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Surgery. 2018 Jan;163(1):31-34. doi: 10.1016/j.surg.2017.04.027. Epub 2017 Nov 3.

Familial isolated primary hyperparathyroidism associated with germline GCM2 mutations is more aggressive and has a lesser rate of biochemical cure.

Author information

1
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
2
Metabolic Disease Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
3
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Surgery, The George Washington University, School of Medicine and Health Sciences, Washington, DC. Electronic address: kebebewe@mail.nih.gov.

Abstract

BACKGROUND:

Hereditary primary hyperparathyroidism may be syndromic or nonsyndromic (familial isolated hyperparathyroidism). Recently, germline activating mutations in the GCM2 gene were identified in a subset of familial isolated hyperparathyroidism. This study examined the clinical and biochemical characteristics and the treatment outcomes of GCM2 mutation-positive familial isolated hyperparathyroidism as compared to sporadic primary hyperparathyroidism.

METHODS:

We performed a retrospective analysis of clinical features, parathyroid pathology, and operative outcomes in 18 patients with GCM2 germline mutations and 457 patients with sporadic primary hyperparathyroidism.

RESULTS:

Age at diagnosis, sex distribution, race/ethnicity, and preoperative serum calcium concentrations were similar between the 2 groups. The preoperative serum levels of intact parathyroid hormone was greater in patients with GCM2-associated primary hyperparathyroidism (239 ± 394 vs 136 ± 113, P = .005) as were rates of multigland disease and parathyroid carcinoma in the GCM2 group (78% vs 14.3%, P < .001 and 5% vs 0%, P = .04, respectively), but the biochemical cure rate was less in the GCM2 group (86% vs 99%, P < .001).

CONCLUSION:

GCM2-associated primary hyperparathyroidism patients have greater preoperative parathyroid hormone levels, a greater rate of multigland disease, a lesser rate of biochemical cure, and a substantial risk of parathyroid carcinoma. Knowledge of these clinical characteristics could optimize the surgical management of GCM2-associated familial isolated hyperparathyroidism.

Comment in

PMID:
29108698
PMCID:
PMC5736428
DOI:
10.1016/j.surg.2017.04.027
[Indexed for MEDLINE]
Free PMC Article

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