Endocrine Abstracts

Aim: To determine the incidence of hypocalcaemia and the need for calcium supplementation after thyroid surgery in 120 patients.Methods: A prospective study to determine the incidence of hypocalcaemia by measuring ionized calcium level in 120 patients underwent thyroidectomy at King Abdul Aziz University Hospital, the data included pre- and post-operative ionized calcium level, albumin, free thyroxine, thyrotopin and alkaline phosphatase. As well include...

Imatinib mesylate is a well-tolerated receptor tyrosine kinase inhibitor that has gained interest as a potential treatment for osteoporosis and other metabolic bone diseases. It is clinically approved for the treatment of chronic myelogenous leukaemia (CML), Philadelphia-positive acute lymphoblastic leukaemia and gastrointestinal stromal tumors (GIST), and targets the receptors for PDGFs, ABL-related gene, c-Abl, c-Kit and c-Fms. Altered bone and mineral metabolism has been de...

Introduction: Parathyroid hormone (PTH) starts to rise very early in the course of kidney disease. As kidney disease progresses, plasma levels of vitamin D and calcium begin to decline, thus contributing to greater secretion of PTH. In addition, the retention of phosphate further increases PTH secretion independent of calcium and vitamin D levels. Continued stimulation of PTH secretion leads to irreversible parathyroid gland hyperplasia.Objectives: To me...

Thyrotoxicosis has been linked to osteoporosis and increased fracture risk. On the other hand, decreasing serum levels of estrogens in postmenopausal women potentially may increase effect of thyroid hormones on bone tissue. Dual-energy X-ray absorptiometry is an accurate and precise method of determining BMD, and has been wildly-used for diagnosing osteopenia and osteoporosis. The aim of our study was to study by means of DXA the peculiarities of bone loss in women of differen...

Aim: To clarify the contribution of leptin to bone mineral density (BMD) in men with type 2 diabetes mellitus (DT2).Materials: We screened 168 Belorussian men aged 50–65 years. Plasma TC, HDL-C, LDL-C, VLDL-C, TG concentrations, HbA1c, IRI, CRP, total testosterone were assessed. BMD was evaluated using dual-energy X-ray absorptiometry (DXA). BMD was expressed as a T score. All statistical analyses were performed using SPSS v11.0 software....

All the defects of gonad formation during intrauterine development have been grouped under the name of gonadal disgenesias. Disturbances of the whole body appears in gonadal disgenesias, the disruption process of sexualization remaing the major event. In the absence or scarcity oestrogen, progesterone or androgens, hypogonadal sexoidoprive osteoporosis develops.Objectives: Early diagnosis of gonad disgenesias; study of bone mineral metabolism alterations...

Objectives: The premature ovarian failure (the poor ovaries’ syndrome) is characterized by the ovaries inability to normally sexualize, due to a poor sexoidogenetic device (low gonocyte population).Analysis of subjective and objective clinical criteria of patients with premature ovarian failure, early diagnosis of the premature ovarian failure, establish the etiology of premature ovarian through basal and dynamic hormones evaluation, assesment of pr...

Background: Delayed puberty means the absence of secondary sexual characters until the age of 16 or the lack of puberty development until the limit of +2DS regarding the age when the puberty normally begins at considered population. Considering the major ethiological factor implied in delayed puberty, three mechanisms can be distinguished: hypothalamic, hypophyseal and gonadal. Osteoporosis depends mainly on the deficiency of one or of all sexual hormones, arised during the on...

Background: Osteogenesis imperfecta (OI) is a few frequent disease with abnormal synthesis of type 1 collagen. That affects skeletal but also extra-skeletal tissues. Aortic root (AR) dilatation and valvular dysfunction have been described. Other studies, to estimate the size of the AR, index it by the body surface area (BSA), however, although these patients are shorter their internal organs have a relatively normal growth, so we could find overestimated AR values. Therefore, ...

