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Disorders of the mineral balance often determine the symptoms, the severity of the course and the prognosis of many diseases. Primary hyperparathyroidism (PHPT) is a common endocrine disease caused by increased secretion of parathyroid hormone as a result of primary damage to the parathyroid glands. Diagnosis of PHPT is often difficult. Clinical signs of PHPT appear months or years after the onset of the disease, however, the presence of hypercalcemia serves as an early indication of the disease of the thyroid gland. Often, patients are observed for a long time by related specialists (rheumatologists, traumatologists-orthopedists, oncologists), which gives rise to a lot of problems consisting in the lack of adequate treatment and its result, the progression of the disease, disability, and a decrease in the quality of life. Often, patients are observed for a long time by related specialists (rheumatologists, orthopedic traumatologists, oncologists) under the “masks” of various pathologies (osteoporosis, recurrent urolithiasis, etc.), which gives rise to a lot of problems, consisting in an erroneous diagnosis, lack of adequate treatment and its result, progression of the disease, disability, and a decrease in the quality of life. Late diagnosis of PHPT leads to the development of severe complications (osteoporetic fractures, renal failure) and an increased risk of premature death. A clinical case of late diagnosis of PHPT at the stage of pronounced bone complications of the disease, which proceeded under the guise of osteoarthritis, is considered. According to the results of laboratory and instrumental studies, the following were revealed: hypercalcemia, a significant increase in the concentration of PTH, adenoma of the left lower parathyroid gland, hyperparathyroid osteodystrophy, and a decrease in bone mineral density. Surgical treatment was performed – selective parathyroidectomy with the development of hypocalcemia in the early postoperative period, which was stopped by taking calcium supplements and active vitamin D metabolites and is designed to help practitioners of various specialties to understand the issues of diagnosis of PHPT and effective care for patients.

Abstract Bone marrow fibrosis represents an important structural change in the marrow that interferes with some of its normal functions. The aetiopathogenesis of fibrosis is not well established except in its primary form. The present review consolidates current understanding of marrow fibrosis. We searched PubMed without time restriction using key words: bone marrow and fibrosis as the main stem against the terms: growth factors, cytokines and chemokines, morphology, megakaryocytes and platelets, myeloproliferative disorders, myelodysplastic syndrome, collagen biosynthesis, mesenchymal stem cells, vitamins and minerals and hormones, and mechanism of tissue fibrosis. Tissue marrow fibrosis-related papers were short listed and analysed for the review. It emerged that bone marrow fibrosis is the outcome of complex interactions between growth factors, cytokines, chemokines and hormones together with their facilitators and inhibitors. Fibrogenesis is initiated by mobilisation of special immunophenotypic subsets of mesenchymal stem cells in the marrow that transform into fibroblasts. Fibrogenic stimuli may arise from neoplastic haemopoietic or non-hematopoietic cells, as well as immune cells involved in infections and inflammatory conditions. Autoimmunity is involved in a small subset of patients with marrow fibrosis. Megakaryocytes and platelets are either directly involved or are important intermediaries in stimulating mesenchymal stem cells. MMPs, TIMPs, TGF-β, PDGRF, and basic FGF and CRCXL4 chemokines are involved in these processes. Genetic and epigenetic changes underlie many of these conditions.

Aim:Peyronie’s disease’s (PD) etiology is still unclear. Many factors that may cause the disease are being investigated. The objective of our study was to clarify the effect of serum parathormone and ionized calcium levels on the pathophysiology of PD.Methods:The study was designed as a cross-sectional study. Demographic data, physical examinations, laboratory tests, and medical and sexual histories of patients between January 2017 and June 2020 were analyzed. Patients were divided into PD and control groups.Results:By measuring serum calcium and parathormone levels of patients, we analyzed 38 PD and 40 control group patients and revealed that i) parathormone (p=0.321) and ionized calcium (p=0.286) levels are not related to PD, and ii) cardiovascular disease (p=0.037), diabetes mellitus (p=0.0001), and hypertension (p=0.001) are significantly associated with PD, whereas smoking, alcohol consumption, and dyslipidemia status are not.Conclusion:The study shows that there is no relationship between serum parathormone and ionized calcium levels and the etiology of PD.

Introduction. Urolithiasis is not a simple disease, but it is a group of metabolic and endocrine disorders in the organism, coupled with changes in the urinary tract. Objectives. Research on the etiopathogenesis of urolithiasis; to analyze parathyroid hormones, to determine citrates in urine; their influence on the occurrence of urolithiasis. Research and the role of infection in the occurrence of urolithiasis, clinical symptoms, diagnostic methods, prevention methods and as well as preventive measures. Materials and methods. The research was conducted on our patients at the Urology Clinic, University Clinical Center of Kosovo, in Pristina. The work was prospective; in our research, we included 102 patients. Results. Our research has increased Parathormone in 5, 88% of cases. We had hypocitraturia in 57, 84% of cases. Hypocyturia then affects the creation of conditions for the crystallization and aggregation of stoneforming substances. Urolithiasis includes both sexes, primarily men 66, 7%, and women 33.3%. With X2- test we obtained a significant difference with statistical significance in the number of cases by gender (X2 = 11.3, P = 0.001). The most attacked age group was 40-49 years old. Symptoms are dominated by colic, nephralgia, dysuria, and hematuria. In this research, we have 22.5% of positive results of urine cultures. Conclusion. Therefore, there is still no explanation about the pathogenesis of urolithiasis, and with the knowledge of the etiopathogenesis of urolithiasis, symptoms, clinic, metabolic disorders and pathomorphology of urolithiasis, prophylactic measures can be taken, and urolith recurrence can be prevented.

