Mean Serum Calcium Concentration Research Articles

Severe hypocalcemia in the emergency department: a retrospective cohort study of prevalence, etiology, treatment and outcome.

The aim of this study was to evaluate the prevalence of severe hypocalcemia in patients attending the emergency department. Symptoms, causes, treatment, and outcome of severe hypocalcemia as well as course of calcium concentrations were assessed. This retrospective case series included all adult patients with measurements of serum calcium concentrations presenting to the emergency department of the Bürgerspital Solothurn between January 01 in 2017 and December 31 in 2020. Medical record reviews were performed of all patients with severe hypocalcemia, defined by a serum calcium concentration < 1.9mmol/L, to assess clinical presentation and management. 1265 (3.95%) patients had a serum calcium concentration of < 2.1mmol/L of which 139 (11%) had severe hypocalcemia of < 1.9mmol/L. 113 patients had at least one measurement of albumin. Of these, 43 (3.4%) had an albumin-corrected serum calcium < 1.9mmol/L defining true, severe hypocalcemia. Hypocalcemia was identified and documented in 35% of all cases. The mean serum calcium concentration was 1.74 ± 0.14mmol/L. Calcium concentrations in malignancy-related hypocalcemia were similar to non-malignancy-related hypocalcemia. The main symptoms attributed to hypocalcemia were cardiac and neurologic. 12% of patients with severe hypocalcemia received intravenous and 23% oral calcium replacement. Active malignancy was the main cause of severe hypocalcemia in 28%, while in most cases, the main cause remained unclear. 41.9% of severely hypocalcemic patients reattended the emergency department for another episode of hypocalcemia within 1 year. Hypocalcemia is common in patients attending the emergency department, however, appears to be neglected frequently. The disorder is often a manifestation of severe disease, triggered by multiple causes. Calcium replacement was administered in less than half of the patients with severe hypocalcemia in this study. Due to frequent readmissions to the emergency department and a high mortality, increased awareness of the disorder and careful follow-up are desirable.

Continuous Subcutaneous Delivery of rhPTH(1-84) and rhPTH(1-34) by Pump in Adults With Hypoparathyroidism.

Continuous subcutaneous infusion of recombinant parathyroid hormone (rhPTH) through a pump has been proposed as a therapeutic alternative for patients with chronic hypoparathyroidism who remain symptomatic or hypercalciuric on conventional treatment (calcium and active vitamin D) or daily injections of rhPTH(1-84) or rhPTH(1-34). However, the real-world evidence of the outcome of this novel therapy is limited. We report the clinical and biochemical outcomes of 12 adults with hypoparathyroidism (11 women, age 30-70 years, and 1 man, age 30 years) from 3 different clinical sites in the United States who were transitioned from conventional therapy to daily injections of rhPTH(1-84) or rhPTH(1-34) and then switched to continuous administration of rhPTH(1-84)/rhPTH(1-34) via pump therapy. In most patients, mean serum calcium concentrations increased while on PTH pump therapy compared with both conventional therapy (in 11 patients) and single/multiple daily rhPTH injections (in 8 patients). Despite this, 10 patients had lower median 24-hour urinary calcium levels while on PTH pump therapy compared with prior therapy (mean ± SD difference: -130 ± 222 mg/24 hours). All patients reported a qualitative decrease in hypocalcemic symptoms while receiving pump therapy. Three patients had pod failure at least once, and 1 patient developed an infusion site reaction. In this case series of 12 patients with chronic hypoparathyroidism treated with rhPTH(1-84)/rhPTH(1-34) administered via a pump, improvement in clinical and biochemical parameters were observed in the majority of the patients. Our observations indicate benefits of pump administration of rhPTH that warrant further investigation.

