ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
Ru
En

Chondrocalcinosis: An Early Sign of Primary Hyperparathyroidism

DOI:10.31550/1727-2378-2020-19-11-52-55
For citation: Eliseev M.S., Novikova A.M., Zhelyabina O.V. Chondrocalcinosis: An Early Sign of Primary Hyperparathyroidism. Doctor.Ru. 2020; 19(11): 52–55. (in Russian). DOI: 10.31550/1727-2378-2020-19-11-52-55
30 December 09:42

Objective: To deeply analyse a case of a patient with calcium pyrophosphate crystal storage disease, where chondrocalcinosis (CC) preceded primary hyperparathyroidism (PHPT).

Key Points. The association of CC and hyperparathyroidism is well-known; and CC is recognised as one of the late signs of hyperparathyroidism. We describe a 67-year old patient with PHPT, presenting for a long time only with X-ray CC and chronic arthritis, associated with calcium pyrophosphate deposits. At the same time, he did not have any electrolyte imbalances, had normal serum calcium and parathyroid hormone levels; PHPT was diagnosed after 10 years of follow-up when the patient developed life-threatening hypercalcemia.

It can be assumed that, unlike other musculoskeletal signs, CC can be one of the earliest symptoms of hyperparathyroidism. Treating CC as a late sign of hyperparathyroidism is likely to be associated with challenges of early diagnosis (asymptomatic in some patients, low sensitivity of X-ray diagnostics). In order to assess the diagnostic value of CC in hyperparathyroidism, including patients with normal calcium levels, specific tests are essential.

Conclusion. Target examination for CC using highly-sensitive methods in patients with minor calcium metabolism disturbances, high/normal parathyroid hormone level or slightly increased parathyroid hormone level and normal calcium can improve the detection frequency of both CC and PHPT and follow-up of such patients. Early PHPT diagnosis (prior to clinical presentation) can help in preventing severe, life-threatening complications.

Contributions: Eliseev, M.S. — data collection and analysis; selection of thematic publications; article preparation and academic reviewing; Novikova, A.M. — data collection and analysis; selection of thematic publications; article preparation; Zhelyabina, O.V. — follow-up, dynamic patient monitoring, processing of information, text of the article.

Conflict of interest: The authors declare that they do not have any conflict of interests.

Source of funding: The article is prepared as a part of a fundamental scientific topic “Elaboration of Complex Therapies for Musculoskeletal System Disorders” No. АААА-А19-119021190150-6.

M.S. Eliseev (Corresponding author) — Nasonova Scientific and Research Institute of Rheumatology; 34А Kashirskoye Shosse, Moscow, Russian Federation 115522. eLIBRARY.RU SPIN: 2524-7320. https://orcid.org/0000-0003-1191-5831. E-mail: elicmax@yandex.ru

A.M. Novikova — Nasonova Scientific and Research Institute of Rheumatology; 34А Kashirskoye Shosse, Moscow, Russian Federation 115522. eLIBRARY.RU SPIN: 3821-1050. https://orcid.org/0000-0002-3667-722X. E-mail: aleksandra.novicova@yandex.ru

O.V. Zhelyabina — Nasonova Scientific and Research Institute of Rheumatology; 34А Kashirskoye Shosse, Moscow, Russian Federation 115522. eLIBRARY.RU SPIN: 8038-6195. https://orcid.org/0000-0002-5394-7869. E-mail: olga-sheliabina@mail.ru

Доктор.ру

Fig. Radiocarpal, metatarsophalangeal chondrocalcinosis. Image courtesy of the authors