We aimed to investigate correlation between perioperative biochemical values and adenoma volume, the effects of perioperative biochemical values and clinicopathological variables on postoperative hypocalcemia after parathyroidectomy. A retrospective study planned in tertiary university hospital on patients undergone surgery for primer hyperparathyroidism. Preoperative calcium (first, close to surgery, maximum), PTH (first, close to surgery, maximum), alkaline phosphatase (ALP) and phosphorus (P) values, postoperative calcium (early, late), postoperative PTH (early, late), 24-hour urinary calcium calculation, time from the first diagnosis of elevated calcium until surgery, preoperative hypercalcemia treatments, excised parathyroid gland, histopathologic diagnosis, maximum diameter and volume of the excised parathyroid on histopathologic examination, postoperative intravenous calcium supplement were analyzed. 73 patients were included in the study. The median age of the patients was 54 years (range, 18-82), and 83.6% were female. In univariate analysis, patients who were administrated intravenous (IV) calcium supplement had higher preoperative PTH (p=0.024). adenoma volume correlated moderate with preoperative PTH first (r=0.396, p=0.001), preoperative maximum parathormone (r=0.380, p=0.001), preoperative PTH CS (r=0.432, p [Med-Science 2023; 12(1.000): 271-7]

Abstract Background Giant parathyroid adenoma is a type of parathyroid adenoma weighing > 3.5 g and having a size of more than 2 cm. Case presentation This report describes giant primary parathyroid adenoma with reference to the literature. We report the case of a 48-year-old Persian man referred to the clinic with knee and lower back pain. He had a history of mitral valve replacement and several episodes of bilateral nephrolithiasis. After a thorough assessment, a neck mass with a possible thyroid origin was detected, but further assessment showed it was of parathyroid origin. The resected mass was 9 × 6× 4 cm and weighed 122 g, and histopathology showed a giant parathyroid adenoma. Conclusion Giant parathyroid adenomas that weigh more than 110 g and are larger than 8 cm can lead to significant hypercalcemia. Despite giant parathyroid adenomas and high parathyroid hormone levels, a calcium crisis may not always occur in these patients, and the masses may be initially misdiagnosed as a thyroid mass.

Renal cancer (RC) – associated increased calcium is rather frequent among cases of kidney neoplasia; it may be the first sign of presentation that allows the detection of the malignancy; typically representing a poor prognostic factor. Weight loss is part of the panel underling hypercalcemia - related signs, but also of the malignancy – associated phenotype. We aim to introduce a male case who was admitted for a clinical picture (including weight loss) correlated with alarming high calcium levels; the biochemistry anomaly was actually a paraneoplasic syndrome due to RC. When admitted as emergency, the assays revealed hypercalcemia of 16.9 mg/dl (normal levels between 8.4 and 10.2 mg/dl) with low PTH (Parathormone) and high CrossLaps as bone turnover marker of resorption. Intravenous contrast computed tomography showed a large left retroperitoneal tumor (involving the kidney and adrenal gland) with iodophil pattern, and post-contrast heterogeneous structure of 8.06/11.09 cm (axial), 10.58/12.16 cm (coronal - reconstruction), 9.12/10.59 cm (sagittal - reconstruction), also associating a mixt structure and micro-calcifications as well as hypodense areas. Whole body bone scintigrame did not show metastasis. The calcium levels were controlled under subcutaneous denosumab 60 mg in addition to IV fluids replacement; then the patient was referred to nephrectomy; post operatory confirmation confirmed a clear cell renal cell carcinoma (T4N1Mx). A normalization of calcium and PTH levels was found immediately after surgery. Unintentional weight loss might become a valuable tool in order to assess a routine biochemistry panel that will detect hypercalcemia. Low PTH represents the next step in order to further look for a tumor. Symptomatic control of hypercalcemia in addition to targeted approach of originating tumor are essential to improve the outcome.

Magnesium (Mg) is one of the most important cations in the organism, essential for regulating vascular tone, cardiac rhythm, and endothelial functions. In patients with advanced stage chronic kidney disease (CKD) Mg deficit was associated in various studies with vascular calcifications and increased cardiovascular morbidity and mortality. Patients with CKD frequently have hyperparathyroidism, parathormone (PTH) being an important risk factor for vascular calcifications. Increased serum Mg levels inhibit PTH secretion and stimulate left ventricular hypertrophy, while low serum Mg levels stimulate PTH secretion. Correcting Mg de deficiency results in reduced cardiovascular mortality in these patients.