Bone densitometry (DEXA) is the best method available today for diagnosing low bone density. However, DEXA is not able to differentiate osteoporosis from osteomalacia. The definitive diagnosis of osteomalacia is made by bone biopsy – rarely used in medical practice – which shows excess unmineralized bone. Tests of blood and urine may also be helpful: concentration of serum and urinary calcium and phosphorus, 25-hydroxyvitamin D and parathyroid hormone b...

Purpose: High serum homocysteine (HCY) and indirectly deficiency of folate and/or vitamin B12 stimulate bone resorption and adversely affect collagen cross-linking. The aim of this study was the evaluation of serum levels of HCY, folate and vitamin B12 in patients with Paget’s disease of bone (PDB) and the effect of zoledronic acid (ZOL) on their serum levels.Methods: This was a prospective open-label cohort study, with a control arm at baseline. Ni...

Backgound: ESRD is associated with a sustained decrease in bone mineral density compared with aged-matched healthy controls. DXA is the standard noninvasive method to asses BMD. QUS is inexpensive, mobile, easy to perform, radiation free, recognize for screening abilities and risk fracture prediction in normal population. This study assessed the ability of QUS versus DXA in determine low bone mass in haemodialised population.Materials and methods: Patien...

Background: The British Society for Osteoporosis proposed a method for comparing different diagnostic measurements for BMD. It defines the upper and the lower limit for the investigated assay, that will identify osteoporosis with a sensitivity of 90% (the upper limit) and a specificity of 90% (the lower limit), compared with the defined golden standard method, mainly DXA for spine or hip. This rationale generate small number of false positive or negative results.<p class="...

Background: The diagnosis of hypoparathyroidism, a clinical situation characterised by reduced production of parathyroid hormone despite the low calcium level, depends on patient’s anamnesis, clinical aspect and the biochemical parameters.Thalassaemia, an inherited autosomal recessive blood disease, caused by the reduced capacity of erythroblasts to synthesize one of the chains that build up hemoglobine. The combination of transfusion and chelation ...

Introduction: The decline of renal function is closely associated to increased parathyroid hormone secretion, resulting to secondary hyperparathyroidism because of: 1) hypocalcemia; 2) hyperphosphatemia; 3) reduced activity of calcitriol; 4) skeletal resistance to the calcemic action of parathyroid hormone (PTH) and 5) reduced secretion of the calcium-sensing receptor (CaSR) in the parathyroid glands.The retention of phosphorus is considered to take an i...

We present a case of a 71-year-old Jamaican man who presented with a 4 weeks history of backache, lethargy, night sweats, decreased appetite, and weight loss. There was no significant medical history.Physical examination revealed tachypnoea, sinus tachycardia with evidence of short QT interval on the ECG, generalised lymphadenopathy with firm, rubbery glands up to 3×3 cm in diameter. Arterial blood gases were consistent with type 1 respiratory failu...

The aim of the study: The paper analyzes the levels of soluble receptor activator of nuclear factor-κB ligand-(sRANKL), osteoprotegerin (OPG), bone alkaline phophatase (BAP), osteocalcin (BGP), estradiol, serum and bone levels of zinc [Zn(2+)], magnesium [Mg(2+)], calcium [Ca(2+)], phosphate [HPO4(2−)], and their correlation with bone mineral density (BMD).Material and method: The study included 74 p...

Aim: To evaluate the effect of strontium ranelate in treatment of systemic osteoporosis in postmenopausal women.Materials and methods: There were examined 82 postmenopausal women with systemic osteoporosis (average age 58.4±4.5 years). Evaluation of pain syndrome and level of physical activity was carried out with VAS (the questionnaire developed by the ‘Servier’ company). Bone mineral density (BMD) was determined by means of dual-energy X...