A Comparative Study of Calcium Metabolism between Quail and Domestic Rabbits

The existing study was conducted to evaluate calcium; vitamin D and calcitonin concentration in two types of amniotes that live in the Iraqi environment include the local rabbit and the Japanese quail. The study included 18 female Japanese quail Coturnix coturnix, weighing 145.5 ± 34.341 g, they were 16 weeks in ages and 18 female local rabbits, Oryctolagus cuniculus, at the age of one years and 1438.5 ± 284.988 g in weight. The results showed that the mean serum calcium concentration in bird and rabbit were 8.134±0.450 (mg/dl) and 7.267±1.761 (mg/dl) respectively and it was significantly at at 0.066 higher in bird in comparison to rabbit, the mean of vitamin D in bird and rabbit were 24.22± 3.159 (ng/ml) and 28.43±4.632 (ng/ml) respectively and it was significantly higher in rabbit than bird at 0.007 while the mean serum calcitonin concentration in bird and rabbit were 1.354±0.1960 (mg/dl) and 1.676±0.4151 (mg/dl) respectively and it was significantly at 0.009 higher in rabbit in comparison to bird. Egg laying, shell calcification and medullary bone formation induce more extra demand of calcium in birds while the high rate of teeth erupting demand extra calcium in rabbits, the metabolism of vitamin D will be altered indirectly by these process which associated with increased requirements for calcium. The study showed an increase in the level of calcium in both rabbits and quail birds, and that this increase will change the metabolism of vitamin D, and many physiological processes will occur.

Effect of low-calcium and standard-calcium dialysate on serum calcium, phosphorus and full-segment parathyroid hormone in patients on peritoneal dialysis: A retrospective observational study.

To investigate the effects of low-calcium and standard-calcium dialysate in patients with chronic kidney disease on peritoneal dialysis, and find out which dialysate has less vascular calcification effect. A total of 141 patients who had undergone peritoneal dialysis (PD) for 2 years in the PD centre from January 2012 to December 2017 were included and divided into two groups according to the calcium concentration of the PD fluid used. There were 79 cases in the low-calcium group, with a dialysate calcium concentration of 1.25 mmol/L and 62 cases in the standard-calcium group, with a dialysate calcium concentration of 1.75 mmol/L. The demographic characteristics and clinical information before initiation of PD were collected and compared between the two groups. Information on the serum calcium, phosphorus and PTH, systolic and diastolic blood pressures and the use of antihypertensive and phosphate-lowering drugs in the second year of dialysis was also collected and compared between the two groups. Vascular calcification was assessed in patients on PD treatment. The mean serum calcium concentrations before initiation of PD in the low- and standard-calcium groups were 1.94 ± 0.27 and 1.89 ± 0.28 mmol/L, respectively. The serum calcium concentrations after PD were 2.30 ± 0.21 and 2.41 ± 0.23 mmol/L, respectively. After PD, the serum calcium concentration in both groups was significantly increased (p < 0.05). The serum calcium concentration in the low-calcium group after PD treatment was lower than that in the standard-calcium group, and the difference was statistically significant (p < 0.05). Compared with the standard-calcium group, patients in the low-calcium group had significantly higher parathyroid hormone concentrations (p < 0.05). More types of phosphate-lowering drugs were used (59.49%) in the low-calcium group than that in the standard-calcium group (35.48%; p < 0.05). The number of antihypertensive drug usage were also higher in the low-calcium group, and the difference was statistically significant (p < 0.05). As for the vascular calcification effect, the two groups have shown no statistical difference in abdominal aortic calcification rate, carotid arteriosclerosis rate and aortic arch calcification rate (p < 0.05). We found that low-calcium PD fluid may increase the PTH level and the proportion of CKD patients using antihypertensive drug and phosphorus-lowering drug, but the vascular calcification effect of the low and standard calcium PD fluid needs further exploration. This paper provides new evidence for the choice of dialysate for PD, low-calcium dialysate has no outstanding advantages for long term dialysis.

Serum and Red Cell Magnesium and Calcium Concentrations in Normotensive and Pre-Eclamptic Pregnant Women in Lagos, Nigeria

Background: Pre-eclampsia is a significant cause of maternal and foetal morbidity and mortality. This study identified the relationship between serum and red cell concentrations of magnesium and calcium in pre-eclampsia. This is to justify the use of magnesium in the prevention of pre-eclampsia and eclampsia. Objective: To compare the serum and red cell levels of calcium and magnesium among pre-eclamptic and normotensive pregnant women. Method: A prospective, comparative study comparing serum and red cell concentrations of magnesium and calcium in sixty pre-eclamptic patients and sixty normotensive pregnant controls. Result: The mean serum calcium concentration among pre-eclamptic patients was 2.33±0.19 mmol/l, compared with 2.47±0.23 mmol/l in the normotensive group (p = 0.244). The mean serum magnesium concentration was significantly higher among normotensive pregnant women than pre-eclamptic women (1.18±0.31 mmol/l vs 0.91±0.23 mmol/l; p = 0.001). The mean red blood cell calcium concentration was also significantly higher among pre-eclamptic pregnant women compared to the normotensive group (4.34±0.62 mmol/l vs 3.95±0.79 mmol/l; p = 0.003), but the mean red cell magnesium concentration was lower in pre-eclamptic than the normotensive control group but without statistical significance (2.04±0.65 mmol/l vs 2.26±0.79 mmol/l; p = 0.098). Conclusion: Pre-eclampsia is associated with low concentrations of serum magnesium and calcium. Therefore, magnesium supplements may be beneficial in preventing pre-eclampsia.

