Disorders Of Calcium Metabolism Research Articles

Follow-up after urinary diversion

Radical cystectomy is currently the standard of care for muscle-invasive bladder cancer. Different parts of the small and large intestines can be utilized for continent and incontinent urinary diversion. The postoperative follow-up after urinary diversion should consider functional, metabolic and oncological aspects. The functional follow-up of (continent) urinary diversion includes stenosis, emptying disorders or incontinence. The oncological follow-up should focus on the detection of local, urethral and upper tract recurrences as well as distant metastases. As 90% of the tumor recurrences occur during the first 3years, aclose follow-up should be carried out during this period. Metabolic disturbances, such as vitamin B12 and bile acid deficits, acidosis and disorders of calcium metabolism can also occur during long-term follow-up. The metabolic follow-up should consider the metabolic consequences of the parts of the intestines utilized for the urinary diversion.

Hypercalcemia in Cancer: Causes, Effects, and Treatment Strategies.

Calcium plays central roles in numerous biological processes, thereby, its levels in the blood are under strict control to maintain homeostatic balance and enable the proper functioning of living organisms. The regulatory mechanisms ensuring this balance can be affected by pathologies such as cancer, and as a result, hyper- or hypocalcemia can occur. These states, characterized by elevated or decreased calcium blood levels, respectively, have a significant effect on general homeostasis. This article focuses on a particular form of calcium metabolism disorder, which is hypercalcemia in neoplasms. It also constitutes a summary of the current knowledge regarding the diagnosis of hypercalcemia and its management. Hypercalcemia of malignancy is estimated to affect over 40% of cancer patients and can be associated with both solid and blood cancers. Elevated calcium levels can be an indicator of developing cancer. The main mechanism of hypercalcemia development in tumors appears to be excessive production of parathyroid hormone-related peptides. Among the known treatment methods, bisphosphonates, calcitonin, steroids, and denosumab should be mentioned, but ongoing research promotes progress in pharmacotherapy. Given the rising global cancer prevalence, the problem of hypercalcemia is of high importance and requires attention.

Patterns of Endocrine Disorders in a Neonatal Intensive Care Unit: A Single-Center Retrospective and Descriptive Study

Background: Endocrine disorders in infants in neonatal intensive care units (NICU) represent a significant clinical concern. Understanding the frequency and variety of these disorders is crucial for effective patient management. Objectives: This single-center retrospective study was conducted to examine the frequency and patterns of endocrine disorders among neonates in the NICU. Methods: We performed a retrospective review of 1 845 patient records over five years from the NICU at Çanakkale Onsekiz Mart University Health Practice and Research Hospital. The study included patients admitted between January 1, 2016, and March 31, 2021, who were diagnosed with endocrine disorders according to the international classification of diseases (ICD). Diagnostic criteria were used to identify and categorize endocrine disorders, primarily focusing on hypoglycemia, congenital hypothyroidism, hypothyroxinemia of prematurity, neonatal hyperthyrotropinemia (HTT), and disorders of calcium and magnesium metabolism. Data analysis was conducted using descriptive statistics. Results: Endocrine disorders were identified in 14.6% (CI: 13.15 - 16.38) of the neonates. The most prevalent were thyroid disorders (5.15%, CI: 4.23 - 6.25), disorders of calcium metabolism (3.68%, CI: 2.92 - 4.64), and disorders of glucose homeostasis (3.63%, CI: 2.87 - 4.58). Notably, neonatal HTT was more frequent than previously reported. The majority of endocrine issues occurred in premature infants. Hypoglycemia was the most frequent glucose homeostasis disorder, affecting 24.7% (CI: 19.9 - 30.2) of those diagnosed with endocrine issues. Among the cases with calcium metabolism disorders, hypocalcemia was predominant (79.4%, CI: 68.3 - 87.3), with the majority (89%, CI: 80.1 - 95.9) being classified as early neonatal hypocalcemia. Conclusions: Endocrine disorders, particularly those related to thyroid, calcium, and glucose homeostasis, remain prevalent issues in the NICU. Prematurity significantly contributes to these complications. The frequency and variety of endocrine disorders are likely to evolve with improvements in laboratory techniques and diagnostic methods. Future larger-scale studies could provide more comprehensive insights into these disorders.

