Prevalence Of Secondary Causes Research Articles

Prevalence and Risk Factors for Secondary Hypertension in Young Adults.

The prevalence of secondary causes of hypertension in young adults is unknown, and therefore, there is no consensus about the indication of screening of secondary hypertension (2HTN) in this population. The objective was to report the prevalence and the causes of 2HTN in young subjects. 2090 patients with confirmed hypertension aged 18 to 40 years with full workup for 2HTN screening were included in this cross-sectional study. We assessed the prevalence of 2HTN and analyzed the factors associated. 619/2090 patients (29.6%) had a 2HTN. The most frequent diagnoses of 2HTN in descending order were primary aldosteronism (n=339; 54.8%), renovascular hypertension (n=114; 18.4%), primary kidney disease (n=80; 12.9%), pheochromocytoma/functional paraganglioma (n=37; 5.9%), hypertension caused by drugs or substances (n=32; 6.0%), and other diagnoses (n=17; 2.7%). Patients with blood pressure <160/100 mm Hg did not have a lower prevalence of 2HTN regardless of the number of treatments. The prevalence of 2HTN was higher in the decade between 30 and 40 years of age than between 18 and 30 years of age (P=0.024). Female sex, hypokalemia, treatment with at least 2 medications, no familial history of hypertension, body mass index <25 kg/m², and diabetes were associated with a higher prevalence of 2HTN. The prevalence of 2HTN is high among young patients with hypertension (29.6% in our cohort), regardless of age and blood pressure level. All patients with hypertension under 40 years of age should be screened for secondary causes.

Applying an LDL-C threshold-based approach to identify individuals with familial hypercholesterolemia

Familial hypercholesterolemia (FH) remains underdiagnosed and undertreated. The optimal electronic health record (EHR) screening strategy for FH is unclear. To evaluate an LDL-C threshold-based approach of identifying patients with FH from the EHR to determine the optimal LDL-C range for FH consideration. Individuals from UT Southwestern Medical Center with an LDL-C level ≥190mg/dL at any time were enrolled in an FH registry. These 5,786 patients were divided into four categories of LDL-C (190- 219, 220 - 249, 250 - 299, and ≥ 300mg/dL) with 100 individuals randomly selected for manual chart review in each category. Chart review included 1) the presence of secondary causes of dyslipidemia, 2) diagnosis of possible/definite FH by modified Simon Broome criteria, and 3) probable/definite FH by modified Dutch Lipid Clinic Network (DLCN) criteria. Of the 400 individuals with an LDL-C level ≥190mg/dL (mean age 52 years ± 14), the presence of secondary causes increased across each LDL-C category (p < 0.001) with the greatest prevalence in those ≥ 300mg/dL (52%). The prevalence of possible/probable or definite FH also varied by LDL-C category, with the highest prevalence of FH by Simon Broome criteria in the 220 - 249mg/dL category (52%) and by DLCN criteria in the 250 - 299mg/dL category (46%). Among those with LDL-C ≥ 190mg/dL, the prevalence of secondary causes increased markedly with higher LDL-C, while the diagnosis of FH has a parabolic relationship. Patients with intermediate LDL-C (220 - 299mg/dL) may be the optimal group to prioritize for FH screening.

SECONDARY CAUSES OF HYPERTENSION IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION

Objective: Resistant hypertension is defined as blood pressure that remains above therapeutic goal despite concurrent use of three antihypertensive agents (at full or maximum tolerated doses) of different classes, one of which is a diuretic. The prevalence of secondary causes of hypertension among patients with resistant hypertension is not exactly known. Design and method: We retrospectively analysed the hospital records of patients with resistant arterial hypertension, who underwent complete laboratory and imaging examinations to exclude the secondary etiology of arterial hypertension. Standard descriptive statistics were used for statistical evaluation. Results: Among the 600 patients with resistant hypertension, secondary etiology of hypertension was found in 160 (27,5%). The most frequent cause was primary aldosteronism in 93 cases (58% relatively), followed by renovascular hypertension (30 cases, 18.8%), renal parenchymal hypertension (25 cases, 15,6%). Less common causes were pheochromocytoma (3,1%), hyperreninism (3.1%), hypercortisolism (0,6%). Obstructive sleep apnoea has been found in 75 (12.5%) patients. Conclusion: Secondary etiology was much more frequent (27,5%) in our group of patients with resistant hypertension than in non-selected hypertensive population (5–15%). Conclusions: This work was supported by IGA_LF_2019_036, IGA_LF_2020_039