Association between Serum Calcium Concentration and Glycated Haemoglobin in Type II Diabetic Nigerian Patients

Background: Diabetes is a metabolic disease that affects key biochemical parameters in the body. The study was carried out to evaluate the serum calcium concentration and the relationship between serum calcium and glycosylated haemoglobin in type 2 diabetics. Methods: A total of 126 subjects consisting of 63 Diabetic patients and 63 controls participated in this study. Serum calcium and glycosylated haemoglobin concentrations were measured. Fasting blood sugar was also measured. Total calcium was measured using colorimetric determination of plasma total calcium by the o-cresolphthalein o-complexone (CPC) assay principle. Plasma albumin was determined using Bromocresol green (BCG) method, and thus corrected calcium was deduced. Glycosylated haemoglobin (HbA1C) was estimated using an ion-exchange chromatographic method. A semi-structured questionnaire was used for data collection. Results: The mean serum calcium levels of diabetics compared to non-diabetics did not differ statistically even though that of diabetics was in the lower range of normal. There was no statistically significant difference (p=0.099) between the mean serum calcium levels of diabetic patients who had glycosylated haemoglobin values below 6.5 (2.26 mmol/l±0.07) and diabetic patients who had glycosylated haemoglobin values above 6.5 (2.17mmol/l±0.09). Surprisingly, there was a weak positive correlation between glycosylated haemoglobin levels above 6.5 and serum calcium levels (p=0.087) and HbA1C below 6.5 correlated negatively albeit weakly with serum calcium levels though they were both insignificant. Socio-demographic data show that more females were diabetic. Conclusion: Overall, the study reveals that mean serum calcium concentrations in diabetic and non-diabetic patients are not different and this may be due to good blood glucose control in these diabetic patients

Parathyroid carcinoma: Single centre experience.

Parathyroid Carcinoma is a rare malignant neoplasm, accounting for less than 1% of primary hyperparathyroidism cases. Parathyroid carcinomas are characterized by markedly elevated levels of PTH, severe hypercalcemia and established target organ damage. The authors report the experience of a single centre regarding the management and outcome of patients with parathyroid carcinomas and revise relevant literature. Retrospective review of all patients with parathyroid carcinoma evaluated at a tertiary oncologic centre from 1991 until 2021. Seventeen patients were identified (10 males), with a mean age at diagnosis of 53 ± 16 years and a median follow-up of 16.5 years. Most patients presented with hypercalcemia (n = 15), with a mean serum calcium concentration of 13.5 mg/dl (9.6-16.5) and mean PTH of 1173 pg/ml (276-2500). Hyperparathyroidism-mediated organ damage was observed in most patients (n = 16), with predominant renal (n = 12) and skeletal (n = 9) complications. En bloc surgical resection was performed in nine patients. Three patients underwent adjuvant radiotherapy. Recurrence was observed in 8 cases (47.1%) after a median of 24 months following surgery and no independent predictors of recurrence were identified. The overall survival and disease specific survival at 5-year was 88% and 94%, respectively. CDC73 mutations were present in 38.5% of analysed patients and one patient was diagnosed with MEN1. Parathyroid carcinoma is associated with a significant rate of recurrence and limited effective treatment beyond initial complete surgical resection. Therefore, preoperatively high index of suspicion is paramount to optimize patient care. This is, to our knowledge, the largest Portuguese cohort published so far.