Hypercalcemia Etiologies in Pediatric Patients: An Informative Narrative Review

Background: Hypercalcemia, although less prevalent, is a critical diagnosis in pediatric patients, consisting of numerous etiologies that differ significantly from those in adults. In children, congenital causes are more prevalent. The differential diagnosis of hypercalcemia encompasses a broad spectrum of etiologies; however, up to 90% of all cases are diagnosed with either primary hyperparathyroidism or malignancy. Primary hyperparathyroidism predominates in ambulatory patients, while malignancy is more common among critically ill hospitalized patients. Objectives: This review addresses several important issues related to calcium metabolism and hypercalcemia: a) Overview of Calcium Metabolism b) Factors affecting serum total and ionized calcium concentration c) Clinical manifestations and importance of Hypercalcemia in pediatric patients d) Overview of the causes of Hypercalcemia in pediatric patients e) Overview of Hypercalcemia management Methods: A literature search was conducted for articles published from 2000 to 2024 using PubMed, Scopus, Web of Science, Cochrane, and Embase databases. The keywords used were: CALCIUM, Calcium metabolism disorders, hypercalcemia, Parathyroid hormone, Vitamin D, and acid-base imbalance. Results: This study provides a review of calcium metabolism and factors affecting total and ionized calcium concentrations, along with a definition of hypercalcemia, classification of its severity, its clinical manifestations, and a comprehensive overview of hypercalcemia etiologies categorized into parathyroid hormone (PTH)-related and unrelated causes. An overview of its management is also included. Conclusions: Hypercalcemia is an important disorder in both pediatric and adult patients. Before initiating a workup for hypercalcemia, it is crucial to understand the physiology of calcium and the factors affecting its serum concentrations. The etiologies of hypercalcemia in pediatric patients have a wide spectrum of differential diagnoses; primary hyperparathyroidism and malignancies account for 80-90% of all hypercalcemia cases found in clinical practice. Genetic and syndromic causes are usually more prevalent in pediatrics due to the nature of these conditions. Managing hypercalcemia requires two simultaneous approaches: first, measures aimed at lowering serum calcium concentrations and second, a workup for the underlying cause.

Don’t pin it all on a stereotype

Hypercalcemia is one of the most frequently encountered problems in endocrinology OPD. Although the evaluation may not always be straightforward in all scenarios. Common factors affecting calcium levels such as dehydration, improper sample collection, and vitamin D supplementation may mask a serious underlying disorder. Here, we discuss a case of an elderly female who had symptoms of myelopathy and hypercalcemia whose etiology was initially attributed to excessive supplementation of calcium, vitamin D, and age- related bone changes; had another serious underlying calcium metabolism disorder.

Altered Vitamin D Status and Bone Mineral Density in Obese and Non-obese Patients With Polycystic Ovary Syndrome: A Cross-Sectional Study in Turkey.

Background Polycystic ovary syndrome (PCOS) is the most common endocrinological disease in women of reproductive age. In addition to providing the basis for comorbidities such as metabolic and cardiovascular diseases, it also affects bone metabolism. This study aimed to determine whether there is a relationship between bone mineral density (BMD), vitamin D status, insulin resistance, sex hormones, and calcium metabolism disorders in women with PCOS. Methodology Fifty-six non-obese women with PCOS, 67 obese women with PCOS, and 45 normal weight controls participated in the study. Circulating levels of gonadotropins, estradiol, prolactin, dehydroepiandrosterone sulfate, total testosterone, thyroid stimulating hormone, sex hormone-binding globulin, insulin, glucose, and calcium metabolism parameters were assessed. We used the Homeostatic Model Assessment-Insulin Resistance Index to detect insulin resistance. BMD values in the various body regions were measured by dual X-ray absorptiometry. Results Women with PCOS had significantly lower vitamin D values and lumbar spine BMD than controls (p <0.001 and p <0.05, respectively). Among the patients with PCOS subgroups, vitamin D deficiency (VDD) was more frequent in obese PCOS patients (67.1%) than in non-obese patients (58.9%). We found significantly lower BMD at all sites only in the subgroup of the non-obese PCOS women than in controls (p <0.001). Conclusions VDD is prevalent in PCOS women in those with obesity and hyperandrogenemia. Non-obese PCOS women have significantly lower BMD measurements than healthy controls, but obese PCOS women have BMD values comparable with normal-weight eumenorrheic controls. Body mass index is the most important factor determining BMD in women with PCOS.

