scholarly journals Brown tumor of the jaw after pregnancy and lactation in a MEN1 patient

2016 ◽  
Vol 2016 ◽  
Author(s):  
Anna Casteràs ◽  
Lídia Darder ◽  
Carles Zafon ◽  
Juan Antonio Hueto ◽  
Margarita Alberola ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Primary Hyperparathyroidism ◽  
Bone Mineral ◽  
Parathyroid Glands ◽  
Brown Tumor ◽  
Mineral Density ◽  
Men 1 ◽  
Pregnancy And Lactation ◽  
Brown Tumors

Summary Skeletal manifestations of primary hyperparathyroidism (pHPT) include brown tumors (BT), which are osteoclastic focal lesions often localized in the jaws. Brown tumors are a rare manifestation of pHTP in Europe and USA; however, they are frequent in developing countries, probably related to vitamin D deficiency and longer duration and severity of disease. In the majority of cases, the removal of the parathyroid adenoma is enough for the bone to remineralize, but other cases require surgery. Hyperparathyroidism in MEN1 develops early, and is multiglandular and the timing of surgery remains questionable. To our knowledge, there are no reports of BT in MEN 1 patients. We present a 29-year-old woman with MEN 1 who developed a brown tumor of the jaw 24 months after getting pregnant, while breastfeeding. Serum corrected calcium remained under 2.7 during gestation, and at that point reached a maximum of 2.82 mmol/L. Concomitant PTH was 196 pg/mL, vitamin D 13.7 ng/mL and alkaline phosphatase 150 IU/L. Bone mineral density showed osteopenia on spine and femoral neck (both T-scores = −1.6). Total parathyroidectomy was performed within two weeks, with a failed glandular graft autotransplantation, leading to permanent hypoparathyroidism. Two months after removal of parathyroid glands, the jaw tumor did not shrink; thus, finally it was successfully excised. We hypothesize that higher vitamin D and mineral requirements during maternity may have triggered an accelerated bone resorption followed by appearance of the jaw BT. We suggest to treat pHPT before planning a pregnancy in MEN1 women or otherwise supplement with vitamin D, although this approach may precipitate severe hypercalcemia. Learning points: Brown tumors of the jaw can develop in MEN 1 patients with primary hyperparathyroidism at a young age (less than 30 years). Pregnancy and lactation might trigger brown tumors by increasing mineral and vitamin D requirements. Early parathyroidectomy is advisable in MEN 1 patients with primary hyperparathyroidism, at least before planning a pregnancy. Standard bone mineral density does not correlate with the risk of appearance of a brown tumor. Removal of parathyroid glands does not always lead to the shrinkage of the brown tumor, and surgical excision may be necessary.

scholarly journals P114 Effect of vitamin D on parathyroid hormone, serum calcium and bone mineral density in patients with primary hyperparathyroidism being managed conservatively

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Mahrukh Khalid ◽  
Vismay Deshani ◽  
Khalid Jadoon
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Bone Mineral ◽  
Serum Calcium ◽  
Mineral Density ◽  
Neck Of Femur ◽  
Vitamin D Levels ◽  
Significant Difference

Abstract Background/Aims  Vitamin D deficiency is associated with more severe presentation of primary hyperparathyroidism (PTHP) with high parathyroid hormone (PTH) levels and reduced bone mineral density (BMD). We analyzed data to determine if vitamin D levels had any impact on PTH, serum calcium and BMD at diagnosis and 3 years, in patients being managed conservatively. Methods  Retrospective analysis of patients presenting with PHPT. Based on vitamin D level at diagnosis, patients were divided into two groups; vitamin D sufficient (≥ 50 nmol/L) and vitamin D insufficient (≤ 50 nmol/L). The two groups were compared for age, serum calcium and PTH levels at diagnosis and after mean follow up of 3 years. BMD at forearm and neck of femur (NOF) was only analyzed in the two groups at diagnosis, due to lack of 3 year’s data. Results  There were a total of 93 patients, 17 males, mean age 70; range 38-90. Mean vitamin D level was 73.39 nmol/L in sufficient group (n = 42) and 34.48 nmol/L in insufficient group (n = 40), (difference between means -38.91, 95% confidence interval -45.49 to -32.33, p < 0.0001). There was no significant difference in age, serum calcium and PTH at the time of diagnosis. After three years, there was no significant difference in vitamin D levels between the two groups (mean vitamin D 72.17 nmol/L in sufficient group and 61.48 nmol/L in insufficient group). Despite rise in vitamin D level in insufficient group, no significant change was observed in this group in PTH and serum calcium levels. BMD was lower at both sites in vitamin D sufficient group and difference was statistically significant at NOF. Data were analyzed using unpaired t test and presented as mean ± SEM. Conclusion  50% of patients presenting with PHPT were vitamin D insufficient at diagnosis. Vitamin D was adequately replaced so that at 3 years there was no significant difference in vitamin D status in the two groups. Serum calcium and PTH were no different in the two groups at diagnosis and at three years, despite rise in vitamin D levels in the insufficient group. Interestingly, BMD was lower at forearm and neck of femur in those with sufficient vitamin D levels and the difference was statistically significant at neck of femur. Our data show that vitamin D insufficiency does not have any significant impact on PTH and calcium levels and that vitamin D replacement is safe in PHPT and does not impact serum calcium and PTH levels in the short term. Lower BMD in those with adequate vitamin D levels is difficult to explain and needs further research. Disclosure  M. Khalid: None. V. Deshani: None. K. Jadoon: None.