Serum Calcium and Its Association with Preeclampsia

Background: The purpose of the study was to evaluate association of serum calcium concentration with preeclampsia.&#x0D; Method: This study was carried out in the Department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2016 to December 2016 including 120 antenatal patients in their second half of pregnancy. All the included patients were classified as 40 mild preeclampsia (Group A) 40 severe preeclampsia (Group B) and 40 normal pregnant women (Group C). Serum calcium was estimated in the Department of Biochemistry and correlated with preeclampsia.&#x0D; Result: In results the mean serum calcium concentration was found 8.2±0.2mg /dl in Group A, 7.6 ± 0.3 mg/dl in Group B and 9.0±0.5 mg/dl in Group C (p=0.001). Low serum calcium was found 53.7% and 12.5% in case and control respectively. The difference was statistically significant (p=&lt;0.05) between case and control groups having OR=8.1 with 95% CI (2.7 - 26.5) %. Pearson’s correlation test revealed that both systolic and diastolic blood pressure had negative correlation with the serum calcium concentration (p=&lt;0.05).&#x0D; Conclusion: In conclusion this study showed that low serum calcium is associated with preeclampsia and its concentration inversely proportional to the severity of preeclampsia and both systolic and diastolic blood pressure.&#x0D; Bangladesh Journal of Medical Science Vol.20(2) 2021 p.379-383

Does increased immune response at early postpartum period have a relationship with metabolic markers and subsequent fertility?

The aim of the present study was to investigate blood parameters and subsequent fertility in cows with or without increased postpartum polymorphonuclear neutrophil activity. The study was conducted with 15 Brown Swiss cows between 1-3 lactations. Polymorphonuclear neutrophil activities were assessed at 10±4 days before and after parturition. The cows which maintained their phagocytic and oxidative burst activites compared to the prepartum period were classified as control (CON), and cows which increased phagocytic and oxidative burst activites were defined as increased cellular immune response (ICIR) cows. Energy, protein metabolism markers, hepatic enzymes, blood mineral levels and body condition scores were measured at -10±4, 3±2, 10±4 days relative to parturition. Pregnancy rates, the number of inseminations, and calving to pregnancy intervals were evaluated. The mean non-esterified fatty acid (NEFA) and beta- -hydroxybutyric acid (BHB) concentrations were lower in ICIR cows. Mean serum calcium (Ca) concentrations were in subclinical hypocalcemia level at day 3±2, 10±4 days postpartum in CON cows. Postpartum immune cell functions and NEFA, BHB concentrations were negatively cor- related. The calving to pregnancy interval were longer in the control cows. However, total preg- nancy rates and the number of insemination in both groups were similar. In conclusion, postpar- tum polymorphonuclear neutrophil activity is affected by periparturient metabolic status. Postpartum energy metabolites negatively affected the postpartum cellular immune response. The increased postpartum polymorphonuclear neutrophil activity at early postpartum period is positively related with subsequent fertility in dairy cows.

Conversion from Intravenous Vitamin D Analogs to Oral Calcitriol in Patients Receiving Maintenance Hemodialysis.

In the United States, intravenous vitamin D analogs are the first-line therapy for management of secondary hyperparathyroidism in hemodialysis patients. Outside the United States, oral calcitriol (1,25-dihydroxyvitamin D3) is routinely used. We examined standard laboratory parameters of patients on in-center hemodialysis receiving intravenous vitamin D who switched to oral calcitriol. We conducted a retrospective cohort study of adult patients treated within Fresenius Kidney Care clinics. During a 6-month period (December 2013 to May 2014), we identified patients on an intravenous vitamin D analog (doxercalciferol or paricalcitol) who switched to oral calcitriol and matched them to patients receiving an intravenous vitamin D analog. Mean serum calcium, phosphate, and intact parathyroid hormone (iPTH) concentrations were examined for up to 12 months of follow-up. We used Poisson and Cox proportional hazards regression models to examine hospitalization and survival rates. The primary analysis was conducted as intention-to-treat; secondary analyses included an as-treated evaluation. A total of 2280 patients who switched to oral calcitriol were matched to 2280 patients receiving intravenous vitamin D. Compared with patients on intravenous vitamin D, mean calcium and phosphate levels in the oral calcitriol group were lower after the change to oral calcitriol. In contrast, iPTH levels were higher in the oral calcitriol group. At 12 months, the percentage of patients with composite laboratories in target range (calcium <10 mg/dl, phosphate 3.0-5.5 mg/dl, and iPTH 150-600 pg/ml) were comparable between groups (45% versus 45%; P=0.96). Hospital admissions, length of hospital stay, and survival were comparable between groups. An as-treated analysis and excluding those receiving cinacalcet did not reveal significant between-group differences. Among patients receiving in-center hemodialysis who were switched to oral calcitriol versus those on an intravenous vitamin D analog, the aggregate of all mineral and bone laboratory parameters in range was largely similar between groups.