Objective: The aim of this research was to investigate the effects of subacute use of lithium carbonate (Li2CO3), on serum T3, T4, thyroid stimulating hormone (TSH), parathyroid hormone (PTH) and calcium (Ca) levels and thyroid tissue. In addition, this research is important as one of the rare studies in which thyroid tissue was subjected to histological examination. Methods: Thirty-two male Sprague Dawley rats were assigned into groups consisting of eight animals each, based on weight; Group 1: Sham control, Group 2: Li2CO3+25 mg/kg, Group 3: Li2CO3+50 mg/kg and Group 4: Li2CO3+100 mg/kg. Li2CO3 was administered orally at varying concentrations, at 1 mL per day for 30 days. Serum samples were separated from blood obtained by intracardiac intervention. Serum T3, T4, TSH, PTH and Ca levels were measured by using an autoanalyzer and chemiluminescence. Thyroid tissue was examined under light microscopy after routine histopathological procedures. Results: T3, T4, PTH and Ca levels increased in rats treated with high-dose Li2CO3, whereas TSH levels were very low in all groups. In addition, thyroid tissue exhibited concentration-dependent histological alterations. Conclusion: Li2CO3, which was administered subacute high dose in rats, caused of increased T4 and T3 hormones levels, hyperparathyroidism and hypercalcemia in the early period. These results now need to be supported by further experimental and clinical studies.

Ektopik paratiroid dokusunun yerini saptamak ve çıkarmak %20’nin üzerinde başarısızlıkla sonuçlanabilmektedir. Tc-99m sestamibi ile yapılan tek foton emisyon bilgisayarlı tomografi/bilgisayarlı tomografi (single photon emission computed tomography/computed tomography, SPECT/CT) görüntülemesinde saptanan ve minimal invaziv cerrahi yöntemler ile tedavi edilen yedi olgu sunulmuştur. Total/subtotal paratiroidektomi operasyonu sonrası yüksek parathormon (PTH) seviyesi nedeni ile SPECT/CT uygulanan ve mediastende ektopik paratiroid saptanan olgular dahil edilmiştir. Cerrahinin başarısı preoperatif ve postoperatif PTH düzeyleri ile değerlendirildi. Beş olguya video yardımlı toraks cerrahisi (video-assisted thoracic surgery, VATS), diğer ikisine video yardımlı mediastinoskopi (video-assisted mediastinoskopi, VAM) uygulandı. Ortalama yaş 52,4±19,0 idi. Altı olgu kadın, bir olgu erkek idi. 1,5 ile 6 cm arasında değişen mediastinal adenomlar tek denemeden sonra basit girişimler ile başarılı bir şekilde tedavi edildi. Mediastinal ektopik paratiroid adenomu ameliyat öncesi tam olarak lokalize edilebilirse minimal invaziv cerrahi yöntemlerle tedavi edilebilir.

Introduction. Low plasma levels of 25-OH vitamin D (25(OH)D) have been associated with an increased prevalence of hypertension. The purpose of the research was to establish the association of clinical and metabolic parameters, Ca2+, parathormone and serum 25(OH)D concentration in hypertensive patients in the West-Ukrainian population. Material and method. 100 subjects with essential arterial hypertension (EAH) and target-organ damaging (2nd stage), moderate, high, very high cardiovascular risk were involved in the case-control study. Among them, 70,84% females, 29,16% males, mean age 57,86±7,81 yo. The control group consisted of 60 healthy individuals. All recruited patients were examined for heart rate, systolic and diastolic blood pressure (SBP, DBP); SCORE, BMI, waist and hip circumference (WC, HC); lipid panel, serum glucose and ionized calcium, 25(OH)D, parathormone levels were studied. Patients were divided into groups depending on total serum 25(OH)D concentration. Results. Low 25(OH)D concentration (5,0%. We found higher SBP and DBP by 9,12% (р=0,014) and 5,17% (р=0,047), higher BMI in men and women – by 20-28,11% (р

Primary hyperparathyroidism is an endocrinological pathology of parathyroid glands. Its predominant form is a single parathyroid gland adenoma. We present a case of a 53-year-old patient, who was referred with primary hyperparathyroidism. She underwent ultrasound and sestamibi radionuclide scanning, and was offered surgery. The postoperative histopathological examination proved the presence of parathyroid gland adenoma. Patients managed with primary hyperparathyroidism require preoperative localization of enlarged, usually single parathyroid glands. Diagnostic modalities include ultrasounds, computed tomography scanning, and sestamibi radionuclide scanning. Parathyroidectomy is a recommended treatment modality for each stage of primary hyperparathyroidism, despite organ involvement, severity of hypercalcemia, and parathormone concentration. Significant bone remineralization is observed postoperatively. Preoperative localization of the enlarged parathyroid gland is crucial. Primary hyperparathyroidism requires surgery for definitive treatment. Surgery, although challenging, leads to a cure.

