High Parathyroid Hormone Levels Research Articles

The Mediation Effect of Peripheral Biomarkers of Calcium Metabolism and Chronotypes in Bipolar Disorder Psychopathology.

Calcium (Ca++) metabolism may be impaired in several psychiatric diseases. We hypothesize that calcium imbalance might also correlate with a specific chronotype and could be recognized as a marker of illness severity in bipolar disorder (BD). We aimed to (1) identify the association between calcium imbalance and a specific chronotype in a cohort of BD patients, and (2) test the mediation role of high parathyroid hormone (PTH) levels towards a specific chronotype and illness severity in BD patients. Patients’ socio-demographic and clinical characteristics were collected with an ad-hoc schedule. We administered the Hamilton Depression Rating Scale (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), the Young Mania Rating Scale (YMRS), and the Morningness Eveningness Questionnaire (MEQ). 100 patients affected by BD were recruited. The Kruskal-Wallis test showed a significant difference between the three MEQ groups in PTH levels (p < 0.001) and vitamin D levels (p = 0.048) but not in Ca++ levels (p = 0.426). Dwass-Steel-Critchlow-Fligner Pairwise analyses performed concerning three MEQ groups revealed significantly higher scores on PTH levels in MEQ-E subjects compared to MEQ-M and MEQ-I (in both cases, p < 0.001). No differences emerged between calcium levels among the three chronotypes. The mediation analysis has shown that elevated PTH levels are directly influenced by more severe HAM-A, HAM-D, and YMRS scores. MEQ-E could be a marker related to BD and predispose to various factors influencing mood symptoms. The combination of vitamin D therapy in MEQ-E may help to improve prognosis in this subtype of patients affected by BD.

Kidney Failure Alters Parathyroid Pin1 Phosphorylation and Parathyroid Hormone mRNA-Binding Proteins, Leading to Secondary Hyperparathyroidism.

Secondary hyperparathyroidism (SHP) is a common complication of CKD that increases morbidity and mortality. In experimental SHP, increased parathyroid hormone (PTH) expression is due to enhanced PTH mRNA stability, mediated by changes in its interaction with stabilizing AUF1 and destabilizing KSRP. The isomerase Pin1 leads to KSRP dephosphorylation, but in SHP parathyroid Pin1 activity is decreased and hence phosphorylated KSRP fails to bind PTH mRNA, resulting in high PTH mRNA stability and levels. The up- and downstream mechanisms by which CKD stimulates the parathyroid glands remain elusive. Adenine-rich high-phosphate diets induced CKD in rats and mice. Parathyroid organ cultures and transfected cells were incubated with Pin1 inhibitors for their effect on PTH expression. Mass spectrometry was performed on both parathyroid and PTH mRNA pulled-down proteins. CKD led to changes in rat parathyroid proteome and phosphoproteome profiles, including KSRP phosphorylation at Pin1 target sites. Furthermore, both acute and chronic kidney failure led to parathyroid-specific Pin1 Ser16 and Ser71 phosphorylation, which disrupts Pin1 activity. Pharmacologic Pin1 inhibition, which mimics the decreased Pin1 activity in SHP, increased PTH expression ex vivo in parathyroid glands in culture and in transfected cells through the PTH mRNA-protein interaction element and KSRP phosphorylation. Kidney failure leads to loss of parathyroid Pin1 activity by inducing Pin1 phosphorylation. This predisposes parathyroids to increase PTH production through impaired PTH mRNA decay that is dependent on KSRP phosphorylation at Pin1-target motifs. Pin1 and KSRP phosphorylation and the Pin1-KSRP-PTH mRNA axis thus drive SHP.