Sex-Specific Variations in Vitamin D and Vitamin D Binding Protein (Vdbp) and Flipped Pattern of their Association in Preeclamptic Women with Dyslipidemia.

Women with preeclampsia frequently have disorders of calcium metabolism during their pregnancies, including hypocalciuria and low vitamin D levels. The link between fetal sex and vitamin D and vitamin D binding protein levels in pregnancy and preeclampsia is not clear. Present study was designed to explore sex-specific variations in vitamin D and vitamin D binding protein levels in maternal and umbilical cord blood samples for age and gestation matched 20 primigravida normotensive and 20 primigravida with preeclampsia with a singleton pregnancy. Routine investigations, vitamin D binding protein (VDBP), and serum vitamin D in both maternal serum and cord blood were measured in both groups. Association between maternal and cord blood vitamin D levels was highly positive in both cases and control with babies of either sex. This association exhibited sexual dimorphism between cord blood vitamin D and vitamin D binding protein (VDBP) suggesting that the occurrence of pregnancy complications differs according to fetal sex with a higher cardiovascular and metabolic load for the mother in the presence of a male fetus. Vitamin D binding protein (VDBP) measurement along with vitamin D level should be advised in clinical practice for early detection and screening.

Caseous calcification of the mitral annulus

Caseous calcification of the mitral annulus (CCMA) is a rare form of degenerative lesion of the mitral valve fibrous ring. It’s a biochemical transformation of calcification area accompanied with formation of masses of a curdled consistency (caseosis). It is usually located in the area of the posterior mitral valve. In most cases, it is asymptomatic or minimally symptomatic, and is an incidental finding during imaging studies. The causes and pathogenesis of CCMA are unknown, however, there is a connection with disorders of calcium and phosphorus metabolism and there is no connection with an valve infection. There is no specific treatment. In cases where CCMA leads to significant disturbances of cardiac hemodynamics and/or there is a high probability of ebolism, it needs to be treated surgically.Differential diagnosis is carried out with other cardiac mass.

Age-related peculiarities of the symptom complex of the increased risk of primary hyperparathyroidism development

Objective — to analyze the peculiarities of the structure of non‑specific complaints in groups aged ≤50 years and &gt;50 years with application of the questionnaire for early detection of individuals at increased risk of the primary hyperparathyroidism (PHPT) development. The questionnaire was developed by specialists of the Danylevsky Institute of Problems of Endocrine Pathology, NAMS of Ukraine.&#x0D; Materials and methods. The analysis was performed on the data of questionnaire survey of 50 patients who were examined for PHPT in the years 2020—2021. The control group consisted of patients with thyropathology who applied for medical assistance to the clinical units of the Danylevsky Institute of Problems of Endocrine Pathology. The frequency of each complaint, included in the questionnaire, was determined in the subgroups aged ≤50 years and &gt;50 years. The factors, presented against the PHPT background and associated with the development of this pathology have been established. Statistical processing of the obtained data was carried out by the methods of variational statistics using the standard package of statistical calculations Microsoft Excel and Statistica 6.0. The probability of differences in mean values was determined by the Student’s t test.&#x0D; Results. Identifying the features of the symptom complex associated with an increased risk of PHPT development in different age periods, made it possible to determine the set of factors that are the most dangerous for the development of PHPT, including: the presence of relatives with diseases related to calcium metabolism disorders, deterioration of memory, attention, pain in bones and joints, chronic pain in the upper and lower limbs, chronic pancreatitis in people under 50 years of age. The most typical, “classic” symptom complex was revealed in patients of the older age group.&#x0D; Conclusions. The presence of only non‑specific symptoms of PHPT in a significant number of patients complicates the diagnosis of the disease at early stages and leads to the development of complications of the disease. The testing of the version of the questionnaire developed by the authors made it possible to determine the list of the most dangerous symptom complex of non‑specific complaints regarding the high risk of PHPT development in the groups ≤50 years and over 50 years. The implementation of this list in the everyday practice of the medical practitioners can increase the effectiveness of efforts for early detection of the disease.&#x0D;

UV irradiance effects on komodo dragon (Varanus komodoensis) vitamin D3, egg production, and behavior: A case study.