Secondary Causes of Hypertriglyceridemia are Prevalent Among Patients Presenting With Hypertriglyceridemia Induced Acute Pancreatitis

BackgroundHypertriglyceridemia induced acute pancreatitis (HIAP) is the third common cause of acute pancreatitis. HIAP can result in recurrent attacks of severe AP with significant morbidity and mortality. Hypertriglyceridemia (HTG) could be primary or secondary. Although genetic causes of HTG are well studied, the prevalence of secondary causes of HTG in patients presenting with HIAP is not well characterized. This study aimed to identify the prevalence of risk factors for secondary hypertriglyceridemia among patients presenting with HIAP in a tertiary referral center in a large metropolitan area. MethodsThis is a retrospective analysis of all patients admitted with AP from August 2012–2017. A subgroup of patients with triglycerides >880 mg/dl were included for analysis. Secondary causes of HTG were identified. Secondary analysis evaluating the severity of pancreatitis was performed. ResultsThere were 3,746 patients admitted for AP of which 57 patients had AP and HTG. Of these 57 patients, 70.2% had history of diabetes mellitus, 26.3% had history of heavy alcohol use, 22.8% had chronic kidney disease, 47.3% with obesity, and 21.1% with metabolic syndrome. Two patients were classified as unexplained HTG. Secondary analysis showed a total of 45.6% of patients requiring ICU admission. 26.3% of patients with severe inflammatory pancreatitis and 17.5% of patients with severe necrotizing pancreatitis. ConclusionsIn our cohort of HIAP, 55 out of 57 patients had secondary causes for HTG. Identifying secondary causes of HTG during acute hospitalization is important to tailor outpatient treatment in order to prevent future admissions with HIAP.

Abstract 15810: Applying an LDL-C Threshold Based Approach to Identify Individuals With Familial Hypercholesterolemia

Background: Familial hypercholesterolemia (FH) is an inherited disorder associated with increased LDL-C and premature coronary heart disease, which remains significantly underdiagnosed. Screening those with very high LDL-C may help identify those with FH, but the optimal means of applying this approach is unclear. Methods: Individuals from UT Southwestern Medical Center, a large, tertiary academic center, with an LDL-C level ≥ 190 mg/dL at any time were enrolled in an FH registry. These 5,786 patients were divided into four categories of LDL-C: 190.0 - 219.9, 220.0 - 249.9, 250.0 - 299.9, and ≥ 300.0 mg/dL. One hundred individuals were randomly selected from each category for manual chart review to determine 1) the presence of secondary causes of dyslipidemia (obstructive liver disease, nephrotic syndrome, hypothyroidism, specific medication use, other secondary cause) and 2) diagnosis of possible/definite FH by modified Simon Broome criteria and 3) probable/definite FH by modified Dutch Lipid Clinic Network (DLCN) criteria. Results: Of the 400 individuals with an LDL-C level ≥ 190 mg/dL (mean age 52 years ± 14) in this cohort, the presence of secondary causes increased across each LDL-C category ( p &lt; 0.001) (Figure) with the greatest prevalence in those ≥ 300.0 mg/dL (52%). The prevalence of FH also varied by LDL-C category, with the highest prevalence of FH by Simon Broome criteria in the 220.0 - 249.9 mg/dL category (52%) and by DLCN criteria in the 250.0 - 299.9 mg/dL category (46%). Conclusions: Amongst those with LDL-C ≥ 190 mg/dL, the prevalence of secondary causes increases with higher LDL-C, while the diagnosis of FH has a parabolic relationship. Patients with intermediate LDL-C (220 - 299 mg/dL) may be the optimal group to prioritize for FH screening using an LDL-C based approach.