Relationship between hematological, endocrine and immunological markers and sarcopenia in the elderly

Objective: To relate hematological, endocrine and immunological markers to the criteria for classifying sarcopenia in older people residents in the community. Method: Cross-sectional study, linked to the institutional research “Integrated Health Care for Older People”. The study population consisted of males and females aged 60 years or more and assisted in primary health care. The research protocol included an interview and physical examination to evaluate the sarcopenia criteria. Analysis of the following were done: complete blood count, 25-hydroxyvitamin D, parathyroid hormone, insulin-like growth factor-1, interleukin-6 and C-reactive protein. Statistical analysis included the Mann-Whitney test, Pearson's chi-square test, Fisher's exact test and Odds Ratio. Results: There was a relationship between interleukin-6 (p= 0,004), erythrocytes (p= 0,038), hemoglobin (p&lt;0,001) and hematocrit (p= 0,002) with sarcopenia. It was also observed that the older people with altered muscular strength had lower values of hematocrit (p= 0,037) and higher of interleukin-6 (p= 0,002); and with altered physical performance had lower values of leukocytes (p= 0,024), hemoglobin (p&lt;0,001), hematocrit (p= 0,007) and 25-hydroxyvitamin D (p= 0,034) and higher levels of parathyroid hormone (p= 0,018) and interleukin-6 (p= 0,002). Conclusion: It is suggested to evaluate and monitor the levels of interleukin-6, parathyroid hormone, 25-hydroxyvitamin D and the red blood count series during care practice.

An association of VDR gene polymorphism in hypovitaminosis D mediated secondary hyperparathyroidism in adolescent girls; a tertiary hospital study in central India

Vitamin D is required to maintain normal serum calcium and phosphate levels that help normal bone mineralization, nerve conduction, muscle contraction, immune function, cell proliferation, and differentiation. Interventions including vitamin D supplementation may not improve vitamin D deficiency, as various complex genomic actions could contribute to vitamin D deficiency in the Indian population. Thus, we assessed hypovitaminosis D’s relationship with vitamin D receptor (VDR) gene polymorphism and evaluated parathyroid hormone (PTH) levels in seemingly healthy adolescent school-going girls. We included 100 school-going girls (aged 12–17 years) studying in four schools of different socio-economic strata of Bhopal, India. The selected participants were divided into four groups based on the school in which they were studying. Blood samples were tested for serum calcium, phosphorus, PTH, ALP, vitamin D 25(OH) D, and albumin levels.VDR polymorphism was detected through the PCR-RFLP. Data were analyzed using the chi-square test, ANOVA, and linear regression. The difference in the age, calcium, ALP, and vitamin D values between the four groups were significant (P < 0.05), whereas high PTH levels (80%) were found. A higher prevalence of homozygous polymorphic allele demonstrates a molecular signature for severe secondary hyperparathyroidism. Hypovitaminosis D ranged from 84.9% to 100%, and a high prevalence of VDR polymorphism was observed. Attention must be paid to the health of this age group of school-going girls as hypovitaminosis D and associated VDR gene polymorphism could be the reason for secondary hyperparathyroidism (SHPT), showing changes in bone mineral density in these adolescent girls to ensure their future health.

MO821: Quality of Life and Depression in Hemodialysis Patients

Abstract BACKGROUND AND AIMS End-stage renal disease (ESRD) has certainly an impact on patients’ health-related quality of life (HRQoL). Depression is, also, highly prevalent in hemodialysis patients. This study aimed to evaluate HRQoL, the prevalence of depression, its associated factors, and its impact on quality of life in our population. METHOD This was a cross-sectional study including 70 hemodialysis patients in Monastir, Tunisia. Depression was evaluated using the Beck Depression Inventory (BDI). Quality of life was assessed with the Short-Form 36. Data were also collected on sociodemographic, laboratory (albumin, parathormone, hemoglobin and phosphorus) and dialysis (dialysis vintage, vascular access and hemodialysis adequacy) characteristics. The analysis was performed with descriptive and analytical statistics. RESULTS Among 70 patients, 64.3% were men. The mean age was 49 ± 15.7 years old. High blood pressure, diabetes and dyslipidemia were the most common comorbidities. Low drug adherence was frequent. The global average score according to the SF-36 was 38.2. The QOL was impaired in 64.2% of the cases. We have identified five variables correlated with impaired QOL: lack of autonomy, a dialysis rhythm of 3 times a week, an age &amp;gt;60 years, low social economic level and living in rural areas. Depression was present in 14.2% of the sample. Depressed patients presented poor quality of life, lower serum albumin and higher parathormone levels. CONCLUSION Our study highlights the high frequency of QOL impairment in patients on hemodialysis. Actions aimed at changing some factors associated with reduced QOL can promote well-being.

