Abstract
Primary hyperparathyroidism (PHP) and myelofibrosis are rare entities in childhood. Myelofibrosis secondary to PHP is also extremely rare. We report a 15-year-old boy presented with generalized weakness, vomiting, and pallor. A parathyroid adenoma was detected on the left distal parathyroid gland. PHP was diagnosed together with hepatosplenomegaly and pancytopenia. Bone marrow biopsy revealed grade 3–4 reticulin fibrosis. As early as 2 months after the left distal parathyroidectomy, hematologic parameters improved without any other intervention. His liver and spleen also gradually decreased in size. We concluded that the pancytopenia was as a result of myelofibrosis from PHP.
References
1. Lichtman MA, Tefferi A. Primary myelofibrosis. In: Kaushansky K, Lichtman MA, Beutler E, editors. Williams Hematology, 8th ed. New York: McGraw-Hill, 2010:1388–9.Search in Google Scholar
2. Lim DJ, Oh EJ, Park CW, Kwon HS, Hong EJ, et al. Pancytopenia and secondary myelofibrosis could be induced by primary hyperparathyroidism. Int J Lab Hem 2007;29:464–8.10.1111/j.1365-2257.2006.00877.xSearch in Google Scholar
3. Levard G, Gaudelus J, Cessans C. Primary hyperparathyroidism in children. Ann Chir 1992;46:653–8.Search in Google Scholar
4. Kollars J, Zarroug AE, van Heerden J, Lteif A, Stavlo P, et al. Primary hyperparathyroidism in pediatric patients. Pediatrics 2005;115:974–80.10.1542/peds.2004-0804Search in Google Scholar
5. Akyay A, Solmaz OA. Myelofibrosis associated with vitamin D deficiency rickets in an older aged child. Pediatr Hematol Oncol 2012;29:691–3.10.3109/08880018.2012.727064Search in Google Scholar
6. Nomura S, Ogawa Y, Osawa G, Katagiri M, Harada T, et al. Myelofibrosis secondary to renal osteodystrophy. Nephron 1996;72:683–7.10.1159/000188961Search in Google Scholar
7. Lotinun S, Sibonga JD, Turner RT. Evidence that the cells responsible for marrow fibrosis in a rat model for hyperparathyroidism are preosteoblasts. Endocrinology 2005;146:4074–81.10.1210/en.2005-0480Search in Google Scholar
8. Coppolino G, Bolignano D, De Paola L, Giulino C, Manella A, et al. Parathyroid hormone and mobilization of circulating bone marrow-derived cells in uremic patients. J Investig Med 2011;59:823–8.10.2310/JIM.0b013e318214edf8Search in Google Scholar
9. Brunner S, Zaruba MM, Huber B, Vallaster M, Assmann G, et al. Parathyroid hormone effectively induces mobilization of progenitor cells without depletion of bone marrow. Exp Hematol 2008;36:1157–66.10.1016/j.exphem.2008.03.014Search in Google Scholar
10. Greenfield EM, Gornik SA, Horowitz MC, Donahue HJ, Shaw SM. Regulation of cytokine expression in osteoblasts by parathyroid hormone: rapid stimulation of interleukin-6 and leukemia inhibitory factor mRNA. J Bone Miner Res 1993;8:1163–71.10.1002/jbmr.5650081003Search in Google Scholar
11. Duarte ME, Carvalho EF, Cruz EA, Lucena SB. Cytokine accumulation in osteitis fibrosis of renal osteodystrophy. Braz J Med Biol Res 2002;35:25–9.10.1590/S0100-879X2002000100004Search in Google Scholar
12. Ohishi M, Schipani E. PTH and stem cells. J Endocrinol Invest 2011;34:552–6.Search in Google Scholar
13. Rao DS, Shih MS, Mohini R. Effect of serum parathyroid hormone and bone marrow fibrosis on the response to erythropoietin in uremia. N Engl J Med 1993;328:171–5.10.1056/NEJM199301213280304Search in Google Scholar
14. Bhadada SK, Bhansali A, Ahluwalia J, Chanukya GV, Behera A, et al. Anaemia and marrow fibrosis in patients with primary hyperparathyroidism before and after curative parathyroidectomy. Clin Endocrinol 2009;70:527–32.10.1111/j.1365-2265.2008.03346.xSearch in Google Scholar
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