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The Parathyroid Glands00:59

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
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The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
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Calcitonin, a vital polypeptide hormone, regulates calcium levels within body fluids. It is released by the parafollicular cells, also known as C cells, situated in the follicular epithelium of the thyroid gland. Calcitonin responds to fluctuations in blood calcium levels and the influence of gastrointestinal hormones like gastrin and cholecystokinin.
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The Thyroid Gland01:23

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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
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Giant Cell Lesions Associated with Primary Hyperparathyroidism.

Sachin Rai1, Vidya Rattan1, Sanjay K Bhadada2

  • 1Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India.

Journal of Maxillofacial and Oral Surgery
|November 26, 2015
PubMed
Summary

Giant cell lesions in the oral and maxillofacial region associated with primary hyperparathyroidism (PHPT) are rare. Surgical treatment for jaw lesions was avoided after parathyroidectomy corrected PHPT.

Keywords:
Alkaline phosphataseBrown tumorGiant cell lesionHypercalcemiaParathyroid hormonePrimary hyperparathyroidism

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Endocrinology
  • Oncology

Background:

  • Giant cell lesions, also known as brown tumors, can manifest in the oral and maxillofacial region.
  • These lesions are sometimes associated with primary hyperparathyroidism (PHPT), a condition characterized by excessive parathyroid hormone production.
  • Understanding the prevalence and clinical presentation of PHPT-associated giant cell lesions is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To determine the prevalence of giant cell lesions linked to PHPT in the oral and maxillofacial area.
  • To describe the clinical features, diagnostic laboratory values, and treatment outcomes for these specific lesions.
  • To evaluate the impact of correcting PHPT on the regression of oral and maxillofacial giant cell lesions.

Main Methods:

  • A retrospective analysis of histopathologically confirmed giant cell lesions in the oral and maxillofacial region over a 5-year period.
  • Identification and tabulation of cases associated with PHPT.
  • Correlation of clinical findings with serum calcium, phosphate, alkaline phosphatase, and parathormone levels.
  • Assessment of lesion regression following parathyroidectomy.

Main Results:

  • Out of 85 giant cell lesions, five (5.9%) were associated with PHPT.
  • Lesions occurred in the maxilla, mandible, and frontal bone, with one case presenting multiple lytic lesions.
  • Patients consistently exhibited elevated alkaline phosphatase and parathormone levels, with hypercalcemia and hypophosphatemia in four cases.
  • All five cases showed lesion regression after parathyroidectomy, negating the need for surgical intervention on the jaw lesions.

Conclusions:

  • Giant cell lesions associated with PHPT are uncommon in the oral and maxillofacial region.
  • These lesions are clinically, radiologically, and histopathologically indistinguishable from other giant cell tumors.
  • Altered biochemical values and patient history are key to linking oral findings to underlying PHPT, which may be the sole presenting sign.
  • Parathyroidectomy effectively resolves these lesions, avoiding the need for surgical excision of jaw lesions.