Abstract #1185030: Primary Hyperparathyroidism Corrected by Vitamin D supplementation: A Rare Presentation

Primary hyperparathyroidism (PHTP) is a common endocrine disorder characterized by high parathyroid hormone (PTH) and calcium levels, commonly detected incidentally. A common concurrent finding is vitamin D deficiency, with a reported incidence of as high 91%. Vitamin D administration in PHPT is controversial due to a risk of exacerbating hypercalcemia, though some studies have shown that this may in fact be beneficial by suppressing PTH levels and decreasing bone demineralization. We present an interesting case of a 45-year-old male presenting with asymptomatic PHPT which was successfully managed solely with vitamin D administration.

Predictive factors and the relationship between the early detection of osteoporosis and pathological fractures in Indonesian menopausal women

Background: Estrogen deficiency in menopausal women induces bone loss and makes them prone to pathological fractures. Age, body mass index (BMI), parental history of osteoporosis, and smoking tobacco also increase bone loss and pathological fractures. This study aims to determine whether age, BMI, parental history of osteoporosis, and smoking tobacco can predict pathological fractures in menopausal women. Moreover, the relationship between the early detection of osteoporosis with pathological fracture incidence will also be determined. Methods: This is an analytic observational epidemiological research with a cross-sectional retrospective design that involved 40 menopausal women. The data were collected from the patients' medical records 2020 in Obstetrics and Gynecology Clinic, Asri Medical Center (AMC) Muhammadiyah Hospital, Yogyakarta. The predictive factors for pathological fracture (age, BMI, parental history, smoking tobacco) were analyzed by using Fisher's exact test and the relationship between osteoporosis early detection, including bone mineral density (BMD) value, parathyroid hormone (PTH) levels, osteocalcin levels, and osteoporosis self-assessment tool for Asians (OSTA) score, with pathological fractures were investigated by using the chi-square test. Result: Age has a significant relationship with the occurrence of pathological fractures in menopausal women (OR = 6.6, 95% CI: 1.128-8.604, p = 0.042), while BMI, parental history of osteoporosis, and smoking tobacco did not have a significant relationship with pathological fractures (p &gt; 0.05). Early detection of BMD and PTH was also found to have a significant relationship to fracture incidence. Additionally, menopausal women with high PTH levels and osteoporosis BMD values are eight times and four times greater risk of acquiring fractures than menopausal women with normal BMD values and PTH levels. Conclusion: Age can be a predictive factor for pathological fractures, and the early detection of PTH and BMD is related to the occurrence of pathological fractures in menopausal women.

Influence of Obesity on Bone Turnover Markers and Fracture Risk in Postmenopausal Women.

Background and aims: The relationship between obesity and bone metabolism is controversial. In recent decades, the protective role of obesity in the development of osteoporosis is questioned. The aims of this study are the following: to evaluate the differences in bone turnover markers between postmenopausal women with and without obesity and to compare the risk of fracture at five years between these groups. Methods: An observational longitudinal prospective cohort study of postmenopausal women with obesity (O) (body mass index (BMI) > 30 kg/m2) and non-obesity (NoO) (BMI < 30 kg/m2) is designed. 250 postmenopausal women are included in the study (NoO: 124 (49.6%) and O: 126 (50.4%)). It measures epidemiological variables, dietary variables (calcium intake, vitamin D intake, smoking, alcohol consumption, and physical activity), biochemicals (β-crosslap, type I procollagen amino-terminal peptide (P1NP), 25OH-vitamin D, and parathyroid hormone (PTH)), anthropometric variables, and fracture data five years after the start of the study. The mean age is 56.17 (3.91) years. Women with obesity showed lower levels of vitamin D (O: 17.27 (7.85) ng/mL, NoO: 24.51 (9.60) ng/mL; p < 0.01), and higher levels of PTH (O: 53.24 (38.44–65.96) pg/mL, NoO: 35.24 (25.36–42.40) pg/mL; p < 0.01). Regarding the bone formation marker (P1NP), it was found to be high in women without obesity, O: 45.46 (34.39–55.16) ng/mL, NoO: 56.74 (45.34–70.74) ng/mL; p < 0.01; the bone resorption marker (β-crosslap) was found to be high in women with obesity, being significant in those older than 59 years (O: 0.39 (0.14) ng/mL, NoO 0.24 (0.09) ng/mL; p < 0.05). No differences are observed in the risk of fracture at 5 years based on BMI (OR = 0.90 (95%CI 0.30–2.72); p = 0.85). Conclusions: Postmenopausal women with obesity showed lower levels of bone formation markers; older women with obesity showed higher markers of bone resorption.