Causes of secondary non-alcoholic fatty liver disease in non-obese children below 10 years.

This study aimed to detect etiologies and histopathological features of non-alcoholic fatty liver disease (NAFLD) in Egyptian children < 10years from hepatologist perspectives. Infants and children below 10years of age with biopsy-proven fatty liver over a 6-year period were included. NAFLD activity score was used to detect the presence of non-alcoholic steatohepatitis (NASH). The study included 66 cases whose age ranged between 5months and 10years. Transaminases were elevated in 60% patients. Glycogen storage disease (GSD) was the most common diagnosis (33.3%) followed by hepatitis C virus (HCV) (10.6%) and Chanarin-Dorfman syndrome (CDS) (9.1%). The cause of steatosis could not be identified in 28.8% of cases. There was a higher prevalence of secondary causes of NAFLD in patients < 10years. Liver histopathological examination revealed preserved lobular architecture in 75.7% with minimal-to-mild fibrosis in 79%. Steatosis was macrovesicular in all specimens (severe steatosis in 39.4%). Four patients had NASH. Higher degree of steatosis was associated with more severe fibrosis (P = 0.01).Conclusion: GSD was the commonest cause of secondary NAFLD in Egyptian children < 10years followed by HCV and CDS with higher degrees of steatosis in younger patients. The degree of fibrosis was significantly related to the degree of steatosis.What is Known:• Primary non-alcoholic fatty liver disease (NAFLD) is rare in children aged less than 10years.• Secondary causes of NAFLD should be considered in patients who do not have traditional risk factors.What is New:• Glycogen storage disease, hepatitis C virus, and Chanarin-Dorfman syndrome are the commonest causes of secondary NAFLD in Egyptian children (< 10years) with higher degrees of steatosis in younger patients.• The degree of liver fibrosis is significantly related to the degree of steatosis.

Prevalence of secondary causes in a population of premenopausal women with low bone mass

Prevalence of secondary causes in a population of premenopausal women with low bone mass

Obstructive Sleep Apnea and Hypertension

Obstructive sleep apnea (OSA) is highly relevant to patients with hypertension (HTN). These 2 conditions frequently coexist (an estimated 50% of patients with HTN have concomitant OSA), and recent evidence supports the notion that OSA represents the most prevalent secondary contributor to elevated blood pressure (BP) in patients with resistant HTN (Figure 1).1 Figure 1. Prevalence of secondary causes of hypertension associated with resistant hypertension in a cohort of 125 patients from Brazil. OSA indicates obstructive sleep apnea. Reproduced from Pedrosa et al1 with permission of the publisher. Copyright © 2011, American Heart Association, Inc. Previously published population-based studies identified an independent correlation between greater apnea–hypopnea index and increasing BP, both at baseline and also when measured over long-term follow-up.2 On the contrary, isolated systolic HTN, which was more commonly seen in elderly patients, was not associated with OSA in any age group.3 The key challenge in deciphering the OSA–HTN connection lies in appropriately accounting for the many confounding variables, particularly obesity and age. Two recent prospective longitudinal cohort studies addressed these questions in normotensive subjects and reached opposing conclusions: The first study reported that after adjusting for relevant confounders, OSA was not associated with incident systolic HTN (1180 subjects over 7.5-year mean follow-up period).4 The second study (also from Spain, 1889 participants, 12.2 years of median follow-up) identified an increased hazard ratio for incident HTN in patients with OSA compared with control subjects, and in this second study, the OSA–HTN association remained independent of confounders including age and obesity. Furthermore, follow-up of this patient cohort revealed a dose–response relationship between the severity of OSA and the cumulative incidence of HTN (Figure 2).5 Given the extensive follow-up period, this second study provides relatively robust epidemiological evidence implicating OSA as a factor in the development …

