuc
- Dept. Endocrinology and Metabolism, National Institute of Endocrinology, Bucharest, Romania
| | - S Ciuffi
- University of Florence - FirmoLab, Department of Surgery and Translational Medicine, Florence, Italy
| | - F Franceschelli
- University of Florence - FirmoLab, Department of Surgery and Translational Medicine, Florence, Italy
| | - F Marini
- University of Florence - FirmoLab, Department of Surgery and Translational Medicine, Florence, Italy
| | - D Ioachim
- Dept. Pathology and Cytopathology, "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - D Terzea
- Dept. Pathology and Cytopathology, "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - M L L Brandi
- University of Florence - FirmoLab, Department of Surgery and Translational Medicine, Florence, Italy
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Abstract
Background Hyperparathyroidism-Jaw Tumor (HPT-JT) syndrome is a rare genetic disorder bearing both a germline and a somatic CDC73 mutation (formerly known as HRPT2), which has been mapped to chromosome 1q25–q31. The association of jaw ossifying fibroma with primary hyperparathyroidisim (PHPT) is typical of HPT-JT. It may also include cystic and neoplastic renal abnormalities and uterine tumors. Case Details Here, we report a case of HPT-JT with an initial presentation of declination in reproductive fitness. Extensive literature search and thorough investigation helped us parturitate the underlying syndrome, thereby predictively improving the prognosis. Conclusion The features of HPT-JT are clinically difficult to ascertain because the parathyroid disease, ossifying fibroma in the jaw and other abnormalities, often occurs asynchronously and may be diagnosed and treated separately.
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Affiliation(s)
- Manchil P Redwin Dhas
- Department of Oral Medicine and Radiology, Sree Mookambika Institute of Dental Sciences, Tamilnadu, India
| | - Kannan S Karthiga
- College of Dentstry, al Zulfi. Majmaah University, Riyad Province, Saudi Arabia
| | - Joy E Tatu
- Department of Oral Medicine and Radiology, Sree Mookambika Institute of Dental Sciences, Tamilnadu, India
| | - Sherubin J Eugenia
- Department of Oral Medicine and Radiology, Sree Mookambika Institute of Dental Sciences, Tamilnadu, India
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Muscarella LA, Turchetti D, Fontana A, Baorda F, Palumbo O, la Torre A, de Martino D, Franco R, Losito NS, Repaci A, Pagotto U, Cinque L, Copetti M, Chiofalo MG, Pezzullo L, Graziano P, Scillitani A, Guarnieri V. Large deletion at the CDC73 gene locus and search for predictive markers of the presence of a CDC73 genetic lesion. Oncotarget 2018; 9:20721-20733. [PMID: 29755684 PMCID: PMC5945533 DOI: 10.18632/oncotarget.25067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/20/2018] [Indexed: 12/11/2022] Open
Abstract
The Hyperparathyroidism with Jaw-Tumours syndrome is caused by mutations of the CDC73 gene: it has been suggested that early onset of the disease and high Ca2+ levels may predict the presence of a CDC73 mutation. We searched for large deletions at the CDC73 locus in patients with: HPT-JT (nr 2), atypical adenoma (nr 7) or sporadic parathyroid carcinoma (nr 11) with a specific MLPA and qRT-PCR assays applied on DNA extracted from whole blood. A Medline search in database for all the papers reporting a CDC73 gene mutation, clinical/histological diagnosis, age at onset, Ca2+, PTH levels for familial/sporadic cases was conducted with the aim to possibly identify biochemical/clinical markers predictive, in first diagnosis, of the presence of a CDC73 gene mutation. A novel genomic deletion of the first 10 exons of the CDC73 gene was found in a 3-generation HPT-JT family, confirmed by SNP array analysis. A classification tree built on the published data, showed the highest probability of having a CDC73 mutation in subjects with age at the onset < 41.5 years (44/47 subjects, 93.6%, had the mutation). Whereas the lowest probability was found in subjects with age at the onset ≥ 41.5 years and Ca2+ levels <13.96 mg/dL (7/20 subjects, 35.0%, had the mutation, odds ratio = 27.1, p < 0.001). We report a novel large genomic CDC73 gene deletion identified in an Italian HPT-JT family. Age at onset < 41.5 ys and Ca2+ > 13.96 mg/dL are predictive for the presence of a CDC73 genetic lesion.