Giant parathyroid adenoma: a case report

BackgroundGiant parathyroid adenoma is a type of parathyroid adenoma weighing > 3.5 g and having a size of more than 2 cm.Case presentationThis 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.ConclusionGiant 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.

Microwave ablation versus parathyroidectomy for the treatment of primary hyperparathyroidism: a cohort study

ObjectiveTo compare the clinical outcomes between microwave ablation (MWA) and parathyroidectomy (PTX) for the treatment of primary hyperparathyroidism (pHPT).Materials and methodsThis retrospective study enrolled 212 patients with pHPT treated by either MWA (MWA group) or PTX (PTX group) from January 2015 to October 2020. The baseline data were balanced through propensity score matching. Clinical cure was evaluated by the Kaplan-Meier method and compared between the MWA and PTX groups. The risk factors related to persistent or recurrent pHPT were screening out using a Cox proportional hazards regression model.ResultsAfter propensity score matching, a total of 174 patients were enrolled in the present study, with 87 patients in each group. During the follow-up period (median, 28.5 months), there were no differences between the two groups regarding the clinical cure (hazard ratio, 1.71; 95% confidence interval: 0.81-3.62; p = .155), persistent pHPT rate (13.8% vs. 10.3%, p = .643), recurrent pHPT rate (6.9% vs. 3.4%, p = .496), or major complications (6.9% vs. 3.4%, p = .496). MWA resulted in a shorter procedure time (30 min vs. 60 min), smaller incision length (0.1 cm vs. 7 cm) and slightly higher costs (25745 CNY vs. 24111 CNY) (all p < .001). High levels of preoperative intact parathyroid hormone (p = .01) and multiple pHPT nodules (p < .001) were independent risk factors for recurrent and persistent pHPT in the two groups.ConclusionMWA and PTX have comparable clinical outcomes for pHPT. MWA has a shorter procedure time and smaller incision length.Key Points• There were no differences in terms of clinical cure, persistent pHPT, recurrent pHPT, or major complications between MWA and PTX in the treatment of pHPT.• MWA is minimally invasive and results in a shorter procedure time.• Multiple nodules and high levels of iPTH were the independent risk factors for recurrent and persistent pHPT.

A patient with femoral osteitis fibrosa cystica mimicking bone neoplasm: a case report

BackgroundOsteitis fibrosa cystica is a rare, benign and osteolytic lesion attributed to hyperparathyroidism. The high level of parathyroid hormone cause rapid bone loss.Case presentationThe patient is a 50-year-old male complaining of severe and persistent pain in the right knee joint. Imaging studies were suspicious for a benign tumor in the right distal femur. Biopsy under CT guidance showed numerous osteoclast aggregation and hemosiderin deposition around the bone trabeculae. Blood tests disclosed significantly elevated parathyroid hormone, serum calcium, serum alkaline phosphatase. Parathyroid ultrasonography and CT scan showed a solid mass in front of the trachea at the thoracic entrance plane. After resection of the mass, the clinical symptoms were relieved and the radiological results were significantly improved, which further confirmed the diagnosis.ConclusionsMetabolic diseases-associated bone lesions require a comprehensive diagnosis of multiple inspection items. An interprofessional team approach to the diagnosis and treatment of osteitis fibrosa cystica will provide the best outcome.