Vitamin D status, seasonal variations, parathyroid adenoma weight and bone mineral density in primary hyperparathyroidism

2005 ◽  
Vol 63 (5) ◽  
pp. 506-513 ◽  
Author(s):  
B. Moosgaard ◽  
P. Vestergaard ◽  
L. Heickendorff ◽  
F. Melsen ◽  
P. Christiansen ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Bone Mineral ◽  
Seasonal Variations ◽  
Vitamin D Status ◽  
Mineral Density

Relationships between Age, Sex, Vitamin D, and Bone Mineral Density in Primary Hyperparathyroidism.

2010 ◽  
pp. P2-239-P2-239
Author(s):  
Huong D. Nguyen ◽  
Thanh D. Hoang ◽  
Vinh Q. Mai ◽  
Patrick W. Clyde ◽  
Babette C. Glister ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Primary Hyperparathyroidism ◽  
Bone Mineral ◽  
Mineral Density

scholarly journals Effect of Low Dietary Vitamin D Fed Prior to and During Pregnancy and Lactation on Maternal Bone Mineral Density, Structure and Strength in C57BL/6 Mice

2021 ◽  
Author(s):  
Christopher R Villa ◽  
Sandra M Sacco ◽  
Jianmin Chen ◽  
Amel Taibi ◽  
Elena M Comelli ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Bone Strength ◽  
Bone Mineral ◽  
Distal Femur ◽  
Bone Structure ◽  
Lumbar Vertebra ◽  
Dietary Vitamin ◽  
Mineral Density ◽  
Pregnancy And Lactation

ABSTRACT Several studies have shown that diets containing lower vitamin D than in the AIN-93G diet do not compromise bone structure, bone mineral density (BMD) and/or bone strength in male and female mice. This study determined if a diet containing low vitamin D from pre-pregnancy through the end of lactation maintained these bone outcomes to a similar extent as a high vitamin D diet. Mice were fed an AIN-93G diet with 25 (LD diet) or 5000 (HD diet) IU vitamin D/kg diet from pre-mating through lactation (n = 15/group). Of the major structure outcomes, only cortical area fraction of the distal femur was lower (P < 0.05) with LD diet. Lumbar vertebra BMD was lower (P < 0.05) with LD while distal femur BMD and bone strength at three sites did not differ. Dams fed a LD diet pre-mating through the end of lactation had largely similar bone outcomes to dams fed a HD diet.

scholarly journals The Vitamin D Receptor (VDR) Start Codon Polymorphism in Primary Hyperparathyroidism and Parathyroid VDR Messenger Ribonucleic Acid Levels1

1999 ◽  
Vol 84 (5) ◽  
pp. 1690-1694
Author(s):  
Pamela Correa ◽  
Jonas Rastad ◽  
Peter Schwarz ◽  
Gunnar Westin ◽  
Andreas Kindmark ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Primary Hyperparathyroidism ◽  
Bone Mineral ◽  
Vitamin D Receptor ◽  
Ribonucleic Acid ◽  
Parathyroid Cell ◽  
Mineral Density ◽  
Foki Polymorphism ◽  
Messenger Ribonucleic Acid

Vitamin D regulates parathyroid cell proliferation and secretion of PTH. Increased prevalence of the polymorphic vitamin D receptor (VDR) alleles b, a, and T has been reported in sporadic primary hyperparathyroidism (PHPT), suggesting that these genetic variants may predispose to the disease. Recently, another polymorphism in the VDR gene was related to bone mineral density, and this VDR-FokI polymorphism causes different lengths of the VDR, implying possible functional consequences. The VDR-FokI polymorphism was studied in 182 postmenopausal women with sporadic PHPT and in matched controls. No significant differences in distribution of the VDR-FokI genotypes could be detected between the groups, although there was a tendency toward overrepresentation of the F allele in the PHPT patients (P = 0.05). There were no significant associations with age, serum calcium, serum PTH, bone mineral density, or parathyroid tumor weight. The VDR genotypes were unrelated to VDR and PTH messenger ribonucleic acid levels in the parathyroid adenomas of 42 PHPT patients. In 23 PHPT patients, the Ca2+-PTH set-points were determined in vivo and were unrelated to the VDR alleles. We suggest that the VDR-FokI polymorphism has at most a minor pathogenic importance in the development of PHPT.

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