Prevalence of causes of secondary osteoporosis and contribution to lower bone mineral density in HIV-infected patients

Eighty-one percent of human immunodeficiency virus (HIV)-infected patients had one or more of seven evaluated causes of secondary osteoporosis, and this rate increases with age. The type and number of causes were associated with a lower bone mineral density (BMD), and with an increased rate of osteopenia/osteoporosis, regardless of age and body mass index. The objective of this study was to determine whether factors of secondary osteoporosis were associated with lower BMD in HIV. This was a cross-sectional study of 285 HIV-infected patients (25 % females) evaluating the impact of seven different factors of reduced BMD: hyperthyroidism, diabetes, chronic viral hepatitis, chronic kidney disease (CKD), hypovitaminosis D, secondary hyperparathyroidism, and hypogonadism. Dual-energy X-ray absorptiometry scan of the femoral neck was obtained at the clinical visit. Mean age was 45.7 years; osteopenia and osteoporosis were diagnosed in 38 and 6 %, respectively. Overall, 230 patients (81 %) had secondary factors; 107 (38 %) had only 1 cause, 94 (33 %) had 2, and 28 (10 %) had 3 or more, predominantly vitamin D deficiency in 61 %, hepatitis C virus coinfection in 45 %, and secondary hyperparathyroidism in 27 %. The number of secondary factors was closely related to a lower BMD, which is statistically significant for patients having ≥2 causes (0.77 vs 0.73 g/cm(2), p = 0.02). The rate of osteopenia ranged from 36 % without any cause to 57 % with three or more, osteoporosis from 0 to 19 %, and Z-score <-2 SD from 0 to 27 %, respectively. In a multivariate linear regression, adjusting by age, body mass index, and HIV-related factors, the number of secondary factors was independently associated with a lower BMD (ß coefficient -0.134; p = 0.02), mainly due to patients with hepatitis C virus (HCV) coinfection, secondary hyperparathyroidism, and CKD. A high prevalence of secondary causes of osteoporosis is observed in HIV-infected patients, and its type and cumulative number determine a lower BMD, after adjusting by age and body mass index.

Resistant hypertension—complex mix of secondary causes and comorbidities

Resistant hypertension—complex mix of secondary causes and comorbidities

An Update on Psoas Muscle Abscess: An 8-Year Experience and Review of Literature

Psoas muscle abscess is a previously rare disease that has increased in its reported prevalence because of improved diagnostic tools. The literature on psoas muscle abscess mostly consists of case reports and case series. We analyzed medical records, such as characteristics, pathogens, and disease pattern, from our hospital in the past 8 years and report nine cases of psoas abscess. We also reviewed the literature for case series and performed a meta-analysis to assess the current characteristics of this disease since 1986. We reviewed a total of 36 studies, with a total of 682 cases. The average age was 52.6 years, and the mortality rate was 8% (55 of 682). In 35 studies, a total of 274 cases (40.77%) received drainage (274 of 672), whereas 290 (43.15%) received surgery. In 522 cases, the ratio of primary to secondary etiologies was 1:1.71. In 209 cases, Staphylococcus aureus, and in 70 cases, Escherichia coli were identified as the pathogens from culture data. Compared with Ricci’s case series, we found an obvious increase in prevalence of secondary causes (63.2% compared with 21.8%) and higher mortality in recent study (6.7% in Ricci’s study and 8.1% in recent study). There was an obvious shift toward drainage as the treatment of choice. We conclude that a higher mortality has occurred in recent study, and psoas abscess is an infrequent and easily overlooked infectious disease requiring early diagnosis with favorable results with percutaneous drainage.

Is screening for secondary causes of osteoporosis worthwhile?

The contribution of secondary causes to low bone mass in postmenopausal women with osteoporosis is unknown. A study by Cerda Gabaroi et al. aimed to fill this gap. While the researchers found a high prevalence of secondary causes, the importance of clinical risk factors should not be underestimated in the primary care setting.