Modifications to UV irradiance for indoor housed herpetofauna can affect behavior and physiology. Low ultraviolet B (UVB) irradiance can result in vitamin D3 deficiency resulting in calcium metabolism disorders including metabolic bone disease and immune suppression. High UVB can result in skin and eye issues, which can be severe enough to cause shock and death. Using tools available for the assessment of UV light, including Ferguson zones and the UV working tool designed by the British and Irish Association of Zoos and Aquaria, we redesigned lighting in our indoor komodo dragon (Varanus komodoensis) habitat to better suit the UV requirements of this species, while studying changes in behavior and physiology. We measured serum vitamin 25-hydroxy D3 values in one male and one female komodo dragon before and after they were housed in indoor and outdoor habitats. We also measured behavior changes in our male komodo as he moved from an outdoor habitat, to an indoor habitat with changing UV irradiance. Our female komodo showed a 98% increase in vitamin D3 values after being moved outdoors, and laid her first clutch of eggs. Our male dragon's vitamin D3 remained consistent 200 days after moving inside. He did show increased activity when higher UV irradiance was available. Importantly, we found the UV lamps we used stopped producing desired UV irradiance within 3.5 months of regular use. We suggest all animal care facilities develop UV monitoring programs to research output and longevity of UVB lamps used in indoor herpetofauna habitats.

Observation of the efficacy of parathyroidectomy for secondary hyperparathyroidism in hemodialysis patients: a retrospective study

PurposeParathyroidectomy (PTX) is commonly performed as a treatment for secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease (ESRD). We aimed to evaluate the efficacy of PTX in patients with SHPT who underwent hemodialysis.MethodsThis retrospective study analyzed the clinical treatment of 80 hemodialysis patients with SHPT who underwent either total PTX with forearm auto transplantation (TPTX + AT) or subtotal parathyroidectomy (SPTX). We compared the changes in biochemical indices before and after surgery as well as the attenuation of intact parathyroid hormone (iPTH) in the TPTX and SPTX groups. We also evaluated clinical symptoms and quality of life using the Visual Analog Scale (VAS) and the Short Form-36 Questionnaire (SF-36) before and at 3, 6, and 12 months after surgery.ResultsSerum iPTH and serum phosphorus levels decreased significantly after surgery in 80 patients with SHPT (P < 0.05). Within one month of surgery, there was a difference in iPTH levels between the TPTX + AT and SPTH groups, but there was no difference over time. Patients experienced significant improvement in their clinical symptoms of restless leg syndrome, skin itching, bone pain, and joint pain at 1 week post operation (P < 0.001). Quality of life significantly improved after surgery, as assessed by SF-36 scores (P < 0.05). Hypocalcemia was the most common postoperative complication, occurring in 35% of patients. Within the first 12 months post surgery, 5 patients had a recurrence.ConclusionPTX is effective in rapidly reducing iPTH levels, improving calcium and phosphorus metabolism disorders, and enhancing patients’ quality of life by safely and effectively relieving clinical symptoms.

The application of MDT model for calciphylaxis management in patients with end-stage renal disease.

This study focuses on the application of nurse-led multidisciplinary collaborative therapy (MDT) management model for calciphylaxis prevention of patients with terminal renal disease. Through the establishment of a multidisciplinary management team spanning nephrology department, blood purification center, dermatology department, burn and plastic surgery department, infection department, stem cell platform, nutrition department, pain department, cardiology department, hydrotherapy group, dermatology group, and outpatient treatment room, the distribution of duties among team members were clarified to bring out the best advantages of a multidisciplinary teamwork during treatment and nursing. For patients with calciphylaxis symptoms in terminal renal disease, a case-by-case management model was carried out with the focus on personalised problem. We emphasised on personalised wound care, precise medication care, active pain management, psychological intervention and palliative care, the amelioration of calcium and phosphorus metabolism disorder, nutritional supplementation, and the therapeutic intervention based on human amniotic mesenchymal stem cell regeneration. The MDT model effectively compensates for traditional nursing mode and could serve as a novel clinical management modality for calciphylaxis prevention in patients with terminal renal disease.