Objective:Parathyroid hormone (PTH) levels are elevated in the blood due to various reasons and named as primary or secondary hyperparathyroidism. There is no any study that investigated the etiology of elevated PTH.Materials and Methods:The study included 137 patients who had elevated PTH, which was detected in blood tests that were performed due to any reason, during 1-year period.Results:Of all patients 118 (86.1%) were female and 19 (13.9%) were male. Vitamin D deficiency was found in 88 (64.2%), primary hyperparathyroidism (PHPT) in 38 (27.7%), familial hypocalciuric hypercalcemia (FHH) in 8 (5.8%), and chronic renal failure (CRF) in 3 (2.2%) patients.Conclusion:Vitamin D deficiency is a common disorder in general population, and occasionally coexisted with increased PTH level. Therefore, vitamin D deficiency should be kept in mind when PTH studied as a first test and is found to be high. The other reason such as PHPT, FHH and CRF must be also investigated.

Objective:The aim of our study was to compare plasma vitamin D levels between patients with breast cancer-related lymphedema (BCRL) and healthy population, and also to investigate the effects of socio-demographic and clinical factors and lymphedema severity on vitamin D levels.Materials and Methods:Eighty patients with BCRL [mean age 55.5±8.9 (36-81)] and age- and sex-matched 80 healthy controls [mean age 53.7±7.4 (32-70)] who were not on calcium or vitamin D supplementation were included in the study. Socio-demographic and clinical characteristics of the subjects were questioned. Plasma 25-Hydroxyvitamin D3, calcium, phosphorus, alkaline phosphatase (ALP), and parathormone (PTH) levels were evaluated. Lymphedema was classified as stage 0, I, II, or III.Results:The mean duration of lymphedema was 23.5±13.8 months. Comparisons revealed lower vitamin D levels and higher PTH and ALP levels in patients with BCRL than healthy controls. As a result of multivariate regression analysis, a significant relationship was revealed between vitamin D levels and age, breast cancer stage, and disease duration in patients with BCRL. Vitamin D levels were significantly lower and PTH levels were significantly higher in stage 3 lymphedema patients compared to stage 1.Conclusion:Vitamin D levels were detected lower in patients with lymphedema than healthy controls. Although vitamin D levels were found to be lower in patients with severe lymphedema, the multivariate regression analysis revealed that the severity of lymphedema does not have a significant effect on vitamin D levels.

Background: Vitamin D is an important factor for bone growth. Vitamin D deficiency reduces absorption of calcium and causes rickets and also increases bone fragility. In addition, Vitamin D deficiency has exoskeleton side effects, such as increased risk of cancer, cardiovascular disease, infections and autoimmune diseases. In most cases, vitamin D intake is not enough in dietary food supplies. Furthermore, prevalence of vitamin D deficiency is increased due to the life style changes and lack of access to enough sun light and other sources of vitamin D. Present study, has been done to evaluation of Vitamin D deficiency in referred patients to Fardis central laboratory with ethnic diversity from 1393 to 1394. Methods: Samples were taken from referred patients to the laboratory. The patient have no history of diseases such as diabetes, cancer, cardiovascular disease, etc… Sampling was done randomly and patients were classified according to the age and sex. Individuals receiving calcium and vitamin D were excluded from this study. 100 girls and boy with age 1 to 13 years, 400 males and females with age 14 to 45 years and 500 males and females with over 45 years of age were examined. Collecting samples were done daily. Vitamin D, calcium, phosphorous and PTH were measured in the day of the sampling. Results: According to the this survey we found that 15.5% of selected population had severe vitamin D deficiency , 45.1% had mild to moderate deficiency and 39.4% did not have vitamin D deficiency. Conclusion: Individuals with the same age but opposite sex had different status of vitamin D deficiency. So that, sever vitamin D deficiency was seen in girls and women. Sever vitamin D deficiency was in girls 3.5 times more than boys. In addition, Sever vitamin D deficiency in women 14 to 45 years old compared with the men of the same age was 1.7 times and sever vitamin D deficiency in women with over 45 years of age compared with the men of the same age was 1.5 times more common.

Introduction: Ectopic Intrathyroid Parathyroid Adenomas (ITPAs) are rare and known to pose preoperative and intraoperative diagnostic challenges in localisation, resulting in failure of parathyroid surgery. The common histopathological features of these tumours are not elaborately described in literature. Aim: To describe the clinico-pathological features of ITPAs, identified among all parathyroid adenomas, diagnosed at a tertiary care hospital. Materials and Methods: This was a cross-sectional study of all ITPAs diagnosed between January 2012 to December 2019, at Christian Medical College and Hospital, Vellore, Tamil Nadu. The gross examination and microscopic findings of ITPAs were reviewed and tabulated. Clinical, radiological and intraoperative findings were compiled to obtain preoperative and intraoperative diagnostic rates. Results: Among 409 parathyroid adenomas, there were ten ITPAs (2.4%), with eight ectopic inferior (80%) and two ectopic superior parathyroids (20%). Four ITPAs were completely intrathyroid (0.97%). Histopathological features of ITPAs were those of usual parathyroid adenomas. Four patients (40%) had concomitant thyroid disease, including one papillary microcarcinoma (10%). Correct preoperative diagnostic rate was 40%. Intraoperative misjudgment of location occurred in two patients (20%). Conclusion: ITPAs are rare and correct preoperative and intraoperative diagnosis may not be always possible. Histopathological evaluation of suspicious intrathyroid nodules is necessary in such instances to correctly diagnose them.

