Endocrine Abstracts

Introduction: MRONJ is defined as exposed bone in the maxillofacial region that persists after eight weeks in patients treated with antiresorptive or anti-angiogenic drugs, without previous radiotherapy. The estimated United Kingdom incidence of MRONJ in osteoporosis patients is 0.01-0.1% (1). MRONJ can cause severe disfigurement, speech and feeding difficulties. We aim to investigate MRONJ incidence and utility of dental screening in patients receiving Zoledronate ...

Background: Primary Hyperparathyroidism is a leading cause of hypercalcaemia and is frequently asymptomatic. Due to its long-term complications, early diagnosis and management is essential. NICE published guidelines on diagnosis and management of Primary Hyperparathyroidism in May 2019. The aim of this audit was to compare our existing practices against NICE guidance.Methods: We conducted retrospective data collection by identifying patients diagnosed wi...

Background: Vitamin D is important for calcium homeostasis. In granulomatous diseases including tuberculosis (TB), hypercalcaemia may be seen. Suspected mechanisms include elevated vitamin D sensitivity and increased extrarenal synthesis of 1,25-dihydroxyvitamin D [1,25(OH)2D] by alveolar macrophages within granulomas. Prevalence of hypercalcaemia in TB patients vary worldwide, yet is rare in the UK. We present a case of hypercalcaemia in a patient with TB reactivat...

Introduction: Cinacalcet is an allosteric modulator of the calcium sensing receptor which lowers parathyroid hormone (PTH) secretion. However, it is expensive and there is limited evidence of benefit in reducing complications of primary hyperparathyroidism (PHPT). In 2019 the National Institute for Health and Care Excellence (NICE) guidelines suggested that cinacalcet could be considered in individuals with PHPT if surgery has been unsuccessful or is unsuitable and if adjCa<su...

The partum period can be seen as a transient condition of “menopause” due to the physiological decline to a baseline of the high estrogens found during pregnancy, and bone metabolism is likely to alter. Moreover, high calcium requirements for fetal growth and during breastfeeding are covered in the maternal metabolism from enhanced intestinal absorption in a Calcitriol dependent pathway, and maternal bone reabsorption under control of parathyroid hormone (PTH) parath...

We report the case of a 63-year-old lady with refractory hypocalcaemia due to surgical hypoparathyroidism, decompensated by malabsorption following gastric bypass, successfully treated with recombinant human parathyroid hormone 1-84 (rhPTH), Natpar. She initially presented with medullary thyroid cancer aged 33 and was found to have MEN2A. She underwent thyroidectomy and developed post-surgical hypoparathyroidism. She was managed for over 20 years with alfacalcidol and oral cal...

Introduction: There are reports of patients having co-existing primary hyperparathyroidism and familial hypocalciuric hypercalcaemia (FHH). The combination of relative hypocalciuria, hypercalcaemia and slightly elevated serum parathyroid hormone (PTH) could indicate FHH. Medications such as, lithium and bendroflumethiazide can reduce renal excretion of calcium. We report a case highlighting the importance of being aware of drug-induced hypocalciuria during the investigation of...

Introduction: Hypercalcemia has a broad differential, including primary hyperparathyroidism, non-parathyroid hormone-mediated hypercalcemia, including humoral hypercalcemia of malignancy, or medication mediated. We report a case of severe hypercalcemia attributable to milk-alkali syndrome due to excessive calcium carbonate use.Case: A 71 year-old female with a history of hypertension presented after a fall without loss of consciousness. She endorsed epis...

Introduction: Vitamin D is a potential immune modulator and low levels are common in inflammatory bowel disease (IBD) patients. The aim of the study was to determine the association between deficient vitamin D and inflammatory profile.Methods: Intestinal (fecal calprotectin) and blood inflammatory profile [erythrocytes sedimentation rate (ESR), protein C reactive, fibrinogen], were performed to all patients. In addition, level of 25 hydroxy vitamin D was...

Purpose: To evaluate long-term safety and efficacy of cinacalcet in management of primary hyperparathyroidism (PHPT).Material/Methods: We retrospectively studied all patients on cinacalcet for primary hyperparathyroidism over 3 year’s period. Data was collected and analyzed for indication, daily maintenance dose, tolerability, biochemical effect at 3, 6 and 12 months, effect on bone mineral density and renal stone disease. This study excluded those ...