Prevalence of secondary causes of bone loss in patients with breast cancer initiating treatment on clinical trials with aromatase inhibitors or bisphosphonates.

e11019 Background: We previously demonstrated that treatable secondary causes of bone loss (SCBL) are prevalent in breast cancer survivors (Camacho, JCO 2008). SCBL may amplify bone loss caused by aromatase inhibitors (AIs) or compromise response to bisphosphonates (BPs). Goals of our study were to determine the frequency of screening for osteoporosis and SCBL in patients (pts) enrolling onto clinical trials involving AIs or BPs, and to determine the prevalence of SCBL in this population. Methods: A retrospective chart review of pts enrolled between 2003-2009 in clinical trials involving treatment with AIs (MA-27, NSABP B-35, SWOG 0226, SOFT, MAP-3) and BPs (SWOG 0307, SWOG 0702) was conducted at a single institution. Charts were reviewed for bone density assessment with dual energy x-ray absorptiometry (DXA scan), and for SCBL including 25OH-vitamin D (25 OHD), parathyroid hormone (PTH) panel, thyroid stimulating hormone (TSH), 24 hr urine for calcium and creatinine. The WHO criteria were used to categorize pts into normal (T score ≥ -1), osteopenia, (T score <-1) and osteoporosis (T score ≤ -2.5) groups. Only MAP-3 study (9 pts) required DXA scan prior to enrollment. None of the studies required screening for SCBL. Results: Ninety-three charts were reviewed (58 on AI trials; 35 on BP trials). Overall 69/93 (74%) pts had DXA scans performed: 52/58 (88%) on AI and 17/35 (49%) on BP trials. Osteopenia was present in 26/52 (50%) pts on AI and 9/17 (53%) pts on BP trials. Ten (11%) pts had osteoporosis. 25 OHD levels were obtained in 45 (48%) pts, PTH in 30 (32%) pts, 24hr urine for calcium and creatinine in 19 (20%) pts, TSH in 29 (31%) pts. Of those pts screened, 24 (53%) had vit D deficiency, 6 (20%) had hyperparathyroidism, 2 (6%) had idiopathic hypercalciuria, and 1 (3%) had hyperthyroidism. Average time to screening for SCBL was 23 months. Conclusions: Osteopenia/porosis is common in patients enrolling onto clinical trials involving AIs and BPs. Screening for treatable SCBL occurs in the minority of patients, though the prevalence is high. Comprehensive evaluation of bone loss may be warranted prior to initiating AI or BP therapy. No significant financial relationships to disclose.

S1208 Papillary Thyroid Cancer and Inflammatory Bowel Disease: Is There an Association?

Aim: Low bone mineral density (BMD) is prevalent in the IBD population. Our aim was 1) to determine predictors for the work-up and treatment of low BMD and 2) to assess the prevalence of secondary causes of low BMD in the IBD population. Methods: 317 patients (pts) with a diagnosis of IBD and who underwent dual energy x-ray absorptiometry (DEXA) tests were identified from 1/1/1996-10/27/2006 at 7 US veterans' hospitals. Low BMD was defined as T score 1yr follow-up after DEXA. Testing rates for serum calcium, phosphate, 25OH vitamin D, and testosterone (in male pts only) were 88%, 89%, 42%, and 61%, respectively. Low calcium, phosphate, 25-OH vitamin D, and male testosterone levels were seen in 8%, 8%, 35%, and 29% of tested pts, respectively. Calcium/Vitamin D supplements (Ca/VitD) and bisphosphonates (BPs) were prescribed to 64% and 71% of pts, respectively (14% received neither). Ergocalciferol and male testosterone replacement was given in 53% and 44% of pts with low levels, respectively. Overall rates of testing for and treatment of causes of low BMD in our population are listed in the table. Logistic regression confirmed endocrine clinic as an independent predictor of 25-OH vitamin D and testosterone testing. Ca/VitD and BPs use did not differ significantly based on clinic. Conclusions: Vitamin D deficiency and male hypogonadism are relatively common contributors to secondary bone loss in IBD pts with T<-2 on DEXA. However, testing for these conditions is suboptimal. Education of GI providers regarding the testing for and treatment of these conditions is warranted, or endocrine referral should be considered. Ca/VitD and BPs are underutilized in the IBD population with low BMD.