Introduction: Ectopic parathyroid adenoma is a rare cause of primary hyperparathyroidism, it accounts for 10% of parathyroid adenomas.Observation: A 56 years old man with no past medical history developed sudden acute renal failure after few weeks of fatigability, polydypsia and emesis. Hypercalcemia of 4.20 mmol/l (2.2–2.5 mmol/l), serum creatinine of 306 mmol/l, hypophospatemia 0.72 mmol/l (0.80–1.5 mmol/l) and high alkaline phosphatase 205 I...

Introduction: Osteoporosis affects a large percentage of the elderly population. Since the disease is preventable, diagnostic techniques are of major importance. Furthermore, the dentist is the most regularly visited doctor in this population and panoramic radiographs are the most frequently used imaging modalities for these patients. The purpose of this study was to evaluate the radiomorphometric indices on panoramic radiographs of post-menopausal females.<p class="abstex...

Primary hyperparathyroidism (PHPT) belongs to the most common endocrine disorders. It is increasingly reported in patients without any symptoms and hypercalcemia. In the 3rd international workshop on asymptomatic PHPT (Orlando 2008) the normocalcemic PHPT was recognised as a stand-alone entity that needs more attention.Aim: The purpose of this study is to analyse data from patients with normocalcemic asymptomatic PHPT and to create an effective source da...

Many studies show insufficient and inadequate vitamin D and calcium levels in postmenopausal women with osteoporosis, thus emphasising the need for supplementation therapy.Aim of the study: To determine vitamin D (25(OH)D) and ionised calcium levels in women treated for postmenopausal osteoporosis at our Clinic in the course of year 2009.Materials and methods: We prospectively followed up 116 women at the age of 59.38±5.55 (mi...

Introduction: Primary hyperparathyroidism (pHPT) is the most frequent cause of hypercalcemia in ambulatory patients. Most persons have no symptoms, and pHPT usually is diagnosed after an elevated serum calcium (Ca2+) level is found incidentally. Parathyroidectomy is the definitive treatment for pHPT. There have been several different approaches to the medical management of pHPT. Our aim in this study is to compare alendronate sodium (ALN) and raloxifene (RLX) effici...

Introduction: Primary hyperparathyroidism (PHP) results from an excessive secretion of parathyroid hormone (PTH), typically leading to hypercalcaemia. This disorder is more common than previously expected, since it is frequently diagnosed in asymptomatic patients.Objectives: To characterize a group of patients with PHP, in what concerns to: age, clinical presentation, biochemical and imaging evaluation, treatment and evolution.Pati...

The oral dosing with cholecalciferol needed to achieve and maintain optimal serum concentration 25-hydroxyvitamin D (25OHD) is still controversial.This study reports on the efficacy of supplementation with oral vitamin D3 1000 U/day for 3–18 months on serum 25OHD levels in 87 ambulatory patients with postmenopausal osteoporosis (mean age 63.5 years). Serum 25OHD, parathyroid hormone (PTH), calcium (serum, urine), phosphate, alkaline phosphatase and ...

Background: At the Third International Workshop on asymptomatic primary hyperparathyroidism (PHPT), recent data on the disease were reviewed, but limited information of the PHPT management in Europe is available.Methods: We performed an online questionnaire survey in hospital endocrinology services to determine knowledge of current PHPT recommendations and its management in the clinical practice during 2009 Spain.Results: Ninety-ni...

GH deficiency (GHD) and excess of glucocorticoids are associated with increased risk of fragility fractures. Most adult GHD patients have other pituitary deficiencies, but it is unclear whether these deficiencies or their overreplacement therapies may influence the bone disease occurring in GHD. The aim of this study was to evaluate whether the prevalence of vertebral fractures may be influenced by glucocorticoid replacement therapy in hypopituitary males with GHD. We studied ...

It has been hypothesized that primary hyperparathyroidism (PH) has a biphasic disease course. During the first phase hypercalcemia is not yet present. Subsequently, the second phase starts with the development of hypercalcemia. In an attempt to identify differences in the calcium regulating hormonal handling in the clinical setting, we evaluated the hormonal responses of gastrin, PTH, phosphate and ionized calcium to oral peptones (a mixture containing L-amino acids with known...

