Endocrine Abstracts

Background: Secondary hyperparathyroidism is a common complication of established renal failure (ERF) and is associated with significant morbidity and mortality. The aims of this study were to determine patient and operative characteristics, which might predict persistent or recurrent hyperparathyroidism after surgery. To assess the influence of pre-operative imaging on the ability to locate and remove parathyroid glands during both the initial and repeat surgery and to assess...

Background: The geographical difference in presentation of primary hyperparathyroidism (PHPT) is well known however, there is spare literature on influence of age and gender on presentation of PHPT.Objective: To study the effect of age and gender on clinical and biochemical presentation of PHPT.Method: This is a retrospective analysis of 184 histopathologically proven PHPT patients between March 1990 and March 2010 from a single ce...

Introduction: Bone mineral density (BMD) and fracture tendency are influenced by diet, activity, drugs, and hormones. Recent studies highlight an inverse relationship between serotonin and BMD, of uncertain mechanism.Purpose: We investigated the relationship between serotonin metabolites and BMD in patients with sporadic neuroendocrine tumours (NETs), with and without the carcinoid syndrome.Materials and methods: One-year prospecti...

Epidemiological studies suggest that hypovitaminosis D is common in patients with primary hyperparathyroidism (PHPT). They have higher levels of serum parathyroid hormone (PTH) and markers of bone turnover, and more frequent fractures than vitamin D replete patients. There are concerns that vitamin D repletion in these patients might exacerbate pre-existent hypercalcaemia, although recent literature suggests this is uncommon.We aimed to determine the eff...

Introduction: Hip fractures are the most serious osteoporotic fractures and difficult to prevent them without a precise knowledge of the causative factors. The risk factors, which precipitate hip fracture in elderly may vary according to the local customs and practices. Indian data on risk factors for hip fractures are scant. The present study was undertaken to assess the various risk factors leading to femoral neck fracture in postmenopausal women and also to define the thres...

Aims/hypothesis: Bone turnover markers mainly reflect three processes: bone remodelling, linear growth, and bone modelling. These occur at different rates depending on age. Oestradiol levels, a mediator of all processes of bone turnover, vary according to sex and age whereas, parathyroid hormone levels, an important regulator of bone remodelling, vary with age. We hypothesised that gender and age differences in the bone formation marker, serum amino terminal propeptide of type...

Background: Vitamin D insufficiency is very common in general population and in patients with primary hyperparathyroidism (PHPT). Measurement of serum 25OHD (25hydroxy-vitamin D) is currently the best available test to assess vitamin D adequacy. However, it has a significant seasonal variation, and is difficult to define a serum 25OHD level that is sufficient for bone health, although a serum 25OHD above 50 nmol/l has been suggested.Previous studies conf...

Hypothyroidism and thyrotoxicosis have detrimental effects on skeletal development and adult bone strength. These effects result from thyroid hormone actions in bone, although a direct role for TSH in osteoblasts and osteoclasts was postulated following analysis of TSH receptor (TSHR) null mice. This hypothesis remains controversial as other studies failed to demonstrate osteoblast or osteoclast responses to TSH in vitro. Thyrostimulin is a heterodimeric glycoprotein ho...

Introduction: Patients with primary adrenal insufficiency (Addison’s disease) and patients with congenital adrenal hyperplasia (CAH) still tend to receive more glucococorticoids than the normal endogenous production in healthy subjects. CAH patients start glucocorticoid treatment usually with diagnosis in their early childhood, whereas Addison’s patients have a later onset of their disease and start of their treatment.Objective: To compare pati...

Aims: Low vitamin D levels may contribute to the pathogenesis of bone disease in thalassaemia major patients. Our haematology department serves one of the UK’s largest populations of thalassaemia patients. We evaluated our thalassaemia major patients’ vitamin D levels and other serum bone markers.Methods: Blood specimens were collected from all thalassaemia major patients under active follow-up in March and April 2010 and serum 25-OH-vitamin D,...

Aminobisphosphonates impair osteoclast cell function and reduce bone remodelling rate. It has been speculated that atypical femoral fractures in patients on bisphosphonates are the result of impaired bone remodelling.The primary aim of this prospective study was to assess levels of bone remodelling in patients with osteoporosis on aminobisphosphonate therapy by measurement of bone turnover markers. The secondary aim was to assess the adequacy of concomit...

Background: Lithium remains a first-line treatment for bipolar affective disorder and acute maniac states.Lithium therapy is associated with a variety of side effects including thyroid dysfunction and hypercalcaemia. Hypercalcaemia and more rarely biochemical picture resembling primary hyperparathyroidism or familial hypocalciuric hypercalcaemia may develop. Recognition of this side effect is of vital importance as an increasing number of patients with b...

Context: Rising evidence of the increased risk in mild PHPT suggests that serum calcium, which has been a main surgical criterion, maybe not an accurate indicator of disease severity or at least, not a reliable predictive factor of its long-term consequences. This study aims to identify the best biochemical predictor of adverse outcomes in untreated PHPT.Outcome measures and methods: Primary outcomes considered were all-cause mortality, fatal and non-fat...

Kyphosis and scoliosis are common spinal disorders that lead to significant morbidity in childhood, adolescence and adulthood. Familial and twin studies have implicated a genetic involvement, although the causative genes remain to be identified. To facilitate these studies, we investigated 12-week-old progeny of mice treated with the chemical mutagen N-ethyl-N-nitrosourea (ENU) using phenotypic assessments that included dysmorphology, radiography and dual-energy ...