Hungry bone syndrome in delay diagnosed primary hyperparathyroidism with fi brocystic osteitis: A case report

Fibrocystic osteitis is a rare but severe primary hyperparathyroidism (PHPT) complication. We describe a 66-year-old female presented with fi brocystic osteitis and nephrocalcinosis with eGFR reduction to CKD stage 4 due to primary hyperparathyroidism. Delayed diagnosis of long-term hypercalcemia, high parathyroid hormone level, unsubstituted 25(OH)D defi ciency, and the use of bisphosphonates in high doses caused development of «hungry bones» syndrome in early postoperative period. Severe hypocalcemia required prescription of active and native vitamin D metabolites, oral calcium supplements as well as intravenous calcium. Delay in diagnosis of PHPT with fi brocystic osteitis formation led to lower well-being, reduced quality of life and also provoked sever postoperative hypocalcemia («hungry bone» syndrome).

Bone Fragility in Chronic Kidney Disease Stage 3 to 5: The Use of Vitamin D Supplementation.

Frequently silent until advanced stages, bone fragility associated with chronic kidney disease-mineral and bone disease (CKD-MBD) is one of the most devastating complications of CKD. Its pathophysiology includes the reduction of active vitamin D metabolites, phosphate accumulation, decreased intestinal calcium absorption, renal alpha klotho production, and elevated fibroblast growth factor 23 (FGF23) levels. Altogether, these factors contribute firstly to secondary hyperparathyroidism, and ultimately, to micro- and macrostructural bone changes, which lead to low bone mineral density and an increased risk of fracture. A vitamin D deficiency is common in CKD patients, and low circulating 25(OH)D levels are invariably associated with high serum parathyroid hormone (PTH) levels as well as with bone mineralization defects, such as osteomalacia in case of severe forms. It is also associated with a variety of non-skeletal diseases, including cardiovascular disease, diabetes mellitus, multiple sclerosis, cancer, and reduced immunological response. Current international guidelines recommend supplementing CKD patients with nutritional vitamin D as in the general population; however, there is no randomized clinical trial (RCT) evaluating the effect of vitamin D (or vitamin D+calcium) supplementation on the risk of fracture in the setting of CKD. It is also unknown what level of circulating 25(OH)D would be sufficient to prevent bone abnormalities and fractures in these patients. The impact of vitamin D supplementation on other surrogate endpoints, including bone mineral density and bone-related circulating biomarkers (PTH, FGF23, bone-specific alkaline phosphatase, sclerostin) has been evaluated in several RTCs; however, the results were not always translated into an improvement in long-term outcomes, such as reduced fracture risk. This review provides a brief and comprehensive update on CKD-related bone fragility and the use of natural vitamin D supplementation in these patients.