Introduction: Vitamin D deficiency is very common in Northern Europe. Recently, we developed an equation to calculate the vitamin D deficit, based on the serum 25-OH vitamin D3 (25OHD3) level and body weight: vitamin D deficit (IU)=40×(75−serum 25OHD3)×body weight. The calculated deficit gives the amount of cholecalciferol that is required to raise the serum 25OHD3 level to the target of 75 nmol/l.<p class="abstex...

Idiopathic hypoparathyroidism (IHP) is an uncommon disease in which soft tissue calcifications may be seen. We report a case with IHP with asymptomatic hypocalcemia and features of ankylosing spondylitis (AS).Case: A 58-year-old male patient was referred to our department due to incidentally discovered hypocalcemia when admitted with blurred speech, gait and posture abnormalities. He had had a generalized convulsion 19 years ago. On physical examination,...

A 74-year-old female patient was admitted to Department of Neurology due to bilateral ptosis and diplopia she suddenly felt 3 weeks prior to admission. She also complained of weakness, dizziness and swallow disability. Her medical history revealed hypertension and minor depressive disorder. Body mass index was 32 kg/m2. Electrocardiogram, chest X-ray and complete laboratory findings were normal, except elevated TSH, so levothyroxin was included in therapy. She had p...

Introduction: Teriparatide (TPTD) is a recombinant aminoterminal fragment (1–34) of the human parathyroid hormone (PTH), which has a predominantly stimulating effect on bone formation. We report results of an 18-month prospective multicenter study with daily s.c. application of 20 μg of teriparatide in 85 elderly women with severe osteoporosis, the efficacy, safety and compliance of the treatment.Outcomes: The primary outcomes were defined as c...

Vitamin D deficiency is increasingly recognized today having taken the form of a modern epidemic. Vitamin D, being synthesized in the skin under the effect of ultraviolet light has been originally thought of as occurring only in areas of the world where people are not exposed to the sun. However, it has recently been observed that vitamin D deficiency exists even in sunny areas. Recent observations suggest that vitamin D deficiency is related to significant comorbidity, specif...

Vitamin D is a lipid-soluble hormone found in certain foods and synthesized from precursors in the skin when exposed to ultraviolet light. Vitamin D plays a critical role in bone metabolism and many cellular and immunological processes; and low levels have been associated with several chronic and infectious diseases. Vitamin D status is assessed by measuring the concentration of serum 25-hydroxy vitamin D (25(OH) D). Vitamin D deficiency is reported to be common worldwide, but...

Introduction: Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcaemia in the outpatient setting. Surgical remove of an adenoma or hyperplastic glands results in cure, but an accurate localization, preoperative whenever possible, is essential for success. Taking into consideration that parathyroid carcinoma is a rare event, FNA of parathyroid glands, complemented by PTH measurement in washouts (FNA/PTH), may be a useful tool in the diagnostic workout.<...

Objectives: Reduced bone mass and compromised bone quality characterise osteoporosis. A positive relationship of the body-mass-index or the body fat mass and the bone density has been reported by several clinical studies. However, it is not clear whether this observation is attributable to higher mechanical stress or whether adipocytes secrete products that directly affect the bone structure.Methods: Isolation of human primary adipocytes to generate fat-...

Tumoral calcinosis is a rare autosomal recessive disease characterized by hyperphosphatemia due to increased renal phosphate reabsorption leading to soft tissue calcifications. The levels of fibroblast growth factor 23 (FGF23), a hormone required for normal renal phosphate reabsorption, are typically low in the classic form of the disease due to homozygous missense mutations in FGF23 or in the UDP-Nacetyl-alpha-D galactosamine:polypeptide N-acetylgalactos...

