Primary Hyperparathyroidism in a Patient with Systemic Lupus erythematosus-Antiphospholipid Syndrome

Benekli, Mustafa; Savaş, Merve; Erdem, Yunus; Yalçın, Ahmet; Yasavul, Ünal; Turgan, Çetin; Çağlar, Şali

doi:10.1159/000045027

Cited by 11 publications

(11 citation statements)

References 2 publications

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“…Two cases have been previously reported of primary hyperparathyroidism and SLE in a single patient (13) (14). Together with this case, all three patients were women aged over 40 years with previously diagnosed SLE.…”

Section: Discussionsupporting

confidence: 62%

Functional parathyroid cyst in a patient with systemic lupus erythematosus: a case report

Jiang

Zhang

et al. 2015

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryFunctional parathyroid cysts are a rare cause of primary hyperparathyroidism and are often mistaken for thyroid cysts. Systemic lupus erythematosus (SLE) is also a very rare cause of hypercalcemia. We report the case of a 62-year-old woman, who was diagnosed with SLE 30 years ago, presenting with clinical and biochemical features of primary hyperparathyroidism. Laboratory investigation revealed increased serum calcium and parathyroid hormone (PTH) levels; neck ultrasonography (USG) revealed 40×34×26 mm cystic mass in the left lobe of thyroid gland. PTH level in the cysts was >2500 pg/ml, determined by USG-guided fine-needle aspiration (FNA). In this case, no evidence for potential pathogenic association between parathyroid cyst and SLE was uncovered. However, the recognition of this association is very important because the therapeutical strategy is completely different. Operative management is usually straightforward and alleviates symptoms and any biochemical abnormalities caused by the cyst.Learning points Functional parathyroid cysts are the rare cause of primary hyperparathyroidism and are often mistaken for thyroid cysts.SLE is also a very rare cause of hypercalcemia.Ultrasound-guided FNA of cystic fluid with assay for PTH level is an accurate method of differentiating parathyroid cyst from thyroid cyst.Appropriate management of functional parathyroid cysts is surgical excision.

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Section: Discussionsupporting

confidence: 62%

Functional parathyroid cyst in a patient with systemic lupus erythematosus: a case report

Jiang

Zhang

et al. 2015

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…Pacientes com hiperparatireoidismo freqüentemente referem dor óssea difusa, sem evidente inflamação articular, o que certamente retarda seu diagnóstico, uma vez que essa condição muitas vezes não é lembrada. A associação de hiperparatireoidismo primário com LES é uma situação bastante rara, sendo descrita previamente em apenas uma paciente (10). As duas pacientes, a da literatura e a nossa, encontravam-se na mesma faixa etária (40-50 anos) quando tiveram diagnóstico de hiperparatireoidismo primário, com quadro clínico e laboratorial parecidos, exceto pelo tempo de diagnóstico do LES, que na nossa paciente foi de dois anos e na paciente da literatura, de dez anos; além disso, o comprometimento renal e a presença da síndrome antifosfolipídica não foram observados na nossa paciente.…”

Section: Discussionunclassified

“…Essa poderia ser decorrente da presença de anticorpos estimuladores contra receptores de PTH (6), produção de peptídeo similar ao PTH (PTH-rP), mesmo na ausência de neoplasia (7), ou fazendo parte da chamada síndrome hipercalcemia/linfedema, que inclui adenomegalia e pleurite (8,9). Em uma ampla revisão de literatura, encontramos um único relato de caso de associação de hiperparatireoidismo primário com lúpus eritematoso sistêmico (10). O objetivo do presente trabalho é apresentar o segundo caso da literatura e discutir a interface dessas duas condições.…”

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Hiperparatireoidismo primário em paciente com lúpus eritematoso sistêmico