Extensive intracranial calcification is rare in iatrogenic hypoparathyroidism and Parkinsonism at the time of diagnosis is uncommon. We report a case of a 55-year-old woman who presented to us 20 years after thyroid surgery with symptoms of hypocalcaemia and clinical features of Parkinsonism. On detailed evaluation, patient was found to have extensive calcification involving the basal ganglia, periventricular white matter and cerebellum and serum parathormone was low. With calcium and calcitriol supplementation there was symptomatic improvement however features of parkinsonism persisted. We present this case to highlight the unusual presentation of Parkinsonism in a patient with post-thyroidectomy hypoparathyroidism with brain calcinosis. This case also underscores the importance of regular follow-up of patients after thyroid surgery to detect hypoparathyroidism, the treatment of which could prevent future morbidity to the patient.

Introduction: Vitamin D deficiency leads to defective mineralisation and in Chronic Kidney Disease (CKD) can contribute to renal osteodystrophy. Aim: To compare the serum level of vitamin D in children with CKD as compared to those with normal condition. Materials and Methods: This cross-sectional survey was performed on 68 consecutive children with CKD and 73 sex and age-matched healthy children who were referred to Mofid hospital in Tehran, Iran in 2016. Serum level of vitamin D was measured by immunoassay kits and was then categorised as ≤15 ng/dL (for vitamin D deficiency), 16-30 ng/dL (for vitamin D insufficiency) and >30 ng/dL (for normal condition). Also, the CKD stage was determined by measuring estimated Glomerular Filtration Rate (GFR). Quantitative variables were compared with the t-test, Mann-Whitney test, ANOVA test, or Kruskal-Wallis H test. Qualitative variables were also compared with chi-square test or Fisher’s-exact test. Results: Comparing serum level of vitamin D between CKD and control group showed a significant difference (14.3±9.8 ng/mL versus 18.3±10.9 ng/mL, p

Epilepsy is the most common neurological disorder affecting approximately 50 million people worldwide. In India, overall prevalence of epilepsy is reported to be 5.59/1000 population. Antiepileptic drugs (AEDs) constitute the main-stay of treatment with a large number of AEDs available in the market. High incidence of adverse effects is a major limitation with AEDs. One of the major concerns is significant metabolic effects on the bone. However, little attention has been paid to this issue because most of the bone effects remain subclinical for a long time and may take years to manifest clinically. The main effects include hypocalcemia, hypophosphatemia, reduced serum levels of Vitamin D, increase in parathormone (PTH) levels, and alterations in bone turnover markers. The CYP450 enzyme-inducing AEDs such as phenytoin, phenobarbital, carbamazepine, and primidone are the most common AEDs associated with bone disorders while the data regarding the effect of valproate and newer AEDs such as lamotrigine, gabapentin, vigabatrin, levetiracetam, and topiramate on bone metabolism and bone density are scanty and controversial. Deficiency of Vitamin D is commonly described as a cause for the bone loss in epileptic patients while others being decreased absorption of calcium, increased PTH levels, and inhibition of calcitonin secretion, etc. However, there are no formal practical guidelines for the management of bone disease among those taking AEDs. Evidence-based strategies regarding monitoring, prevention, and treatment of bone diseases in patients on AED therapy are needed.

The aim of the present study was to determine the relationship between biochemical parameters, mean diameter of parathyroid adenoma (MDPA) and parathyroid hormone (PTH) levels in patients who underwent parathyroid surgery.Materials and Methods: Data were collected retrospectively from patients with hyperparathyroidism who were operated and followed in our hospital between September 2011 and April 2014. Twenty-nine (male/female = 8/21) patients with a mean age of 58.31 ± 12.59 years were enrolled into the study. The mean pre-operative serum calcium and intact PTH (iPTH) levels were 11.98±1.23 mg/dl and 386.52±374.96 pg/ml, respectively. Serum pre-operative calcium levels were found to be significantly higher in patients who had nephrolithiasis than those who did not, whereas pre-operative serum phosphate levels were lower. Pre-operative iPTH levels were found to be correlated with pre-operative calcium, alkaline phosphatase and MDPA but not with pre-operative serum phosphate. Also, pre-operative calcium levels were found to be significantly correlated with MDPA.Conclusion: Presence of nephrolithiasis is associated with higher pre-operative calcium and lower phosphate levels. Pre-operative iPTH and calcium levels were also found to be significantly correlated with MDPA; this suggests that serum iPTH and calcium levels can be useful in predicting MDPA. [Med-Science 2015; 4(3.000): 2401-13]