OUR EXPERIENCE IN THE TREATMENT OF CHOROIDAL OSTEOMA

Choroidal osteoma is a rare, benign formation of the choroid, which occurs most often in women of working age and characterized by the formation of neovascularization in 31-47% of cases, even the development of bilateral optic nerve atrophy is described. The etiology of the disease remains unknown, persistent associations with other ocular or systemic diseases, as well as with any disorders of calcium or phosphorus metabolism, have not been described in the literature. The paper presents a clinical case of diagnosis and treatment of choroidal osteoma, which was combined with secondary serous retinal detachment. A patient underwent a closed subtotal vitrectomy with endotamponade with 1300cc silicone oil due to an existing choroidal osteoma, which was complicated by secondary retinal detachment. The course of the early postoperative period was uneventful, but 2 weeks after surgical treatment, signs of inflammation of the anterior part of the vascular tract occurred with the formation of precipitates and secondary ophthalmohypertension, decrease in visual acuity, the Tyndall effect, which gradually led to the formation of a pigmented exudate in the anterior chamber. Anti-inflammatory and hypotensive therapy allowed to minimize the manifestation of inflammatory changes and to restore normotonia. As a result of the complex treatment, it was possible to improve the visual acuity and restore the morphological structure of the retina, but the functional results after the treatment remained low, which, in our opinion, may be related to the topographical location of the osteoma, since localization in the paramacular zone can not have some positive prognosis in postoperative period. Also, the existing long-term retinal detachment and complications in the early postoperative period could affect the low functional results after the surgical treatment.

Reconsideration of “Albumin corrected total calcium” Determinations: Potential errors in the Clinical management of disorders of calcium metabolism

BackgroundThe formula, referenced in major textbooks, for albumin corrected calcium [Calcium(alb)] may not accurately depict ionized calcium [ICa]. We evaluated the accuracy of unadjusted calcium [Calcium(Unadjusted)] and [Calcium(alb)], and developed a protocol for local laboratory adjustment of calcium for albumin. MethodsLaboratory data were obtained from an electronic health record. Assessments were accuracy, false positive, and false negative rates. Clinical reliability was defined in “error zones” for calcium [Ca]: Zone A = Ca(normal), ICa(low); Zone B = Ca(low), ICa(normal); and Zone C = Ca(normal), ICa(high), Zone D = Ca(high), ICa(normal). ResultsA linear regression from 468 laboratory tests was used to derive a formula for “revised corrected calcium” [Calcium (revised)] over a range of albumin concentrations where, [Calcium (revised)] = plasma calcium (mg/dl) + [(4- Albumin (g/d)L)]*(plasma calcium (mg/dl)*0.052)]. [Calcium(alb]] vs [Calcium(Unadjusted)] decreased zone B errors 12%, [95%CI;8–15%], vs 44% [95%CI;37–50%], p < 0.001. However, [Calcium(alb]] vs [Calcium(Unadjusted)] increased zone A error (60%,[95%CI;42–78%], vs 7% [95%CI;1–13%], p < 0.001). [Calcium (revised)] decreased zone A errors (15%, [95%CI;6–24%]) vs [Calcium(alb) ] (60% [95%CI;42–78%], p < 0.001) and Zone D errors from 9% [95%CI;6–12%] to 2% [95%CI;1:5%, p < 0.001]. Conclusions[Calcium(alb)] is unreliable in hypo- or hypercalcemia. We provide a protocol for locally derived correction of calcium for albumin.

Бисфосфонаты в лечении нарушений обмена кальция у детей: более 40 лет применения (лекция)

Лекция содержит анализ результатов использования бисфосфонатов (БФ) в лечении нарушений обмена кальция в костях и мягких тканях у детей и взрослых. БФ – целый класс (более 10) синтетических аналогов естественных регуляторов обмена кальция в организме – неорганических пирофосфатов. За 40 лет клинического использования БФ определены показания к их применению (резорбция кости, риск переломов, наследственные остеопатии у детей и взрослых). Установлены основные механизмы действия БФ (ингибиторы ферментов, повышающих активность остеокластов). Определены фармакологические свойства БФ, различия в степени активности отдельных препаратов (от 1 до 10 000 единиц), выявлены их противовоспалительные свойства. Определены дозы, способы введения БФ и схемы лечения, а также условия, при которых повышается риск побочных эффектов. Продолжается поиск новых видов БФ для лечения некостных заболеваний. The lecture contains an analysis of outcomes of bisphosphonates (BP) use in treatment of calcium metabolism disorders in bones and soft tissues in children and adults. BP is a whole class (more than 10) of synthetic analogues of natural regulators of calcium metabolism in the body - inorganic pyrophosphates. Over 40 years of clinical use of BP, indications for their use (bone resorption, fractures risk, hereditary osteopathies in children and adults) were determined. The main mechanisms of BP action were established (inhibitors of enzymes that increase the activity of osteoclasts). Pharmacological properties of BP, differences in the activity of individual drugs (from 1 to 10,000 units) were defined, and their anti-inflammatory properties were revealed. Doses, methods of BP administration and treatment regimens were determined, as well as conditions increasing adverse effects risk. Further investigations of new types of BP for non-bone diseases treatment are underway.