PREVALENCE AND RISK FACTORS OF VITAMIN D INADEQUACY AMONG THAI ELDERLY PATIENTS WITH OSTEOPOROTIC HIP FRACTURE

Background: Vitamin D deficiency directly impacts bone biology, eventually resulting in elevated risk of fragility fracture. Despite its global abundance, data concerning its prevalence and risk factors among Thai patients with osteoporotic hip fractures remains lacking.&#x0D; Objectives: This study aimed to evaluate the average level of serum vitamin D, prevalence of hypovitaminosis D and its risk factor among Thai elderly patients with fragility hip fractures.&#x0D; Methods: A cross-sectional study was conducted among Thai patients with fragility hip fractures aged 60 years or older in a single center from April 2016-April 2020. The patients were divided according to serum 25-hydroxy vitamin D (25-(OH)D) levels. Demographic data were compared to identify risk factors of vitamin D inadequacy.&#x0D; Results: Of 258 patients, 74.81% were females with mean age of 78.76 years. The average serum 25(OH)D level was 19.64 ng/mL. Prevalences of vitamin D inadequacy, vitamin D insufficiency and vitamin D deficiency were 86.05, 28.69 and 57.36%, respectively. When compared with the vitamin D sufficiency group, the vitamin D inadequacy group had a history of frequent falls, higher body mass index (BMI) as well as high parathyroid hormone (PTH) levels.&#x0D; Risk factors associated with vitamin D inadequacy were BMI &gt;23 kg/m2 (AOR= 4.67, 95%CI=1.24-17.73), and two or more falls within a year (AOR= 3.96, 95%CI=1.38-11.33). Moreover, risk factors associated with vitamin D deficiency were being female (AOR= 2.87, 95%CI=1.06-7.78), BMI &gt;23 kg/m (AOR=7.20, 95%CI =1.67-31.02), two or more falls within one year (AOR=7.32, 95%CI =2.17-24.69) and elevated PTH level (AOR= 3.38, 95%CI=1.17-0.74).&#x0D; Conclusion: Most elderly patients with fragility hip fractures had hypovitaminosis D. Risk factors included high BMI, frequent falls for vitamin D inadequacy, being female and high PTH levels for vitamin D deficiency. Serum 25(OH)D assessment and appropriate supplement are recommended, especially for patients with fragility hip fractures and aforementioned risk factors.

\xa0Misdiagnosis of brown tumour caused by primary hyperparathyroidism: a case report with literature review

BackgroundBrown tumour is a rare tumour-like lesion of the bone, which is considered as an end-stage lesion of abnormal bone metabolism caused by persistently high parathyroid hormone (PTH) levels. Brown tumour can be found in any part of the skeleton; in some cases, it can occur in multiple bones and can be easily misdiagnosed as a metastatic tumour.Case presentationWe report the case of a 44-year-old man who presented to the Department of Oncology in our hospital with a 2-month history of local pain in his left shoulder joint. The initial diagnosis was an aneurysmal bone cyst by biopsy, for which the patient underwent tumour resection surgery. The diagnosis of a malignant tumour was made again following postoperative pathological examination. The pathological sections and all clinical data were sent to the Department of Pathology of the First Affiliated Hospital of Sun Yat-sen University; the diagnosis made there was brown tumour. His blood PTH level was 577 pg/ml (15–65 pg/ml). Colour Doppler ultrasonography of the parathyroid gland suggested a parathyroid adenoma. For further treatment, the left parathyroid adenoma was removed by axillary endoscopic resection. Postoperatively, a pathologic examination was performed, and the diagnosis of a parathyroid adenoma was confirmed. One year after the surgery, the left humerus was completely healed, and the left shoulder joint had a good range of movement.ConclusionsIn summary, histopathological diagnosis is not sufficient for the diagnosis of brown tumours. A comprehensive analysis combining clinical symptoms with findings of imaging and laboratory tests is also required. Generally, the treatment of brown tumour includes only partial or complete resection of the parathyroid glands. However, when the tumour is large, especially when it involves the joint, surgery is indispensable.

Mineral and bone disorders in peritoneal dialysis

Introduction&#x0D; Disorders of mineral and bone metabolism are common in dialysis patients and are responsible for an increased risk of fracture, cardiovascular risk and mortality. The mineral and bone disorder most frequently found in peritoneal dialysis (PD) is adynamic osteopathy. The aim of our work is to describe the mineral and bone profile of patients on peritoneal dialysis, to determine the prevalence of hyperparathyroidism in this population and to identify the risk factors associated with it.&#x0D; Material and method&#x0D; This is a cross-sectional study including all our PD patients in whom we analyzed the various clinical, biological, radiological and therapeutic data related to mineral and bone metabolism.&#x0D; We defined hyperparathyroidism by a parathyroid hormone (PTH) ≥ 600pg/ml and we determined the risk factors by comparing two groups : with and without hyperparathyroidism.&#x0D; Results&#x0D; We retained 85 patients whose mean age was 49.18 ± 17.28 years and the sex ratio of 0.77. The seniority in dialysis was 33.31 ± 26.68 months. Median PTH was 668 pg/ml [34-3800] with serum calcium at 87.75±7.52 mg/l, phosphatemia at 54.07±16.69 mg/l and vitamin D at 23.74±11.56 ng/ml. Hyperparathyroidism was found in 60% of patients.&#x0D; The risk factors for hyperparathyroidism noted in our study are: seniority in PD, high PTH before the start of dialysis, and hyperphosphatemia. The short medical follow-up before dialysis seems to play an important role in the development of secondary hyperparathyroidism.&#x0D; Conclusion&#x0D; Hyperparathyroidism is the most frequent mineral and bone disorder in our series. Factors correlated with hyperparathyroidism are length of time on dialysis, hyperphosphatemia and high parathormone levels before the start of dialysis.

