Estrogen Receptor-Alpha Expression and The Correlation Between Pathologic and Clinical Features in Parathyroid Adenomas

Öz

Aim: Primary hyperparathyroidism is the most common cause of hypercalcemia.Primary hyperparathyroidism shows a marked increase in postmenopausal women.In this study, we aimed to evaluate the estrogen receptors alpha (ERα) expression in parathyroid adenomas and the association of preoperative serum calcium and parathyroid hormone (PTH) levels with adenoma weight of patients diagnosed with primary hyperparathyroidism. Material and Methods: Total of 50 patients were included in the study, after excluding the patients diagnosed with tertiary hyperparathyroidism, double adenoma, parathyroid hyperplasia and parathyroid carcinoma. The diagnosis of parathyroid adenoma was confirmed by pathologist. After validation of parathyroid adenoma, ERα expression was evaluated with immunohistochemical method. Pathological features of the parathyroid adenomas were recorded. Results: The patients included in the study are mostly women and are in the postmenopausal period. Parathyroid adenoma hasn’t shown ERα expression in immunohistochemical staining. Male patients had higher mean pre-operative calcium and vitamin D levels than women (p=0.026, p=0.009 respectively). There was no correlation between menopause and pre-postoperative calcium, vitamin D and PTH. Correlation was found between adenoma diameter and adenoma weight with pre-operative serum calcium and PTH levels. Conclusion: In our study, statistically significant positive correlation was detected between the diameter of parathyroid adenoma and preoperative serum calcium together with PTH levels. This finding suggests the preoperative clinical features of the patients may be useful in predicting the adenoma diameter. However, it is important to determine the cut-off values of serum calcium and PTH level which might have a significant association with the adenoma diameter.

Anahtar Kelimeler

• hyperparathyroidism
• parathyroid adenoma
• Estrogen receptor alpha

Paratiroid Adenomlarında Östrojen Reseptör-Alfa Ekspresyonu ve Patolojik ve Klinik Özellikler Arasındaki Korelasyon

Öz

Amaç: Primer hiperparatiroidizm hiperkalseminin en yaygın nedenidir. Primer hiperparatiroidizm postmenopozal kadınlarda belirgin bir artış gösterir. Bu çalışmada primer hiperparatiroidi tanısı alan hastaların paratiroid adenomlarında östrojen reseptör alfa (ERα) ekspresyonu ile preoperatif serum kalsiyum ve paratiroid hormon (PTH) düzeylerinin adenom ağırlığı arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Tersiyer hiperparatiroidizm, çift adenom, paratiroid hiperplazi ve paratiroid karsinomu tanısı alan hastalar hariç tutulduktan sonra toplam 50 hasta çalışmaya dâhil edildi. Paratiroid adenom tanısı bir patolog tarafından doğrulandı. Paratiroid adenomunun doğrulanmasından sonra immünohistokimyasal yöntemle ERα ekspresyonu değerlendirildi. Paratiroid adenomlarının patolojik özellikleri kaydedildi. Bulgular: Çalışmaya dâhil edilen hastalar çoğunlukla kadın ve menopoz sonrası dönemdedirler. Hiçbir paratiroid adenomu immünohistokimyasal boyamada ERα ekspresyonu göstermemiştir. Erkek hastaların ameliyat öncesi ortalama kalsiyum ve D vitamini düzeyleri kadınlara göre daha yüksekti (sırasıyla p = 0.026, p = 0.009). Menopoz ile ameliyat öncesi kalsiyum, D vitamini ve PTH arasında korelasyon yoktu. Ameliyat öncesi serum kalsiyum ve PTH düzeyleri ile adenom çapı ve adenom ağırlığı arasında güçlü bir korelasyon bulundu. Sonuç: Çalışmamızda PTH düzeyleri ile birlikte paratiroid adenom çapı ve preoperatif serum kalsiyum arasında istatistiksel olarak anlamlı pozitif güçlü korelasyon saptandı. Bu bulgu hastaların ameliyat öncesi klinik özelliklerinin adenom çapının öngörülmesinde yararlı olabileceğini düşündürmektedir. Bununla birlikte, adenom çapı ile anlamlı bir ilişkisi olabilecek serum kalsiyum ve PTH seviyesinin cut-off değerlerini belirlemek önemlidir.

Anahtar Kelimeler

• hiperparatiroidizm
• paratiroid adenom
• Östrojen reseptör alfa

Kaynakça

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