The present study was aimed to evaluate the association of serum 25-hydroxy vitamin D and parathormone in 46 patients of type 2 diabetes mellitus with diabetic retinopathy [non-proliferative, (n=27); proliferative (n=19)]. Twenty one diabetic patients without retinopathy were taken as control. Serum 25-hydroxy vitamin D and intact parathyroid hormone were measured by chemiluminescence microparticle immunoassay. Concentration of 25-hydroxy vitamin D differed significantly among groups (p=0.018) and it was significantly lower in proliferative diabetic retinopathy than no diabetic retinopathy (p=0.003). Logistic regression analysis revealed that vitamin D deficiency [25-hydroxy vitamin D

Background: The increasing incidence of Pregnancy induced hypertension (PIH) or Pre-eclampsia in developed and developing countries are alarming. Systemic inflammation and disturbances in vitamin D and minerals (Sodium & Calcium) metabolism are almost invariable consequences of PIH; and variation in their levels can adversely affect the pregnancy leading to the development of PIH. Aim: In this context, a study was carried out to assess the level of serum vitamin D, sodium, calcium and inflammatory marker C-reactive protein (CRP) in non-pregnant (NP), normotensive pregnant (NTP) and PIH women and to determine their role in the etio-pathogenesis of PIH. Material and method: Serum vitamin D, sodium, calcium and CRP levels were estimated in 20 NTP women (Group I) and 20 PIH women (Group II) by using standard methods and statistically compared it with that of age matched 20 healthy non pregnant women (Control group) by using student’s t-test. Result: Serum Ca++ level were found to be significantly low in both Group I (p

Denosumab is a human monoclonal antibody representing a novel therapy of osteoporosis. Contrary to always other antiosteoporotic drugs, it is not contraindicated in advanced chronic kidney disease, as its pharmacokinetic does not differ from patients with normal kidney function. However, published case reports in chronic kidney disease (CKD) patients stopped the therapy after single dose because of hypocalcemia. We present a case of successful treatment of osteoporosis in a young hemodialysis patient with repeated denosumab doses.

Brown tumors are bony lesions caused by rapid osteoclastic activity, which rare involved jaws. Renal osteodystrophy (ROD) is associated with different pathogenetic mechanisms – disorder of calcium-phosphate metabolism, impaired metabolism of vitamin D, increased parathyroid activity that lead to extreme concentrations of parathormone. The authors report two cases of jaw enlargement in patients received haemodialysis with excessive increase values of alkaline phosphatase and parathormone in serum. The patients were treated surgically with corrective procedures in maxillo-facial area.ROD of the jaws could be severe complication in dialysis patients with end stage of CKD if no appropriate care aimed at correction or prevention of parathyroid hyperfunction was applied to them.

Objetivo: determinar la frecuencia y características de los pacientes que, por patología hiperparatiroidea, se atendieron en los hospitales México, San Juan de Dios y “Dr. Rafael Ángel Calderón Guardia”, en un periodo de tres años. Métodos: análisis de registros de parathormona intacta sérica elevada, expedientes clínicos y revisión bibliográfica. Estudio descriptivo, cuya muestra fue pacientes hiperparatiroideos atendidos entre enero 2007 y diciembre 2009. La determinación de frecuencias y proporciones para las variables cualitativas se realizó por medio de la prueba chi cuadrado, y las cuantitativas, mediante la estimación de la prueba t de student. Resultados: de 199 pacientes estudiados, se excluyeron 9. El sexo femenino predominó (68,9%), el grupo etario más frecuente fue de 60 y más años de edad (33,1%). El hiperparatiroidismo primario fue la enfermedad más frecuente (n=46; 24,2%; 73,9% mujeres, 69,5% mayores de 50 años), luego hipovitaminosis D y falla renal crónica. La mayoría vivía en San José (59,4%) y se atendió en el Hospital México (65,8%). No se posee el concepto claro y se desdeña el hiperparatiroidismo normocalcémico, por parte de algunos médicos, y la mayoría no solicita determinaciones de vitamina D. Discusión: los pacientes con parathormona intacta elevada por diversas causas están expuestos a muchas patologías que pueden comprometer su sobrevivencia y calidad de vida. La hipovitaminosis D probablemente sería más frecuente, si su medición se solicitara más. Debe enfatizarse la solicitud de calcifediol en cualquier patología paratiroidea.Aim: To determine the frequency and characteristics of patients who received treatment for hyperparathyroid pathologies in the Mexico, San Juan de Dios and “Dr. Rafael Ángel Calderón Guardia” hospitals in a three-year period. Methods: Analysis of records of high serum intact parathormone, medical records and bibliographical review. Descriptive study, whose sample was patients treated between January 2007 and December 2009. Determination of frequencies and proportions for the qualitative variables was made by means of the Chi-Square test. The quantitative variables were determined by the estimate of Student’s t-test. Results: Out of 199 patients studied, 9 were excluded. Women prevailed (68.9 %), the most frequent age group was 60 years and over (33.1 %). Primary hyperparathyroidism was the most frequent disease (n=46, 24.2 %; 73.9 % women, 69.5% older than 50), then hypovitaminosis D and chronic renal failure. The majority lived in San José (59.4 %) and were assisted at the Mexico Hospital (65.8%). There is no clear concept among some doctors, thus normocalcemic hyperparathyroidism is underestimated. The majority do not request determinations of vitamin D in these patients. Discussion: Patients with raised PTH by diverse reasons are exposed to many diseases that can compromise their survival and quality of life. Hypovitaminosis D would probably be more frequent if measurement was requested more often. The request for calciphediol must be emphasized in any parathyroid disease.