Multiple endocrine neoplasia type 1 (MEN1) is a rare but misleading disease. The diagnosis is evocated when two main lesions are present (parathyroid, pituitary gland, endocrine pancreas tumor: Gastrinoma). We studied a 36 year-old woman hospitalized in orthopedics for a neck femur fracture. A hypercalcaemia (Ca++=2.84 mmol/l) with elevated PTH=500 pg/ml were discovered before intervention. The bone biopsy concluded to primary hyperparathyroidism lesions.<p class="abstext"...

We report a 25 years old man who admitted in our department for primary hyperparathyroidism. He has previously been diagnosed with urolithiasis in 2006 and two pathological fracture of the humerus in 2009.Physical exam was normal laboratory findings showed hypercalcemia (4.06 mmol/l) associated to a high parathyroid hormone level (PTH: 1930 pg/ml).Ultrasound examination of the neck showed two enlarged parathyroid adenoma.<p cla...

Background: Idiopathic scoliosis is a pathological entity of unknown etiology, characterized by a three-dimensional deformity of the spine and a low bone mass. The exact mechanism of bone loss in idiopathic scoliosis is unknown yet. However is well known that RANKL is a potent stimulator of bone resorption by binding receptor activator of nuclear factor-kB (RANK) in the osteoclasts cell membrane. OPG is a decoy receptor for RANKL, which interferes with RANKL/RANK binding and i...

I fine-needle aspiration (FNA) is the gold standard in thyroid nodules management, but it is less common in the evaluation of parathyroid nodules. When imagery fails to localize a parathyroid adenoma, morphological and functional investigations, like FNA of the suspected area and scintigraphy may be useful. We present the case of a 58 years-old woman, menopaused at 47 years, who consulted for lombalgia. Vertebral DXA confirmed osteoporosis (Tscore −3.8). She was not trea...

Osteoprotogerin (OPG) and the receptor activators of nuclear factor-kβ (RANK) and nuclear factor-kβ ligand (RANKL) play an important role in bone metabolism. RANKL binds to RANK, which is expressed by osteoclasts, whereas OPG acts as its decoy receptor, blocking the RANK–RANKL interaction.The aim of our study was to evaluate bone turnover parameters (serum calcium, phosphorus, alkaline phosphatase, parathormone, osteocalcine, 24-...

Primary hyperparathyroidism during pregnancy is a rare condition associated with a high frequency of complications in both mother and fetus. Operation in the second trimester is offered. Here we report about a case with hyperemesis and hyperparathyroidism during routine laboratory examinations.A 30-years-old pregnant woman attendant our policlinic with hyperemsis gravidarum. Her calcium and parathormone level were elevated; 11.6 mg/dl and 135 pg/ml, resp...

Question: Can be reliably diagnosed osteoporosis with quantitative ultrasound of bone? Can the therapeutic progress of a specific osteoporosis therapy reliably judged by that?Patients and methods: Three hundred and twenty patients were enrolled between July 1999 and October 2004. All patients were studied in the osteoporosis clinic at time 0, after 1, 2 and 3 years. BMD was done with Hologic QDR-1000 (low back or hip) and the Osteometer DTU one (paramete...

Background: Survival of patients after the transplantation (Tx) of solid organs is improving. Osteoporosis and bone fractures belong to their long-term complications. The contributing factors are disturbances of bone metabolism in pre-transplant period and immunosuppressive therapy including corticosteroids after the transplantation.Patients and methods: We investigated the prevalence of osteoporosis and osteopenia in 248 diabetic patients after the Tx o...

Introduction: Osteoporosis is a disease characterized by a low bone mass and the development of nontraumatic fractures, most commonly in the spine. However, bone mineral density (BMD) alone is not completely satisfactory in vertebral fracture risk assessment.Aim of the study: To identify clinical and laboratoristic factors associated with an increased risk of vertebral fractures in osteoporotic Caucasian women and to define a new clinically relevant scal...

Introduction: Primary hyperparathyroidism (PHP) affects predominantly the adult age (incidence 1/10 000) and it is unusual.The aim of the study: Is to present a rare pathology in a child, which implied interdisciplinary collaboration.Material and method: We present a teenager girl of 16 years old, diagnosed with osteomalacia after a thoracic and pelvis trauma, based on knee and pelvis radiographs (diffuse bone demineralization, tra...