S1206 Testing for and Treatment of Secondary Causes of Bone Loss in Inflammatory Bowel Disease (IBD) Patients With Abnormal Dexa Studies

Aim: Low bone mineral density (BMD) is prevalent in the IBD population. Our aim was 1) to determine predictors for the work-up and treatment of low BMD and 2) to assess the prevalence of secondary causes of low BMD in the IBD population. Methods: 317 patients (pts) with a diagnosis of IBD and who underwent dual energy x-ray absorptiometry (DEXA) tests were identified from 1/1/1996-10/27/2006 at 7 US veterans' hospitals. Low BMD was defined as T score 1yr follow-up after DEXA. Testing rates for serum calcium, phosphate, 25OH vitamin D, and testosterone (in male pts only) were 88%, 89%, 42%, and 61%, respectively. Low calcium, phosphate, 25-OH vitamin D, and male testosterone levels were seen in 8%, 8%, 35%, and 29% of tested pts, respectively. Calcium/Vitamin D supplements (Ca/VitD) and bisphosphonates (BPs) were prescribed to 64% and 71% of pts, respectively (14% received neither). Ergocalciferol and male testosterone replacement was given in 53% and 44% of pts with low levels, respectively. Overall rates of testing for and treatment of causes of low BMD in our population are listed in the table. Logistic regression confirmed endocrine clinic as an independent predictor of 25-OH vitamin D and testosterone testing. Ca/VitD and BPs use did not differ significantly based on clinic. Conclusions: Vitamin D deficiency and male hypogonadism are relatively common contributors to secondary bone loss in IBD pts with T<-2 on DEXA. However, testing for these conditions is suboptimal. Education of GI providers regarding the testing for and treatment of these conditions is warranted, or endocrine referral should be considered. Ca/VitD and BPs are underutilized in the IBD population with low BMD.

Tension-type headache in the elderly

Tension-type headache (TTH) is the most common type of headache in the general population, including individuals over the age of 65 years. Although the prevalence of migraine decreases markedly with age, TTH has a greater tendency to persist later in life. Less commonly, TTH can present for the first time after the age of 50 years. As the elderly population continues to grow, more patients will be presenting to physicians with headache. Special considerations in this population include the higher prevalence of secondary causes and multiple medical comorbidities. This article presents an update on the epidemiology and prognosis of TTH in the elderly.

Secondary Causes of Low Bone Mass in Patients With Breast Cancer: A Need for Greater Vigilance

An observational study to assess the prevalence of secondary causes of low bone density in patients with breast cancer. Female patients within 5 years of breast cancer diagnosis and age older than 50 years at diagnosis were recruited. Consenting patients completed a questionnaire and had blood taken for serum calcium, vitamin D, parathyroid hormone (PTH), and thyroid function testing. Bone mineral density (BMD) was assessed. Abnormalities were additionally investigated and treated. Two hundred patients were recruited. The median age at diagnosis was 62 years. One hundred sixty-nine patients had hormone receptor (HR) -positive cancer. Vitamin D and thyroid function were assessed in 200 patients; PTH was assessed in 197 patients; and BMD was assessed in 187 patients. Eighty-seven patients (46.5%) had osteopenia, and 24 patients (12.8%) had osteoporosis. Vitamin D levels were insufficient (ie, 50 to 75 nmol/L) in 74 patients (37%) and were deficient (ie, < 50 nmol/L) in 54 patients (27%). Only 24 of 65 patients taking vitamin D supplements were replete (ie, > 75 nmol/L). Thirty-nine (21%) of 197 patients had PTH concentrations greater than the normal range. Six had primary hyperparathyroidism (PHPT), and two more had recent surgery for PHPT. Twenty-seven had secondary hyperparathyroidism (HPT) from vitamin D deficiency and six had normocalcemic HPT. Of 90 patients with low BMD and HR-positive cancer, 8% (seven of 90 patients) had new or recent PHPT, and 63% (57 of 90 patients) had insufficient or deficient vitamin D. More patients with HR-positive cancer than with HR-negative cancer had elevated PTH (38 of 167 v three of 30 patients, respectively; P = .10). Secondary causes of low BMD are common in postmenopausal women. Identification and management of secondary causes should be included in bone health management algorithms.