Aim: In our study we compared the structure and functions of the heart between predialysis and hemodialysis patients and investigated the related factors. Methods: This study included a total of 105 patients (mean age: 18-75 years): 51 on continuous hemodialysis and 54 predialysis subjects followed by the Nephrology Clinic and not yet involved in dialysis program. Laboratory data showing calcium-phosphorus metabolism disorders and transthoracic echocardiography results were evaluated. Results: Serum parathormone, phosphorus, calcium x phosphorus, alkaline phosphatase levels were significantly higher in the dialysis group compared to the predialysis group (p

Secondary hyperparathyroidism (SHPTH) can develop early in the course of chronic renal failure and becomes more prominent as kidney function declines. We studied the effect of diabetes, age, and dialysis on parathyroid function in 60 (21 women, 39 males; 44 non-diabetic, 16 diabetic) hemodialysis (HD) patients. Serum intact PTH (iPTH), calcium, phosphorus, alkaline phosphatase (ALP), and magnesium (Mg) were measured. Adequacy of HD was evaluated by calculating the urea reduction rate (URR). There were significantly lower values of serum iPTH, ALP, and dialysis adequacy among diabetic than non-diabetes HD patients. In addition, there were an inverse correlation of age and serum iPTH (r= -0.27, p= 0.034) as well as age and serum phosphorus (r= -0.28, p= 0.031). There was also a positive correlation between serum iPTH with the duration (r= 0.001, p=0.42) and doses of dialysis treatment (r= 0.38, p= 0.002). We conclude that a significant negative correlation between age and serum phosphorus and lower parathyroid activity in diabetic HD patients, which implies more prevalence of bone disease in elderly diabetic HD patients. Further study of bone disease in this group of patients is required to evaluate its effect on outcome and different therapeutic interventions.

Bone loss is common in the elderly. Parathyroid hormone (PTH), which regulates serum calcium levels,calcitonin and vitamin D metabolites have various effects on skeletal system. The aim of this study was to assess secondary hyperparathyroidism (HPTH) and bone turnover in elderly with bone loss. Fifty-five patients (9 men,46 women) older than 65 years with bone loss were included in the study. Bone mineral density was measured by dual energy x-ray absorptiomety (DXA) at L1-4 vertebrae and proximal femur regions. Patients with T scores

Introduction: There are several potential explanations for the development of PH in patients with stable hemodialysis patients. Hormonal and metabolic derangement associated with end-stage renal failure might lead to pulmonary arterial vasoconstriction and an increase of the pulmonary vascular resistance. The aim of this study was to consider the association of pulmonary artery pressure (PAP) with serum parathormone in end-stage renal disease (ESRD) patients under regular hemodialysis treatment. Material and methods: This cross-sectional study was conducted on patients with end-stage renal disease undergoing maintenance hemodialysis treatment through an arteriovenous fistula which was created on the hand, and with acetate basis dialysate and polysulfone membranes. For all patients serum intact parathormone (iPTH) was measured. For assessment of pulmonary artery pressure, all patients were subjected to two-dimensional and doppler echocardiographic studies that were done for the patients after their hemodialysis sessions. Results: The study comprised 102 patients (F=46, M=56) consisting of 73 non diabetic hemodialysis patients (F=33, M=40), and 29 diabetic hemodialysis patients (F=13, M=16). The duration of hemodialysis was 17.8±29 months. The mean ±SD of serum iPTH of total patients was 338±306 pg/ml. The mean ±SD of pulmonary artery systolic pressure (PAP) was 41.5±12.6 mmHg. A significant positive correlation of PAP with the dosage (r=0.36, p=0.001) and duration of hemodialysis (r=0.35, p

Secondary hyperparathyroidism (SHPT) is a common, important, and treatable complication of end-stage renal disease. This study was conducted to investigate the role of serum magnesium (Mg) in regulating the secretion of parathyroid hormone (PTH) by the parathyroid gland in patients on maintenance hemodialysis (HD). Pre-dialysis serum levels of calcium (Ca), phosphorus (P), Mg, alkaline phosphatase (ALP), intact serum PTH (iPTH), serum 25-hydroxy Vitamin D (25-OH Vit D) and plasma bicarbonate (HCO3) were measured. The Urea Reduction Rate as well as duration and dosage of HD treatment were noted. Our study did not show any significant correlation between serum Mg levels and duration of HD treatment, levels of serum ALP, and plasma HCO3, Ca and P. An inverse correlation, albeit insignificant, was found between the serum Mg levels and iPTH (r=-0.30 p=0.079); also, a significant positive correlation was found between serum Mg levels and serum 25-OH Vit D levels (r= 0.40 p= 0.009). Our findings are in agreement with previous data, which suggest that factors other than serum Mg are more important in the regulation of PTH secretion in HD patients. A positive and strong association between serum Mg with 25-OH Vit D needs to be studied in greater detail.