US-guided microwave ablation for secondary hyperparathyroidism in patients after renal transplantation: a pilot study

Objective: To assess the safety and efficacy of ultrasound-guided microwave ablation (MWA) in the treatment of patients who develop secondary hyperparathyroidism (SHPT) after renal transplantation (RT).Methods: In total, nine patients, each with symptomatic SHPT caused by RT and at least one enlarged parathyroid gland, underwent MWA via hydrodissection. Intact parathyroid hormone (i-PTH), serum calcium, serum phosphorus, creatinine and blood urea nitrogen concentrations, before and after MWA, were assessed and compared.Results: Complete ablation was achieved in all patients for a total of 14 ablated parathyroid glands. The mean follow-up time was 17.2 ± 1.7 months post-operation. The mean maximum diameter of the parathyroid glands was 1.3 ± 0.4 cm (range: 0.4–2.0 cm). The ablation power implemented was 30 W and the mean time for each parathyroid gland to achieve complete ablation was 287.5 ± 83.4 s. The mean i-PTH, serum calcium and phosphorus concentrations at one day post-MWA (69.6 pg/mL, 2.23 ± 0.29 mmol/L, 1.2 2 ± 0.48 mmol/L, respectively) were significantly lower than those before MWA (780.0 pg/mL, 2.62 ± 0.32 mmol/L, 1.39 ± 0.61 mmol/L, respectively; p < .01), whereas the creatinine and blood urea nitrogen concentrations before and after MWA did not differ significantly from each other (p > .05). No significant differences were found between the biomarker concentrations observed at one day post-MWA and at the follow-ups (p > .05). No major operation-related complications occurred.Conclusion: Ultrasound-guided MWA is a safe and effective technique for destroying parathyroid gland tissue in patients who develop SHPT after RT and its clinical effects are long-lasting.

Associations between serum calcium concentration and postpartum health and reproductive performance in dairy cows

In the present study, the aim was to evaluate the associations between serum calcium concentration after calving and serum metabolites, postpartum disorders, and reproductive performance in dairy cows. Blood samples were collected from 200 Holstein cows immediately and 1, 2, 4, 6, and 8 weeks after calving to measure serum metabolites and progesterone concentrations. Cows were divided into three groups on the basis of the mean serum calcium concentration after calving: a Low group (<7.9 mg/dL, n = 52), a Moderate group (7.9–9.6 mg/dL, n = 100), and a High group (≥9.7 mg/dL, n = 48). Total cholesterol (TCH) concentration was greater in the High group than in the Moderate group during the postpartum period (P < 0.01). The High group had greater albumin concentrations during the postpartum period (P < 0.01) and glucose concentrations after calving and 1 week postpartum (P < 0.05) than the Low and Moderate groups. The High group had a lesser incidence of retained placenta than the Low (P < 0.1) and Moderate (P < 0.01) groups, and a lesser incidence of clinical endometritis than the Moderate group (P < 0.05). The probability of resuming estrous cyclicity by 8 weeks postpartum was greater in the High group than in the Low group (hazard ratio = 3.71, P < 0.05). In conclusion, greater serum calcium concentration after calving is associated with greater serum TCH, albumin, and glucose concentrations, a lesser incidence of retained placenta, and clinical endometritis, and earlier resumption of estrous cyclicity in dairy cows.

Evaluation of Spot Urinary Calcium to Creatinine Ratio in Preeclampsia: A Cross Sectional Comparative Study

Background: Preeclampsia (PE) is a pregnancy related condition leading to significant mortality and morbidity. A number of renal changes are seen in preeclampsia.Objectives: This study was designed to determine the association of calcium to creatinine ratio in a spot sample of urine with preeclampsia.Methodology: This cross-sectional comparative study was conducted in the Obstetrics &amp; Gynaecology department of Dhaka Medical College, Dhaka, Bangladesh. Pregnant women with preeclampsia without complication and women with normal pregnancy without complications were selected for the study. Calcium, creatinine, Protein and calcium to creatinine ratio was measured in a spot urine sample of all these 150 subjects. Blood was also collected from all the cases for measurement of serum calcium, creatinine and uric acid.Results: A total of 150 pregnant women, 75 with preeclampsia without complication and 75 with normal pregnancy without complications were selected for the study. Significant difference between PE and normal group was observed in case of mean serum calcium and uric acid concentration but mean serum creatinine did not vary significantly. Urinary creatinine concentration did not show any significant difference. But mean urinary calcium concentration in spot sample of urine was significantly lower in preeclampsia than normal pregnant woman (3.45 ± 2.61 mg/dl vs 7.39 ± 2.80 mg/dl, p&lt; 0.001). Similarly mean calcium to creatinine ratio in spot sample of urine was significantly lower in the pre-eclampsia than normal group (0.06 ± 0.05 vs 0.13 ± 0.06, p&lt;0.001). Positive correlation was observed between urinary calcium/creatinine ratio and urinary calcium (r=+0.68, p&lt;0.001) but negative correlation (r = - 0.39, p&lt;0.001) noted between urinary calcium/creatinine and urinary protein.Conclusion: Spot urinary calcium and creatinine ratio decreases in preeclampsia. So spot urinary calcium and creatinine ratio can be regarded as a predictor for preeclampsia.Journal of National Institute of Neurosciences Bangladesh, 2017;3(1): 14-20