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Affiliation(s)
- Lucia Anna Muscarella
- Laboratory of Oncology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
| | - Daniela Turchetti
- Medical Genetics, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna 40138, Italy
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
| | - Filomena Baorda
- Medical Genetics, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
| | - Orazio Palumbo
- Medical Genetics, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
| | - Annamaria la Torre
- Laboratory of Oncology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy.,ISBReMIT, Institute for Stem-cell Biology, Regenerative Medicine and Innovative Therapies, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
| | - Danilo de Martino
- Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
| | - Renato Franco
- Pathology , Istituto Nazionale Tumori, Fondazione "G. Pascale", Napoli 80131, Italy
| | - Nunzia Simona Losito
- Pathology , Istituto Nazionale Tumori, Fondazione "G. Pascale", Napoli 80131, Italy
| | - Andrea Repaci
- Endocrinology, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna 40138, Italy
| | - Uberto Pagotto
- Endocrinology, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna 40138, Italy
| | - Luigia Cinque
- Medical Genetics, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
| | - Maria Grazia Chiofalo
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale Tumori, Fondazione "G. Pascale", Napoli 80131, Italy
| | - Luciano Pezzullo
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale Tumori, Fondazione "G. Pascale", Napoli 80131, Italy
| | - Paolo Graziano
- Pathology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
| | - Alfredo Scillitani
- Endocrinology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
| | - Vito Guarnieri
- Medical Genetics, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo 71013, Italy
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Iacobone M, Carnaille B, Palazzo FF, Vriens M. Hereditary hyperparathyroidism--a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg 2015; 400:867-86. [PMID: 26450137 DOI: 10.1007/s00423-015-1342-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hereditary hyperparathyroidism has been reported to occur in 5-10 % of cases of primary hyperparathyroidism in the context of multiple endocrine neoplasia (MEN) types 1, 2A and 4; hyperparathyroidism-jaw tumour (HPT-JT); familial isolated hyperparathyroidism (FIHPT); familial hypocalciuric hypercalcaemia (FHH); neonatal severe hyperparathyroidism (NSHPT) and autosomal dominant moderate hyperparathyroidism (ADMH). This paper aims to review the controversies in the main genetic, clinical and pathological features and surgical management of hereditary hyperparathyroidism. METHODS A peer review literature analysis on hereditary hyperparathyroidism was carried out and analyzed in an evidence-based perspective. Results were discussed at the 2015 Workshop of the European Society of Endocrine Surgeons devoted to hyperparathyroidism due to multiple gland disease. RESULTS Literature reports scarcity of prospective randomized studies; thus, a low level of evidence may be achieved. CONCLUSIONS Hereditary hyperparathyroidism typically presents at an earlier age than the sporadic variants. Gene penetrance and expressivity varies. Parathyroid multiple gland involvement is common, but in some variants, it may occur metachronously often with long disease-free intervals, simulating a single-gland involvement. Bilateral neck exploration with subtotal parathyroidectomy or total parathyroidectomy + autotransplantation should be performed, especially in MEN 1, in order to decrease the persistent and recurrent hyperparathyroidism rates; in some variants (MEN 2A, HPT-JT), limited parathyroidectomy can achieve long-term normocalcemia. In FHH, surgery is contraindicated; in NSHPT, urgent total parathyroidectomy is required. In FIHPT, MEN 4 and ADMH, a tailored case-specific approach is recommended.
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Affiliation(s)
- Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padova, Italy.
| | - Bruno Carnaille
- Department of Endocrine Surgery, Université de Lille, Lille, France
| | - F Fausto Palazzo
- Department of Endocrine and Thyroid Surgery, Hammersmith Hospital and Imperial College, London, UK
| | - Menno Vriens
- Department of Surgical Oncology and Endocrine Surgery, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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