AN INTERESTING CASE OF KNOCK KNEE

Primary hyperparathyroidism is a generalized disorder of calcium, phosphate, and bone metabolism due to an increased secretion of parathyroid hormone. The manifestations may be subtle, and the disease may have a benign course for many years or a lifetime. If the patients are symptomatic , the most commonly involved system include the renal and the skeletal system. Herein we present a case of 16 year old male who presented with complaints of multiple large joint pain and progressive deformity of both knees over the past 1 year. Physical examination revealed bilateral genu valgum. Investigations taken showed elevated serum calcium levels, parathormone levels, alkaline phosphatase levels and low levels of vitamin D. Skeletal radiograph taken showed evidence of osteitis brosa cystica along with salt and pepper appearance of the skull. USG Neck showed evidence of left parathyroid adenoma and a Tc99 Sestamibi parathyroid scintigraphy scan conrmed it. Patient underwent inferior parathyroidectomy. Post procedure, patient's parathormone levels were within the normal limits and hence was discharged with calcium and vitamin D supplements.

Calcium homeostasis and certain aspects of its disturbances in juvenile idiopathic arthritis

Background. In the pathogenesis of juvenile idiopathic arthritis (JIA), the main role is played by immunopathological changes in the body with a loss of tolerance to the elements of own tissues; herewith, disorders of calcium and bone metabolism are very important. Such changes occur as a result of autoimmune inflammation, pharmacotherapy, and the influence of a number of other factors that negatively affect calcium homeostasis in the body. Purpose: to study the features of calcium homeostasis and certain aspects of its disorders with an assessment of the structural and functional state of bone tissue, taking into account clinical subtypes and disease activity. Material and methods. Sixty-two children with JIA aged 3.5 to 16 years were examined, of them 11 had systemic and 51 had oligo- and polyarthritis. There were determined serum concentrations of a total calcium using the Lachema test kit (Czech Republic), protein-bound and ultrafiltered fractions, content of inorganic phosphorus (with the generally accepted spectrophotometric method using the Cobas 6000 analyzer and test systems by Roche Diagnostics, Switzerland), the activity of total alkaline phosphatase and its isoenzymes (bone and intestinal) using the Lachema test system (Czech Republic). Ultrasonic osteometry of the calcaneal (trabecular) bone was performed on the Achilles device (Lunar, USA). Results. A significant decrease was found in the average concentration of total calcium, protein-bound calcium in systemic JIA and in high disease activity. The concentration of the ultrafiltered calcium fraction decreased only with high disease activity. The average concentration of inorganic phosphorus in children with oligo- and polyarthritis was within the normal range, while in systemic JIA it decreased. A significant decrease in the serum content of inorganic phosphorus, as well as in the activity of total alkaline phosphatase and its bone isoenzyme was detected in patients with high activity of systemic JIA. In patients with JIA (oligo-, polyarthritis) characterized by a slowly progressive rheumatic process, only the indicator of broadband ultrasound attenuation significantly changed during the first year of the disease, while the speed of ultrasound propagation and the index of bone tissue strength were not changed. In patients with a longer duration of the disease, all densitometric indicators decreased significantly. In the group of patients with systemic JIA and a rapidly progressive course, high activity of the disease that required a glucocorticoid therapy, a significant loss of bone mass was noted by the end of the first year of the disease. Conclusions. In JIA, there are changes in the concentration of total calcium and its protein-bound and ultrafiltered fractions in the blood serum, which indicate the tension of calcium-phosphorus metabolism and possible calcium deficiency in the body already at the early stages of the pathological process. A decrease in the activity of the alkaline phosphatase and its bone isoenzyme is associated with a violation of the structural and functional changes in the bone system of patients with JIA, which progresses with the duration of the disease. Patients with JIA require timely diagnosis and monitoring of calcium-phosphorus metabolism disorders with an assessment of the structural and functional state of the bone system for purposeful correction of comprehensive therapy due to the use of drugs in order to increase bone tissue regeneration, reduce the progression of osteopenia and osteoporosis, and preserve the health of the growing organism.