Serum biochemical values of some species of apparently healthy free-living wild birds in Zaria, Nigeria

The research was carried out to establish baseline serum biochemical parameters for some species of apparently healthy free-living wild birds in Zaria, Nigeria. A total of 133 free-living wild birds, belonging to seven species, comprising 20 each of Poicephalus senegalus (Senegal Parrot), Psittacula krameri (Rose-Ringed Parakeet), Streptopelia senegalensis (Laughing Dove), Treron waalia (Bruce’s Green Pigeon), 19 Columba guinea (Speckled Pigeons), 16 Streptopelia decipiens (Mourning Collar-Doves) and 18 Bubulcus ibis (Cattle Egrets) were used. The Audiocomb serum auto-analyser was used for the analyses. The highest mean glucose (154.70 ± 5.72 mg/dl), creatinine (0.49 ± 0.02 mg/dl) and urea (5.53 ± 0.28 mg/dl) concentrations were obtained from the apparently healthy Mourning Collar Dove, Bruce Green Pigeon and Speckled Pigeon, respectively. Except for mean serum calcium concentration of 2.64 ± 0.05 mg/dl which was highest in the apparently healthy Cattle Egret, the glucose (139.20 ± 4.64 mg/dl), urea (4.24 ± 0.15 mg/dl), total protein (6.65 ± 0.10 g/dl) and albumin (3.77 ± 0.10 g/dl) concentrations were lowest in this species of bird. The mean total protein concentration of 6.93 ± 0.10 g/dl and globulin concentration of 2.97 ± 0.04 g/dl were highest in the apparently healthy Laughing Dove. The apparently healthy Rose-Ringed Parakeet had the highest mean phosphorus concentration of 1.05 ± 0.03 mg/dl and lowest mean globulin fraction of 2.89 ± 0.05 g/dl. The range values for urea (4.40–7.20 mg/dl), calcium (2.53–3.01 mg/dl) and phosphorus (0.87–1.96 mg/dl) were obtained from the Speckled Pigeon, while the Mourning Collar-Dove had range value of 139–202 mg/dl for glucose concentration. In conclusion, there were interspecies variations in biochemical parameters of free-living wild birds in Zaria, Nigeria.

Mice deleted for cell division cycle 73 gene develop parathyroid and uterine tumours: model for the hyperparathyroidism-jaw tumour syndrome

The hyperparathyroidism-jaw tumour (HPT-JT) syndrome is an autosomal dominant disorder characterized by occurrence of parathyroid tumours, often atypical adenomas and carcinomas, ossifying jaw fibromas, renal tumours and uterine benign and malignant neoplasms. HPT-JT is caused by mutations of the cell division cycle 73 (CDC73) gene, located on chromosome 1q31.2 and encodes a 531 amino acid protein, parafibromin. To facilitate in vivo studies of Cdc73 in tumourigenesis we generated conventional (Cdc73+/−) and conditional parathyroid-specific (Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre) mouse models. Mice were aged to 18-21 months and studied for survival, tumour development and proliferation, and serum biochemistry, and compared to age-matched wild-type (Cdc73+/+ and Cdc73+/+/PTH-Cre) littermates. Survival of Cdc73+/− mice, when compared to Cdc73+/+ mice was reduced (Cdc73+/−=80%; Cdc73+/+=90% at 18 months of age, P<0.05). Cdc73+/−, Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre mice developed parathyroid tumours, which had nuclear pleomorphism, fibrous septation and increased galectin-3 expression, consistent with atypical parathyroid adenomas, from 9 months of age. Parathyroid tumours in Cdc73+/−, Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre mice had significantly increased proliferation, with rates >fourfold higher than that in parathyroid glands of wild-type littermates (P<0.0001). Cdc73+/−, Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre mice had higher mean serum calcium concentrations than wild-type littermates, and Cdc73+/− mice also had increased mean serum parathyroid hormone (PTH) concentrations. Parathyroid tumour development, and elevations in serum calcium and PTH, were similar in males and females. Cdc73+/− mice did not develop bone or renal tumours but female Cdc73+/− mice, at 18 months of age, had uterine neoplasms comprising squamous metaplasia, adenofibroma and adenomyoma. Uterine neoplasms, myometria and jaw bones of Cdc73+/− mice had increased proliferation rates that were 2-fold higher than in Cdc73+/+ mice (P<0.05). Thus, our studies, which have established mouse models for parathyroid tumours and uterine neoplasms that develop in the HPT-JT syndrome, provide in vivo models for future studies of these tumours.