r10_1.jpg

Received: 28.10.2020
Accepted: 07.12.2020

30 December 09:42
LITERATURE
  1. Silverberg S.J., Bandeira F., Liu J. et al. Primary hyperparathyroidism. In: Bilezikian J.P., ed. Primer on the metabolic bone diseases and disorders of mineral metabolism. Wiley-Blackwell; 2018: 619–28.
  2. Pappu R., Jabbour S.A., Reginato A.M. et al. Musculoskeletal manifestations of primary hyperparathyroidism. Clin. Rheumatol. 2016; 35(12): 3081–7. DOI: 10.1007/s10067-016-3450-3
  3. Bennett J., Suliburk J.W., Morón F.E. Osseous manifestations of primary hyperparathyroidism: imaging findings. Int. J. Endocrinol. 2020; 2020: 3146535. DOI: 10.1155/2020/3146535
  4. Diniz E.T., Bandeira F., Lins O.G. et al. Primary hyperparathyroidism is associated with subclinical peripheral neural alterations. Endocr. Pract. 2013; 19(2): 219–25. DOI: 10.4158/EP12207.OR
  5. Insogna K.L. Primary hyperparathyroidism. N. Engl. J. Med. 2018; 379(11): 1050–9. DOI: 10.1056/NEJMcp1714213
  6. Shah V.N., Bhadada S.K., Bhansali A. et al. Influence of age and gender on presentation of symptomatic primary hyperparathyroidism. J. Postgrad. Med. 2012; 58(2): 107–11. DOI: 10.4103/0022-3859.97171
  7. Ganie M.A., Raizada N., Chawla H. et al. Primary hyperparathyroidism may masquerade as rickets-osteomalacia in vitamin D replete children. J. Pediatr. Endocrinol. Metab. 2016; 29(10): 1207–13. DOI: 10.1515/jpem-2016-0018
  8. Bywaters E.G.L., Dixon A.J., Scott J.T. Joint lesions of hyperparathyroidism. Ann. Rheum. Dis. 1963; 22(3): 171–87. DOI: 10.1136/ard.22.3.171
  9. Dodds W.J., Steinbach H.L. Primary hyperparathyroidism and articular cartilage calcification. Am. J. Roentgenol. Radium Ther. Nucl. Med. 1968; 104(4): 884–92. DOI: 10.2214/ajr.104.4.884
  10. McGill P.E., Grange A.T., Royston C.S. Chondrocalcinosis in primary hyperparathyroidism. Influence of parathyroid activity and age. Scand. J. Rheumatol. 1984; 13(1): 56–8. DOI: 10.3109/03009748409102668
  11. Zhang W., Doherty M., Bardin T. et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann. Rheum. Dis. 2011; 70(4): 563–70. DOI: 10.1136/ard.2010.139105
  12. Geelhoed G.W., Kelly T.R. Pseudogout as a clue and complication in primary hyperparathyroidism. Surgery. 1989; 106(6): 1036–42, discussion 1041-2.
  13. Rho Y.H., Zhu Y., Zhang Y. et al. Risk factors for pseudogout in the general population. Rheumatology (Oxford). 2012; 51(11): 2070–4. DOI: 10.1093/rheumatology/kes204
  14. Dedov I.I., Melnichenko G.A., Mokrysheva N.G. et al. Primary hyperparathyroidism: the clinical picture, diagnostics, differential diagnostics, and methods of treatment. Problems of Endocrinology. 2016; 62(6): 40–77. (in Russian). DOI: 10.14341/probl201662640-77
  15. Tuna M.M., Çalışkan M., Ünal M. et al. Normocalcemic hyperparathyroidism is associated with complications similar to those of hypercalcemic hyperparathyroidism. J. Bone Miner. Metab. 2016; 34(3): 331–5. DOI: 10.1007/s00774-015-0673-3
  16. Canhão H., Fonseca J.E., Leandro M.J. et al. Cross-sectional study of 50 patients with calcium pyrophosphate dihydrate crystal arthropathy. Clin. Rheumatol. 2001; 20(2): 119–22. DOI: 10.1007/s100670170081
  17. Walker M.D., Silverberg S.J. Primary hyperparathyroidism. Nat. Rev. Endocrinol. 2018; 14(2): 115–25. DOI: 10.1038/nrendo.2017.104
  18. Gordon С., Swan А., Dieppe Р. Detection of crystals in synovial fluids by light microscopy: sensitivity and reliability. Ann. Rheum. Dis. 1989; 48(9): 737–42. DOI: 10.1136/ard.48.9.737