Male osteoporosis is a reality and in many cases appears to be secondary to drug administration. Many pharmaceutical agents are related to the appearance of osteoporosis, affecting bone metabolism by multiple and diverse mechanisms.The aim was to describe the case of a patient who presented with male osteoporosis of multiple drug aetiology.A patient, male aged 52 years, an orthodox priest, presented with spontaneous fractures and d...

Raloxifene is a selective estrogen receptor modulator which has shown to decrease bone resorption, increase bone density and reduce vertebral fracture rate in women with postmenopausal osteoporosis. Recent studies have shown a decrease on breast cancer incidence after raloxifene treatment. Although the mechanism is not clear, its mixed agonist and antagonist properties in different tissues could partially explain this effect.Objective: To evaluate the ef...

The compounds derived from the oxidative stress and lipid peroxidation stimulate the bone loss, in part because they enhance the adipogenesis and blunt the osteoblastogenesis from mesenchymal stem cell (MSC), increasing the marrow adiposity that accompanies the osteoporosis. The consumption of omega-3 seems to have a protective effect on bone. This effect has been associated with the production of 15-hydroxy-eicosapentaenoic acid and 17-hydroxy-docosahexaenoic...

Vertebral morphometric X-ray absorptiometry (MXA) is a new tool developed to evaluate the presence of vertebral fractures – main symptoms of osteoporosis. The study aimed at comparing selected morphometric parameters of vertebrae in men and women in various age groups. 965 healthy persons have been involved in the study: 616 female and 349 male, their age ranging from 18 to 79 years. Lateral densitometric scans of the thoracic-lumbar spine were made using Expert-XL densit...

Primary hyperparathyroidism (PHPT) is a relatively frequent problem in clinical endocrine practice. Minimally invasive parathyroid surgery is the treatment of choice but requires precise preoperatory localization. The most commonly investigation methods are ultrasonography and scintigraphy, but they are not always diagnostic. PTH assay of the aspirate from an ultrasound-guided fine-needle aspiration (USFNA) may confirm the location of pathological parathyroid tissue. The aim o...

Background: Hypophosphatasia (HPP) is characterized by low serum alkaline phosphatase (S-AP) activity due to loss-of function mutations in the ALPL gene. A hallmark of adult HPP is painful, slowly healing metatarsal and femur stress fractures. There is no treatment for the disease but beneficial effects of parathyroid hormone (PTH) treatment was previously demonstrated in one patient. It is unclear how parathyroid hormone (PTH) can stimulate S-AP despite loss-of functio...

Osteoporosis and diabetes mellitus type 2 (DM2) have severe health consequences, with high morbidity and mortality risks.Aims: To study the differences of the sex steroid hormones levels and the free androgen index (FAI) in DM2 men with low BMD and osteoporosis and their relationships with BMD.Materials and methods: In 317 men with DM2, the BMD (g/cm2) was evaluated at the lumbar spine (L1-L4), at t...

Parathyroid hormone (PTH) has a biphasic effect on bone cells and can induce opposing responses resulting in both net bone loss and net bone formation. Patients with primary hyperparathyroidism (PHPT) lose the circadian rhythm for PTH and bone mass decreases. PTH administered intermittently resulting in increase in bone mass. We studied the differences in the circadian variability of bone turnover markers between women with PHPT and women with postmenopausal osteoporosis treat...

Background: Diagnosis of primary hyperparathyroidism (PHP) is sometimes challenging and needs supportive evidence. We aimed to document laboratory findings (ratio of calcium clearance to creatinine clearance, ratio of phosphorus clearance to creatinine clearance, serum chloride to phosphorus ratio, serum alkaline phosphatase) and thyroid pathologies associated with established PHP that may provide supplementary clues to the diagnosis.Methods: We document...