Galrão

Lima

Santos

et al. 2004

Arq Bras Endocrinol Metab

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RESUMOO hiperparatireoidismo primário (HPP) é uma doença metabólica que resulta da secreção anormal do hormônio da paratireóide (PTH), sendo uma das causas mais comuns de hipercalcemia na população geral. Apresentamos o caso de uma paciente de 47 anos, com diagnóstico prévio de lúpus eritematoso sistêmico (LES) há dois anos, que apresentou manifestações clínicas (dor óssea difusa, labilidade emocional, tumoração em ramo mandibular esquerdo) e laboratoriais (cálcio séri-co= 13,5mg/dL, fosfato= 1,8mg/dL, fosfatase alcalina= 3.028U/L, PTH intacto= 1472pg/dL) que culminaram com o diagnóstico de HPP, complementado pelo estudo anátomo-patológico, que evidenciou adenoma de paratireóide. Após o tratamento com calcitonina nasal 400UI/dia, pamidronato 90mg IV/semana e, por fim, a paratireoidectomia subtotal, a paciente apresentou melhora do quadro clínico e normalização dos exames laboratoriais. A presente descrição se constitui no segundo caso relatado na literatura, com tal associação de doenças. Embora os mecanismos etiopatogênicos do HPP em LES não estejam ainda definidos, essa associação deve ser sempre lembrada, uma vez que a estratégia terapêutica tende a mudar completamente. Primary hyperparathyroidism (PHP) is a metabolic illness that results from autonomous secretion of parathyroid hormone and is one of the most common causes of hypercalcemia. We present the case of a 47-yearold female with a previous diagnosis of systemic lupus erythematosus (SLE) in whom clinical (diffuse bone pain, emotional lability, jaw tumor) and laboratory features (calcium= 13.5mg/dL, phosphate= 1.8mg/dL, alkaline phosphatase= 3028U/L, PTH intact= 1472pg/dL) prompted the diagnosis of PHP secondary to parathyroid adenoma as demonstrated by the anatomopathology. After treatment with calcitonin spray 400UI per day, IV pamidronate 90mg/week, and subtotal parathyroidectomy, the patient status improved with normal laboratory tests. This is the second report to describe the coexistence of these two disorders in a single patient. Although the pathophysiology of the association of PHP and SLE is not known, the recognition of this association has a practical implication since the therapeutical strategy is completely different.

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“…Our review of the literature uncovered three reports linking aPL and APS to the parathyroid gland. In 1998, Benekli et al 82 presented a case of primary hyperparathyroidism in a patient with SLE/APS. Another report in 2001 by Sefer et al 83 described spontaneous healing of necrotic skin lesions of the lower leg and rapid aCL titers regression after parathyroidectomy in a 68-year-old dialyzed female patient with hyperparathyroidism and calcific-uremic arteriolopathy.…”

Section: Parathyroidmentioning

confidence: 99%

Antiphospholipid Syndrome: Endocrinologic Manifestations and Organ Involvement

Mehdi

Salti

Uthman

2011

Semin Thromb Hemost

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Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by thrombotic tendency that affects most organ systems in the human body. In this report, we present a review of the endocrinologic manifestations associated with APS by evaluating the medical literature from 1968 to 2009 using MEDLINE and these keywords: APS, antiphospholipid syndrome, antiphospholipid antibodies, anticardiolipin antibodies, lupus anticoagulant, anti β-2 glycoprotein I, pituitary, adrenal, thyroid, parathyroid, ovary, testes, diabetes mellitus, and diabetes insipidus. Adrenal insufficiency was found to be the most common endocrine manifestation associated with APS. Autoimmune thyroid disease was associated with increased titers of antiphospholipid antibodies (aPL) without any APS clinical manifestations. In addition, hypopituitarism and Sheehan syndrome are increasingly being reported in association with aPL. Data regarding the prevalence and significance of aPL in diabetic patients remains uncertain. Finally, only a few cases of ovarian and testicular derangements have been reported. APS should be considered in any patient with adrenal insufficiency even in the absence of other thrombotic manifestations. It is also advisable to assess aPL in the sera of patients presenting with pituitary insufficiency. Further studies are needed to clarify the relationship between aPL and thyroid disorders and diabetes mellitus.

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Primary Hyperparathyroidism in a Patient with Systemic Lupus erythematosus-Antiphospholipid Syndrome

Cited by 11 publications

References 2 publications

Functional parathyroid cyst in a patient with systemic lupus erythematosus: a case report

Functional parathyroid cyst in a patient with systemic lupus erythematosus: a case report

Hiperparatireoidismo primário em paciente com lúpus eritematoso sistêmico

Antiphospholipid Syndrome: Endocrinologic Manifestations and Organ Involvement

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