Multiple brown tumor revealing primary hyperparathyroidism associated with Behçet’s disease: A case report

BackgroundPrimary hyperparathyroidism (PHP) is defined as hypercalcemia that may remain asymptomatic for years and cause lesion in skeletal system such as brown tumor (BT). Endocrine involvement in Behçet’s Disease (BD) regarding various systems can be seen. Case reportWe report an association between BD and PHP in a 45-year-old female. She had complained of inflammatory pain in the lower limb. Plain x-ray showed a lytic lesion on the upper tibia. Laboratory investigations revealed hypercalcemia (3.32 mmol/L), hypophosphatemia (0.48 mmol/L), a high parathyroid hormone (PTH) level (2278 pg/L) and a low vitamin D level (8.1 μg/L). An adenoma in the right lower parathyroid has been shown on scintigraphy, a vertebral fracture was present on lumbar spine X-ray and salt and pepper skull was shown on the lateral skull X-ray. Severe osteoporosis was present on the lumbar bone mineral density (t score −3.3), and multiple BT were revealed on bone scan. The patient was operated on and developed Hungry Bone Syndrome (HBS) following surgery. Therefore, she received high doses of calcium with favorable outcome. ConclusionThis case is a leading report for the coexistence of BD with PHP. This case provides further evidence that BD should be considered as an autoimmune process, which may be associated with endocrine involvement including PHP. On the other hand, musculoskeletal manifestations of PHP including BT still seen in daily practice require continued vigilance on the part of the physician.

Parathyroid Hormone Regulates Circulating Levels of Sclerostin and FGF23 in a Primary Hyperparathyroidism Model.

Parathyroid hormone (PTH) increases fibroblast growth factor 23 (FGF23), mediated both by protein kinase A (PKA) and Wnt signaling, and decreases expression of sclerostin, a Wnt antagonist derived from osteocytes. Patients with primary hyperparathyroidism (PHPT) have lower serum sclerostin levels than healthy controls, consistent with the idea of SOST downregulation by PTH. Nevertheless, the relationship between FGF23 and sclerostin in PHPT is still unclear. We examined this issue in a mouse model of PHPT. PHPT mice had increased FGF23 and decreased sclerostin expression in calvaria and in their serum concentrations compared with wild-type (WT) mice. In UMR106 osteoblasts, PTH increased Fgf23 expression and decreased Sost expression, as well as forskolin, a PKA agonist, whereas inhibition of PKA reversed the changes in Fgf23 and Sost expression, stimulated by PTH. Sclerostin treatment had no effect on Fgf23 expression, but when it was added together with PTH, it statistically significantly abrogated the increase in Fgf23 expression. By contrast, there was no statistically significant correlation between serum FGF23 and sclerostin, whereas PTH was positively and negatively correlated with serum FGF23 and sclerostin, respectively. These results indicate that the high level of PTH in PHPT mice leads to increased FGF23 and decreased sclerostin expression in serum and calvaria. A decrease of sclerostin may further augment FGF23 in vitro; however, there was no statistically significant association between circulating FGF23 and sclerostin. It is suggested that the pathogenesis of increased FGF23 expression in PHPT mice may be modified by not only sclerostin, but also other regulatory factors modulated by PTH.