Renal osteodystrophy (ROD), which is most evident in patients on renal replacement therapy (RRT), usually begins when the kidney function starts to deteriorate. The spectrum of skeletal abnormalities seen in ROD is classified according to the state of bone turnover. In the past two decades, the prevalence of high turnover ROD has decreased while low bone turnover has become increasingly recognized. Secondary hyperparathyroidism represents a common disorder in patients with chronic kidney disease (CKD); it develops as a result of hyperphosphatemia, hypocalcemia and impaired synthesis of renal vitamin D with reduction in serum calcitriol levels. Patients with secondary hyperparathyroidism have a range of symptoms that affect their quality of life. The aim of treatment of ROD is to reduce the incidence of uremic bone disease as well as cardiovascular morbidity and mortality caused by elevated serum levels of parathormone (PTH) and calcium X phosphorus product. Treatment measures include control of phosphorus retention and prevent hyperphosphatemia, maintaining serum calcium concentrations within the normal range and prevent excess PTH secretion.

Introduction: To investigate the role of 25-OHD as a marker of nutrition and its association with mineral metabolism and serum parathormone secretion in end-stage renal failure patients undergoing regular hemodialysis (HD), a cross sectional study was carried out on a group of maintenance hemodialysis patients. Material and methods: Serum 25-hydroxy (25-OH vitamin D) levels, Intact serum PTH (iPTH) and also serum C-reactive protein(CRP), calcium, phosphorus and alkaline phosphatase (ALP) were measured. Results: In the study, significant differences of serum 25-OH vitamin D between diabetic and non-diabetics of male dialysis patients with more values in nondiabetic HD patients and a significant positive correlation of serum 25-OH vitamin D with BMI and also a near significant inverse correlation of serum 25-OH vitamin D with serum phosphorus were found, also a significant inverse correlation of serum 25-OH VitD with serum calcium was seen, too. Moreover, a weakly significant inverse correlation of serum 25-OH vitamin D with serum iPTH was seen, too. In this study no significant association between serum 25-OH vitamin D with serum albumin, CRP, ALP, dialysis adequacy and ages of the patients, duration and sessions of dialysis were found. Conclusions: In hemodialysis patients, low serum 25-OHD levels could be a risk factor for secondary hyperparathyroidism. Serum 25-OHD could show the nutritional status of HD patients. In dialysis patients, we suggest that the plasma levels of 25-OHD are maintained around the upper limit of the reference range of sunny countries.

Helicobacter pylori (H. pylori) has been shown to play an important role in the development of gastritis and gastric ulcer. Excess parathyroid hormone (PTH) has long been considered detrimental to the health of patients with end-stage renal disease. PTH has been implicated as a multisystem uremic toxin, and hyperparathyroidism can be a debilitating complication in dialyzed patients. The aim of our study was the assessment of relationships between PTH abnormalities and concentration of IgG antibodies against H. pylori. The study included 44 (F=17, M=27) stable hemodialysis (HD) patients with upper gastrointestinal symptoms. Significant positive correlations between H. pylori IgG antibody titers with serum iPTH and phosphorus and significant inverse correlation of H. Pylori IgG antibody titers with serum alkalin phosphatase were found. Hyperparathyroidism is related with stimulation of gastrin synthesis as well with increased acidity of gastric juice. Hypergastrinaemia induced stimulation of gastrin synthesis and resultant increased acidity of gastric juice could intensify the H. pylori infection in HD patients. Further studies on the association of secondary hyperparathyroidism with helicobacter pylori infection are necessary, because both dyspeptic symptoms and secondary hyperparathyroidism are quite common in HD patients and in the meantime, more attention toward control of high levels of parathormone in HD patients is needed.

Aims and objectives: Vitamin D in addition to its effect on bone- mineral homeostasis has many extra-skeletal effects. Recently its association with cardiovascular disease, diabetes, hypertension are well described. In our study we have tried to find out any of its association with cerebrovascular accident (CVA) patients. Material and Methods: In a cross sectional study serum 25 OH vitamin D3, parathormone, calcium and phosphate were estimated in 38 CVA patients and 46 age and sex matched controls. Results: Vitamin D level was found to be low in CVA patients [mean 20.01(±7.13) ng/ml] irrespective of their sex, residence, diabetes and hypertension. However there was no significant difference with control population [mean 20.37(±5.74) ng/ml; P= 0.79]. Conclusion: There is no significant difference in vitamin D level between CVA patients or non-CVA population. So the role of vitamin D deficiency in the causation of CVA needs reevaluation, especially in Indian patients.