Bone Density Status and Vitamin D and Calcium Concentrations in Pregnant and Non-Pregnant Women

Background: The aim of this study was to analyse differences in bone density and vitamin D and calcium concentrations between pregnant and non-pregnant women. Methods: This was an analytical, cross-sectional study of women aged 30 years or over, residing in the Puskesmas Bangkalan district. The sample population was chosen at random and included 10 pregnant women in their third trimester and 10 non-pregnant women. This observational study consisted of an interview, a blood test, and a 24-hour recall. The concentration of serum vitamin D (25(OH)D) was measured by Gas Chromatography and a Photometric Test measured the concentration of serum calcium. Participant's bone density was measured by bone ultra sonometer. The data was analysed using the Mann-Whitney test and assessed ultraviolet-B exposure, bone density values, and consumption of vitamin D, calcium, energy, and protein. The Student t -test was used to analyse serum vitamin D and calcium concentrations. Results: There were no differences between the groups' serum vitamin D concentrations ( p = 0.946). However, there were significant differences between the groups' serum calcium concentrations ( p = 0.047) and bone density values ( p = 0.019). Conclusion s : A high prevalence of vitamin D deficiency (25(OH)D < 50 nmol/L) and insufficiency (25(OH)D < 80 nmol/L) was observed in both groups. The mean serum calcium concentrations and bone density values were lower in pregnant subjects than non-pregnant subjects.

Treatment with cinacalcet increases plasma sclerostin concentration in hemodialysis patients with secondary hyperparathyroidism.

BackgroundSclerostin is a paracrine acting factor, which is expressed in the osteocytes and articular chondrocytes. Sclerostin decreases the osteoblast-related bone formation through the inhibition of the Wnt/β-catenin pathway. Osteocytes also express the Calcium sensing receptor which is a target for cinacalcet. The aim of this study was to assess the influence of six-month cinacalcet treatment on plasma sclerostin concentration in hemodialysed patients with secondary hyperparathyroidism (sHPT).MethodsIn 58 hemodialysed patients with sHPT (PTH > 300 pg/ml) plasma sclerostin and serum PTH, calcium and phosphate concentrations were assessed before the first dose of cinacalcet and after 3 and 6 months of treatment.ResultsSerum PTH concentration decreased after 3 and 6 month of treatment from 1138 (931–1345) pg/ml to 772 (551–992) pg/ml and to 635 (430–839) pg/ml, respectively. Mean serum calcium and phosphate concentrations remained stable. Plasma sclerostin concentration increased after 3 and 6 months of treatment from 1.66 (1.35–1.96) ng/ml, to 1.77 (1.43–2.12) ng/ml and to 1.87 (1.50–2.25) ng/ml, respectively. In 42 patients with cinacalcet induced serum PTH decrease plasma sclerostin concentration increased after 3 and 6 months of treatment from 1.51 (1.19–1.84) ng/ml to 1.59 (1.29–1.89) ng/ml and to 1.75 (1.42–2.01) ng/ml, respectively. Contrary, in the 16 patients without cinacalcet induced serum PTH decrease plasma sclerostin concentration was stable. Plasma sclerostin concentrations correlated inversely with serum PTH concentrations at the baseline and also after 6 months of treatment.Conclusions1. In hemodialysed patients with secondary hyperparathyroidism treatment with cinacalcet increases plasma sclerostin concentration 2. This effect seems to be related to decrease of serum PTH concentration.