Prevalence of Secondary Causes of Bone Loss Among Breast Cancer Patients With Osteopenia and Osteoporosis

To determine the prevalence of secondary causes of bone loss among patients with breast cancer with osteopenia and osteoporosis. All women referred to a bone health clinic over a 6-year period for bone evaluation were included in this retrospective study and stratified based on presence or absence of a breast cancer history. The prevalence of secondary causes of bone loss in the two groups was compared. Of the 238 women identified, 64 women had breast cancer. The non-breast cancer group (n = 174) was significantly older (P = .015), had a lower mean weight (P = .019), lower 25 hydroxy-vitamin D level (P = .019), and greater degree of bone loss in both the spine and hip (P < .001 and 0.004, respectively). The presence of at least one secondary cause of bone loss, excluding cancer-related therapies, was seen in 78% of the breast cancer patient group and in 77% of the non-breast cancer group (P = not significant). Newly diagnosed metabolic bone disorders were seen in 58% of the breast cancer population. The most common was vitamin D deficiency, seen in 38% of patients in the breast cancer group and 51% of patients in the non-breast cancer group. Idiopathic hypercalciuria was diagnosed in 15.6%, primary hyperparathyroidism in 1.6%, and normocalcemic hyperparathyroidism in 3.1% of the breast cancer population. A high prevalence of secondary causes of bone loss among patients with breast cancer supports a comprehensive evaluation in these patients, particularly those considering therapy with an aromatase inhibitor.

Secondary causes of restless legs syndrome in older people

Secondary causes of restless legs syndrome (RLS) have been reported to be more common in those with late-onset RLS. However, 'late-onset' in previous studies was defined as onset after 45 years. To determine the prevalence of secondary causes of RLS and the relationship between aetiological factors and age of symptom onset in an older population. Prospective study conducted over a 5-year period. 80 consecutive non-related patients diagnosed with RLS. Patients were assessed according to a standard protocol. Age at symptom onset, severity of symptoms, neurological findings and laboratory tests were examined. Iron deficiency (serum ferritin <50 ng/ml) was present in 22% of patients with onset before 50 years, 39% of those with onset at 50 to 64 years and 58% in those with onset after 64 years (P = 0.009). Clinical neuropathy was also more common in older-onset patients (P = 0.08). Family history was positive in 39%, 23% and 8% of these groups, respectively (P = 0.008). Secondary causes of RLS become more common and a positive family history less common with increased age of symptom onset.

Resistant hypertension.

Recent clinical trials suggest that resistant hypertension is increasingly common. In the majority of patients, uncontrolled hypertension is due to persistent elevation of the systolic blood pressure. Older age and obesity are associated with poor blood pressure control. Other contributing factors include severity of the underlying hypertension and renal insufficiency. Poor patient adherence is thought be a common cause of medication resistance. Exogenous substances such as nonsteroidal anti-inflammatory drugs, oral contraceptives, and sympathomimetic agents can interfere with treatment. The prevalence of secondary causes of hypertension increases with age, especially atherosclerotic renal artery stenosis. Recent reports suggest that primary aldosteronism may be the most common secondary cause of hypertension. It should be considered in all patients with resistant hypertension. Effective treatment of resistant hypertension requires identification and reversal of contributing factors and/or secondary causes of hypertension. Pharmacologic therapy should utilize combination therapy, including a long-acting diuretic.