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

Yıl 2020, Cilt: 4 Sayı: 2, 78 - 85, 31.08.2020

Funda Öztürk Berrin Çetinaslan Emre Gezer Yeşim Saliha Gürbüz Alev Selek Mehmet Sözen Zeynep Cantürk İlhan Tarkun

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

Destekleyen Kurum

herhangi bir kurum yada kuruluştan fon almamıştır

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

Kaynakça

• 1. O’Connor C, Levine JA, Hahr A. Primary Hyperparathyroidism. In: Metabolic Bone Diseases. Cham: Springer International Publishing; 2019. p. 15–25.
• 2. Cetani F, Marcocci C. Parathyroid Carcinoma. In: The Parathyroids: Basic and Clinical Concepts. Elsevier Inc.; 2015. p. 409–21.
• 3. Bilezikian JP, Bandeira L, Khan A, Cusano NE. Hyperparathyroidism. Vol. 391, The Lancet. Lancet Publishing Group; 2018. p. 168–78.
• 4. Haglund F, Ma R, Huss M, Sulaiman L, Lu M, Nilsson IL, et al. Evidence of a functional estrogen receptor in parathyroid adenomas. J Clin Endocrinol Metab. 2012 Dec;97(12):4631–9.
• 5. Farford B, Presutti RJ, Moraghan TJ. Nonsurgical management of primary hyperparathyroidism. Vol. 82, Mayo Clinic Proceedings. Elsevier Ltd; 2007. p. 351–5.
• 6. Greenberg C, Kukreja SC, Bowser EN, Hargis GK, Henderson WJ, Williams GA. Parathyroid hormone secretion: Effect of estradiol and progesterone. Metabolism. 1987;36(2):151–4.
• 7. Nilsson S, Koehler KF, Gustafsson JÅ. Development of subtype-selective oestrogen receptor-based therapeutics. Vol. 10, Nature Reviews Drug Discovery. Nat Rev Drug Discov; 2011. p. 778–92.
• 8. Bindlish V, Freeman JL, Witterick IJ, Asa SL. Correlation of biochemical parameters with single parathyroid adenoma weight and volume. Head Neck. 2002 Nov 1;24(11):1000–3.
• 9. Wagner PK, Rothmund M. Untersuchungen zur Korrelation von Tumorgewicht und typisch pathologischen Laborparametern beim primären und sekundären Hyperparathyreoidismus. Langenbecks Arch Chir. 1983 Jun;360(2):133–9.
• 10. Saadeh G, Licata AA, Esselstyn C, Gupta M. Relationship of parathyroid adenoma volume and biochemical function. Horm Res Paediatr. 1989;32(4):142–4.
• 11. F. Richard Bringhurst, Demay MB, Kronenberg HM. Hormones and Disorders of Mineral Metabolism. In: S M, KS P, PD L, HM K, editors. Williams Textbook of Endocrinology. 12th ed. ElsevierSanderspublications; 2011. p. 1237–304.
• 12. Prince RL, Maclaughlin DT, Gaz RD, Neer RM. Lack of evidence for estrogen receptors in human and bovine parathyroid tissue. J Clin Endocrinol Metab. 1991 Jun 1;72(6):1226–8.
• 13. Saxe AW, Gibson GW, Russo IH, Gimotty P. Measurement of estrogen and progesterone receptors in abnormal human parathyroid tissue. Calcif Tissue Int. 1992 Nov;51(5):344–7.
• 14. Carrillo-López N, Román-García P, Rodríguez-Rebollar A, Fernández-Martín JL, Naves-Díaz M, Cannata-Andía JB. Indirect regulation of PTH by estrogens may require FGF23. J Am Soc Nephrol. 2009 Sep 1;20(9):2009–17.
• 15. Mazeh H, Sippel RS, Chen H. The role of gender in primary hyperparathyroidism: Same disease, different presentation. Ann Surg Oncol. 2012 Sep 26;19(9):2958–62.
• 16. Shah VN, Bhadada SK, Bhansali A, Behera A, Mittal BR, Bhavin V. Influence of age and gender on presentation of symptomatic primary hyperparathyroidism. J Postgrad Med. 2012 Apr;58(2):107–11.
• 17. Cigerli O, Parildar H, Unal AD, Tarcin O, Erdal R, Guvener Demirag N. Vitamin D deficiency is a problem for adult out-patients? A university hospital sample in Istanbul, Turkey. Public Health Nutr. 2013 Jul;16(7):1306–13.
• 18. Moretz WH, Watts TL, Virgin FW, Chin E, Gourin CG, Terris DJ. Correlation of intraoperative parathyroid hormone levels with parathyroid gland size. Laryngoscope. 2007 Nov 1;117(11):1957–60.
• 19. Kebebew E, Hwang J, Reiff E, Duh QY, Clark OH. Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: A simple and accurate scoring model. Arch Surg. 2006 Aug 1;141(8):777–82. 20. Williams JG, Wheeler MH, Aston JP, Brown RC, Woodhead JS. The relationship between adenoma weight and intact (1-84) parathyroid hormone level in primary hyperparathyroidism. Am J Surg. 1992 Mar 1;163(3):301–4.
• 21. Hamidi S, Aslani A, Nakhjavani M, Pajouhi M, Hedayat A, Kamalian N. Are biochemical values predictive of adenoma’s weight in primary hyperparathyroidism? ANZ J Surg. 2006 Oct 1;76(10):882–5.
• 22. Cetani F, Picone A, Cerrai P, Vignali E, Borsari S, Pardi E, et al. Parathyroid Expression of Calcium-Sensing Receptor Protein and in Vivo Parathyroid Hormone-Ca 2+ Set-Point in Patients with Primary Hyperparathyroidism 1 . J Clin Endocrinol Metab. 2000 Dec 1;85(12):4789–94.
• 23. Mun HC, Conigrave A, Wilkinson M, Delbridge L, Duh QY, Delbridge L. Surgery for hyperparathyroidism: Does morphology or function matter most? Surgery. 2005 Dec 1;138(6):1111–20.