Influence of Sunlight on Vitamin D and Health Status in Green (Chelonia mydas) Sea Turtles with Fibropapillomatosis.

Simple SummaryGreen sea turtles are an endangered species prone to a disease called fibropapillomatosis (FP). FP causes the growth of large debilitating tumors on the skin, eyes, and shell of sea turtles. Sea turtle rehabilitation facilities often treat turtles with this disease by removing the tumors, but many of these individuals do not survive or the tumors regrow. A way to improve the treatment of these turtles could help the population as a whole. The aim of this study was to compare plasma vitamin D levels in green sea turtles with and without evident FP tumors, as vitamin D influences immune function and overall health. We determined that exposure to more sunlight influences plasma vitamin D levels in sea turtles brought into a rehabilitation facility. We found that tumored individuals arriving at the facility had lower vitamin D and ionized calcium levels and higher parathyroid hormone levels compared to both wild-caught and rehabilitation turtles without evident tumors. Individuals housed in tanks exposed to greater ultraviolet (UV) (sun)light showed greater increases in plasma vitamin D levels and a more successful recovery. The results suggest that increasing sun exposure in rehabilitation facilities may enhance health and recovery in green turtles with FP. Green sea turtles (Chelonia mydas) are an endangered species, which as juveniles are prone to the debilitating disease green turtle fibropapillomatosis (FP). Previous work has shown an association between reduced immune function and FP. As vitamin D has been linked to immune function in numerous animals, the aim of this study was to compare vitamin D levels in green sea turtles with and without evident FP and determine if exposure to sunlight would influence vitamin D levels and other health parameters. Various health markers, including vitamin D, in turtles with and without evident tumors being treated at a rehabilitation facility in southeast Florida were compared to apparently healthy wild-caught juvenile green turtles. Turtles receiving treatment were housed in tanks exposed to higher or lower levels of sunlight for up to 6 months. Upon intake, tumored individuals had lower plasma vitamin D and ionized calcium levels and higher parathyroid hormone levels when compared to both wild-caught and rehabilitation turtles without evident tumors. Individuals exposed to greater sunlight showed greater increases in plasma vitamin D and a more successful recovery. The results suggest that increasing sun exposure in rehabilitation facilities may enhance health and recovery in green turtles with FP.

Parathyroid hormone and phosphate homeostasis in patients with Bartter and Gitelman syndrome: an international cross-sectional study.

Small cohort studies have reported high parathyroid hormone (PTH) levels in patients with Bartter syndrome and lower serum phosphate levels have anecdotally been reported in patients with Gitelman syndrome. In this cross-sectional study, we assessed PTH and phosphate homeostasis in a large cohort of patients with salt-losing tubulopathies. Clinical and laboratory data of 589 patients with Bartter and Gitelman syndrome were provided by members of the European Rare Kidney Diseases Reference Network (ERKNet) and the European Society for Paediatric Nephrology (ESPN). A total of 285 patients with Bartter syndrome and 304 patients with Gitelman syndrome were included for analysis. Patients with Bartter syndrome type I and II had the highest median PTH level (7.5pmol/L) and 56% had hyperparathyroidism (PTH>7.0pmol/L).Serum calcium was slightly lower in Bartter syndrome type I and II patients with hyperparathyroidism (2.42versus 2.49mmol/L; P=.038) compared to those with normal PTH levels and correlated inversely with PTH (rs -0.253; P=.009). Serum phosphate and urinary phosphate excretion did not correlate with PTH. Overall, 22% of patients had low serum phosphate levels (phosphate-standard deviation score < -2), with the highest prevalence in patients with Bartter syndrome type III (32%). Serum phosphate correlated with tubular maximum reabsorption of phosphate/glomerular filtration rate (TmP/GFR) (rs 0.699; P <.001), suggesting renal phosphate wasting. Hyperparathyroidism is frequent in patients with Bartter syndrome type I and II. Low serum phosphate is observed in a significant number of patients with Bartter and Gitelman syndrome and appears associated with renal phosphate wasting.