Abstract P055: Serum Calcium and Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Non-skeletal calcium serves a variety of functions. Pertinent to diabetes, an influx of calcium through calcium channels into pancreatic β-cells is required for insulin secretion. Previous cohort studies exploring the association between serum calcium and diabetes have not accounted for 25-hydroxyvitamin D [25(OH)D], or parathyroid hormone (PTH), and have had limited racial/ethnic diversity. Hypothesis: We hypothesized that serum calcium concentration would be positively and independently associated with diabetes incidence. Methods: A total of 12,800 black and white ARIC study participants without diabetes at baseline (visit 1, 1987-1989) were followed for incident diabetes. Serum calcium was measured at baseline, and corrected for serum albumin. Levels of 25(OH)D and PTH were assessed at visit 2. Diabetes was identified by glucose levels, self-report or medication use at any of three follow-up exams (each approximately 3 years apart). Multivariate Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals. Results: Mean age was 54, 23% were black and 56% female, mean serum calcium concentration was 9.87 mg/dL overall, and 9.96 mg/dL in blacks, and 9.84 in whites. During a median of 9 years of follow-up, 1516 cases of diabetes were identified. Baseline serum calcium was positively and independently associated with incident diabetes after adjustment for demographic and lifestyle characteristics (Table). This association was largely unchanged with further adjustment for biomarkers that may lie on the metabolic pathway (i.e. 25(OH)D, PTH, phosphorus). While there was not a significant race interaction (p-interaction &gt; 0.25 in all models), the calcium-diabetes association was somewhat stronger among blacks than whites (Table). Conclusions: Consistent with prior studies, elevated serum calcium was associated with greater risk of type 2 diabetes. Further research is needed to understand the role calcium plays in the pathogenesis of diabetes.

Serum metabolites and macro mineral profile of prepartum buffaloes affected with cervico-vaginal prolapse

Blood samples were collected from 36 pregnant buffaloes in third trimester of pregnancy. Out of total, 24 were suffering with pre partum vaginal prolapse (affected group) while the remaining 12 were normal pregnant buffaloes (control group). Serum was separated from blood and serum calcium, phosphorus, magnesium and other metabolic panels like protein, glucose, triglyceride, cholesterol and urea were estimated to study their relationship during cervico-vaginal prolapse. Mean serum calcium (mg/dl) concentration in affected group was significantly lower as compared to control buffaloes. Serum phosphorus and magnesium levels did not differ significantly between 2 groups. Serum glucose level (mg/dl) was significantly higher in affected group as compared to the control animals. Total protein (mg/dl) was significantly lower in prolapsed buffaloes as compared to healthy buffaloes. No significant difference of serum urea and cholesterol was found between affected and control groups while serum triglycerides (mg/dl) was significantly higher in prolapsed buffaloes (45.25) as compared to control group.

Both serum 25-hydroxyvitamin D and calcium levels may increase the risk of incident prostate cancer in Caribbean men of African ancestry.

Circulating 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with both higher and lower risk of prostate cancer (PCa), whereas elevated levels of circulating calcium has been related to higher risks. However, there are few studies that account for effects of both calcium and 25(OH)D concentrations on incident PCa in a black population. We examined these relationships in a case–control study of men 40–80 years old with newly diagnosed, histologically confirmed PCa in Jamaica, a tropical country. Mean serum calcium concentrations was higher among cases (2.32 ± 0.19 mmol/L) than controls, (2.27 ± 0.30 mmol/L) (P = 0.023) however, there were no differences in 25(OH)D by cancer status (cases, 33.67 ± 12.71 ng/mL; controls (32.25 ± 12.59 ng/mL). Serum calcium was not correlated with 25(OH)D (partial correlation: r, 0.06; P = 0.287). Multivariable-adjusted models showed a positive linear relationship between PCa and serum calcium (OR, 1.12; CI, 1.00–1.25 per 0.1 nmol/L). Serum 25(OH)D concentration also showed a positive association with PCa (OR, 1.23; CI, 1.01–1.49 per 10 ng/mL). The odds of PCa in men with serum 25(OH)D tertile 2 was OR, 2.18; CI, 1.04–4.43 and OR, 2.47 CI, 1.20–4.90 for tertile 3 (Ptrend = 0.013). Dietary intakes of calcium showed no relationship with PCa. Despite the strong relationship between serum calcium and vitamin D the mechanism by which each affects prostate cancer risk in men of African ancestry needs additional investigation.