  19. Abreu M., Johnson K., Chung C.B. et al. Calcification in calcium pyrophosphate dihydrate (CPPD) crystalline deposits in the knee: anatomic, radiographic, MR imaging, and histologic study in cadavers. Skeletal Radiol. 2004; 33(7): 392–8. DOI: 10.1007/s00256-004-0767-9
  20. Filippucci E., Gutierrez Riveros M., Georgescu D. et al. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthritis Cartilage. 2009; 17(2): 178–81. DOI: 10.1016/j.joca.2008.06.003
  21. Frediani B., Filippou G., Falsetti P. et al. Diagnosis of calcium pyrophosphate dihydrate crystal deposition disease: ultrasonographic criteria proposed. Ann. Rheum. Dis. 2005; 64(4): 638–40. DOI: 10.1136/ard.2004.024109
  22. Filippou G., Adinolfi A., Iagnocco A. et al. Ultrasound in the diagnosis of calcium pyrophosphate dihydrate deposition disease. A systematic literature review and a meta-analysis. Osteoarthritis Cartilage. 2016; 24(6): 973–81. DOI: 10.1016/j.joca.2016.01.136
  23. Checa A. Ultrasonography, an operator-dependent modality versus dual-energy computed tomography (DECT) in the detection of chondrocalcinosis: with regard to Tanikawa et al.'s study. J. Orthop. Surg. Res. 2018; 13(1): 255. DOI: 10.1186/s13018-018-0953-4
  24. Tanikawa H., Ogawa R., Okuma K. et al. Detection of calcium pyrophosphate dihydrate crystals in knee meniscus by dual-energy computed tomography. J. Orthop. Surg. Res. 2018; 13(1): 73. DOI: 10.1186/s13018-018-0787-0
  25. McCarty D.J. Pseudogout, articular chondrocalcinosis. In: Hollander J.L., ed. Arthritis and allied conditions. Philadelphia: Lea & Febiger; 1966: 947–63.
  26. Rynes R.I., Merzig E.G. Calcium pyrophosphate crystal deposition disease and hyperparathyroidism: a controlled, prospective study. J. Rheumatol. 1978; 5(4): 460–8.
  27. Kudaeva F.M., Vladimirov S.A., Eliseev M.S. et al. The clinical manifestations of calcium pyrophosphate crystal deposition disease. Rheumatology Science and Practice. 2014; 52(4): 405–9. (in Russian). DOI: 10.14412/1995-4484-2014-405-409
  28. Melvin K.E. Articular chondrocalcinosis, hyperparathyroidism and pseudogout: hypomagnesaemic crisis. Proc. R. Soc. Med. 1966; 59(7): 595–6.
  29. Genant H.K., Heck L.L., Lanzi L.H. et al. Primary hyperparathyroidism. A comprehensive study of clinical, biochemical and radiographic manifestations. Radiology. 1973; 109: 513–24. DOI: 10.1148/109.3.513

News

30 June 00:00
A New Issue of Doctor.Ru Neurology Psychiatry, Vol. 20, No. 5 (2021), Published

Find original articles and reviews covering various aspects of neurology, psychiatry and the interview with Professor Marina Arkadievna Kinkulkina

28 June 00:00
A New Issue of Doctor.Ru Internal Medicine, Vol. 20, No. 4 (2021), Published

Find original articles and reviews covering various aspects of cardiology, gastroenterology, internal medicine and the interview with Professor Elena Zelikovna Golukhova

 

3 May 17:06
A New Issue of Doctor.Ru Pediatrics, Vol. 20, No. 3 (2021), Published

Find original articles and reviews covering various aspects of pediatrics and the interview with Professor Evgeny Grigorievich Furman

3 May 17:06
A New Issue of Doctor.Ru Endocrinology, Vol. 20, No. 2 (2021), Published

Find original articles and reviews covering various aspects of endocrinology and the interview with Professor Valentin Viktorovich Fadeev

16 April 11:57
Igor Evgenievich Khatkov joined the American Surgical Association

Igor Evgenievich Khatkov, Head of A. S. Loginov Moscow Clinical Scientific and Practical Centre, Chief Oncologist in and for Moscow is now an honoured member of the American Surgical Association.

All news