Severe hypomagnesaemia associated with the use of proton pump inhibitors (PPIs) is now increasingly recognised. The exact underlying mechanism is unclear but is likely to involve altered intestinal absorption of magnesium ions. Hypomagnesaemia from any cause results in functional hypoparathyroidism. PTH levels vary widely in reported cases of hypomagnesaemia associated with the use of PPIs. We examined PTH levels in patients admitted to hospital with severe (Mg<0.4 mmol/l)...

High-resolution peripheral computed tomography (HR-pQCT) (XtremeCT, Scanco) obtains three-dimensional images of the distal radius with a resolution of 82 microns, which enables detailed study of the microarchitecture of cortical and trabecular bone. Better description of the microarchitectural changes in bone with ageing will improve understanding of which preventative and therapeutic interventions are most likely to be effective.The aim of this study wa...

Osteoarthritis (OA) may be associated with endocrine disorders such as hypothyroidism, obesity, primary hyperparathyroidism or acromegaly, although often its cause remains undefined. To facilitate investigations of the underlying molecular mechanisms of OA we have investigated N-ethyl-N-nitrosourea (ENU) mutant mice using a genotype-driven approach in which candidate genes are examined for mutations. One such investigated gene is growth and differentiation factor...

Treatment with a single annual infusion of zoledronic acid 5 mg (ZOL) for 3 years has been shown to be effective in increasing bone mineral density (BMD) and decreasing fractures. In order to investigate the long-term effects of ZOL, we performed a 3-year extension of the HORIZON-PFT to 6 years. A total of 1233 women who received ZOL for 3 years in the core study were randomly allocated to 3 additional years of ZOL (Z6, n=616) or blinded placebo (Z3P3, n=617). Pr...

Case: A 77-year-old man was admitted with a pathological fracture of the right femur, which required intramedullary nailing. He had previously been diagnosed with Paget’s disease affecting the right femur and also hyperparathyroidism with a large parathyroid adenoma on Sestamibi scan which had been managed at another hospital. On this admission, his corrected calcium was 2.79 (2.15–2.55) mmol/l, PTH 643 (15–65) pg/ml and alkaline phosphatase 258 (30–130) U/...

Introduction: Primary hyperparathyroidism is not an uncommon disease with incidence of ~25–30 cases per 100 000 people, whether caused by adenoma or hyperplasia, can be cured surgically with a high rate of success. Over past decade minimally invasive surgery has become mainstay of treatment compared to traditional bilateral exploration approach. Accurate preoperative localisation of parathyroid disease is absolutely imperative for effective minimally invasive surgery....

Introduction: We describe a 31-year-old man with sarcoidosis found having concomitant primary hyperparathyroidism and vitamin D deficiency. Although hypercalcaemia is common in sarcoidosis, when accompanied by hypophosphatemia and resistance to steroids, should suggest coexisting primary hyperparathyroidism\.. Associated vitamin D deficiency presented management difficulties.Case report: A 31-year-old bodybuilder presented with dyspnoea. Sarcoidosis was ...

A 57-year-old man with a history of alcohol excess was admitted following a road traffic accident. He suffered multiple trauma with fractures to his left femur, tibia and fibula, his right pubic ramus and several ribs. In addition severe abdominal trauma necessitated nephrectomy and splenectomy. Routine biochemistry and bone profile on admission was within normal limits.He had a prolonged stay in the Intensive Therapy Unit (ITU) with acute kidney injury ...

AMPK is a key regulator of cellular and body energy homeostasis. We previously demonstrated that AMPK activation in osteoblasts increases bone formation in vitro while deletion of the AMPKα1 subunit leads to decreased bone mass in vivo. To determine whether bone turnover can be stimulated in the absence of AMPKα1 subunit, we subjected WT and AMPKα1−/− mice to catabolic (ovariectomy: OVX) and anabolic (intermittent PTH adminis...

Primary hyperparathyroidism (PHPT) is a common reason for referral to the endocrinology team. We aimed to estimate the prevalence of associated vitamin D deficiency and osteoporosis, to evaluate the usefulness of imaging studies in identifying a parathyroid adenoma prior to surgery and to assess response to surgical treatment in the setting of a District General Hospital.We searched our outpatient clinic letters and identified 64 patients diagnosed with ...

Aim: To compare the efficacy, tolerability and safety of high doses of i.m. vitamin D2 (ergocalciferol) with oral vitamin D3 (colecalciferol) supplementation in women with low vitamin-D levels.Design and settings: Of 107 patients (s25(OH)D≤50 nmol/l), aged 21–89 years were recruited in a retrospective audit. Participants were separated in two groups according to serum vitamin D levels. The Group 1 included individuals wit...

Introduction: Primary hyperparathyroidism (PHPT) is a relatively frequent problem presenting with hypercalaemia detected on a routine blood test. All PHPT patients should have a urine calcium concentration, DEXA scan and vitamin D level checked at the time of diagnosis. Vitamin D supplementation aims to achieve a vitamin D level over 50 nmol/l which may be associated with positive outcomes such as a lower serum parathormone (PTH), calcium and alkaline phosphatase concentration...