Metastatic calcinosis cutis in a dialysis patient

Metastatic calcinosis cutis is an uncommon complication of end-stage kidney disease but has severe and disabling effects. Its development is attributed to disorders of calcium and phosphate metabolism associated with secondary hyperparathyroidism. The mainstay of treatment remains medical therapy; however, in refractory cases a parathyroidectomy is indicated. We describe the case of a 22-year-old female with refractory hyperparathyroidism treated with a subtotal parathyroidectomy resulting in complete resolution of metastatic calcinosis cutis of the hands. Clinicians should be aware that this complication can occur soon after the initiation of dialysis and that rapid complete resolution can be achieved with parathyroidectomy.

501 CASEOUS CALCIFICATION OF THE MITRAL ANNULUS AND THE IMPORTANCE OF ITS IDENTIFICATION IN THE CLINICAL PRACTICE: A REPRESENTATIVE CASE

Abstract 1. Introduction Caseous Calcification of the Mitral Annulus (CCMA) is a rare condition characterized by a liquefaction degeneration that usually involves posterior mitral ring and it is considered a variant of mitral annulus calcification. Its prevalence is very low, but it is possible that it is often underdiagnosed or misdiagnosed. This condition is related with increased age, female sex, chronic kidney disease and calcium metabolism disorders. The lesion can be detected using imaging techniques and its management is conservative in most cases. 2. Case Study A 72-year-old man hospitalized for bilateral pneumonia complicated with ARDS has come to our attention. The patient had a history of stage IV renal failure, type 2 diabetes mellitus and calcific degenerative aortic valve disease. During its stay in the Intensive Care Unit a routine Transthoracic Echocardiogram showed a vegetation suspected for infective endocarditis that involved the posterior mitral leaflet. However, the clinical presentation did not support endocarditis diagnosis as no microorganisms were isolated at multiple blood cultures and other Duke Criteria were negative. Given the limited acoustic viewing of transthoracic echocardiogram it was necessary to perform a Transesophageal Echocardiogram (TEE) for a better characterization of the valve lesion. TEE showed the presence of a round lesion, about 2×2 cm in size, with smooth borders, located over the mitral annulus with extension up to the posterior mitral leaflet and with a partially mobile portion. The lesion had a corpuscular appearance inside with less echogenicity and without evidence of flow. No significant functional alterations of the mitral valve were detected (anterograde transmitral flow Mean Gradient 4-5 mmHg; Mild regurgitation). We therefore concluded for Caseous Calcification of the Mitral Annulus as the most likely diagnosis and decided for a conservative management. A new TEE was performed as a control after one week showing no significant changes on the valve lesion. 3. Conclusions It is important for echocardiographers to be familiar with CCMA and to know how to distinguish it from other valve lesions such as infective vegetation, abscesses or tumors. An integration with other cardiac imaging techniques, patient past medical history and clinical-laboratory data can help the physician in the correct characterization of valve lesions and subsequent most appropriate therapeutic approach for the patient.

Etiopathogenesis of Calcium–Phosphorus Metabolism in Rabbits

In this article clinical signs, hematological indicators and photo morphological changes in bones of the etiopathogenesis of calcium–phosphorus metabolism in rabbits are described. Low–nutrition, poor–quality feeding of mother rabbits during the estrus period means that the needs of the mother rabbits’ body for vitamins and macro–microelements are not fully met. Disorders of calcium and phosphorus metabolism in rabbits are on average 53,3% during the gestation period and on average 73,3% during the postpartum period. It is accompanied by symptoms such as a decrease in response to external influences, swelling of the skin, a decrease in gloss, strong whitening of the mucous membranes, a decrease in body weight, accompanied by symptoms such as a change in appetite.