Evaluating Patients for Secondary Causes of Osteoporosis

2022 ◽  
Author(s):  
E. Michael Lewiecki
Keyword(s):  
Secondary Causes

Male Osteoporosis

2013 ◽  
Vol 22 (04) ◽  
pp. 260-266 ◽  
Author(s):  
S. P. Tuck ◽  
R. M. Francis ◽  
B. C. Hanusch
Keyword(s):  
Prostate Cancer ◽  
Older Men ◽  
Good Evidence ◽  
Male Osteoporosis ◽  
Fracture Rate ◽  
Common Cause ◽  
Increased Risk ◽  
Osteoporosis In Men ◽  
Considerable Morbidity ◽  
Secondary Causes

SummaryMale osteoporosis is common and results in considerable morbidity and mortality. There are distinct differences in the normal aging of bone between the genders, which result in a lower fracture rate in men. Men who suffer from osteoporosis are much more likely than women to have secondary causes. The identification and treatment of these secondary causes, wherever possible, will result in substantial improvements in BMD. There is now evidence for use of many of the existing agents to treat osteoporosis in men. In younger hypogonadal men testosterone replacement is worth considering, but in older men especially the over sixties this is less effective and there is an increased risk of adverse cardiovascular and prostatic outcomes. Prostate cancer is an increasingly common cause, which is partially the result of the success of ADT. There is now good evidence for the use of bisphosphonates and denosumab in this group of patients. HIV, whilst not being specific to men, is an increasingly recognised cause of male osteoporosis. The reasons for this are multifactorial and some may well be attributable to the anti-retroviral therapy itself. There is emerging evidence of an increased fracture risk in HIV infected individuals. The bone loss can be prevented by the use of bisphosphonates.

The Invisible Evil Twin of an Adrenal Adenoma

2019 ◽  
Vol 4 (1) ◽  
pp. 58
Author(s):  
Aimi Fadilah Mohamad ◽  
Fatimah Zaherah Mohamed Shah ◽  
Nur Aisyah Zainordin ◽  
Ur 'Aini Eddy Warman ◽  
Nazimah Ab Mumin ◽  
...  
Keyword(s):  
Adrenal Glands ◽  
Adrenal Adenoma ◽  
Definitive Diagnosis ◽  
Dynamic Tests ◽  
Venous Sampling ◽  
Aldosterone Secretion ◽  
Aldosterone Level ◽  
Suppression Test ◽  
The Right ◽  
Secondary Causes

Primary aldosteronism (PA) causes a persistently elevated blood pressure (BP) due to excessive release of the hormone aldosterone from the adrenal glands. Classically, it is called Conn’s syndrome and is described as the triad of hypertension and hypokalemia with the presence of unilateral adrenal adenoma. It can be cured with surgical resection of the aldosterone-secreting adenoma leading to resolution of hypertension, hypokalemia and increased cardiovascular risk associated with hyperaldosteronism. We present a case of a man with previous ischemic heart disease (IHD) who presented with resistant hypertension. Investigations for secondary causes of hypertension revealed an elevated aldosterone level and saline suppression test confirmed the diagnosis of PA. Radiological examination revealed a left adrenal adenoma and a normal right adrenal gland. However, adrenal venous sampling showed lateralization of aldosterone secretion towards the right. He subsequently underwent a laparoscopic right adrenalectomy which improved his BP control promptly. This case highlights the importance of recognizing the need to investigate for secondary causes of hypertension. It also underscores the importance of dynamic tests, which may not be easily accessible to most clinicians but should pursue, to allow a definitive diagnosis and effective treatment.

scholarly journals Diagnosis and management of secondary causes of steatohepatitis

2021 ◽  
Author(s):  
Roman Liebe ◽  
Irene Esposito ◽  
Hans H. Bock ◽  
Stephan vom Dahl ◽  
Jan Stindt ◽  
...  
Keyword(s):  
Diagnosis And Management ◽  
Secondary Causes

scholarly journals AB0622 WHEN OSTEOPOROSIS, COELIAC DISEASE AND MULTIPLE MYELOMA CO-EXIST

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1345.1-1345
Author(s):  
S. Khalid ◽  
R. Smith
Keyword(s):  
Bone Mineral Density ◽  
Multiple Myeloma ◽  
Vitamin D ◽  
Coeliac Disease ◽  
Secondary Osteoporosis ◽  
Gluten Free ◽  
Z Score ◽  
Mineral Density ◽  
History Of ◽  
Secondary Causes

Background:Secondary causes of bone loss are sometimes overlooked in patients who are diagnosed as having osteoporosis. This is especially true if more than one risk factor for secondary osteoporosis is present, with clinicians focusing on the more common cause. Here we present a case of secondary osteoporosis caused by coeliac disease and multiple myeloma.Objectives:Secondary osteoporosis should be suspected in patients with very low bone mineral density and those with no obvious risk factors. Comprehensive examination and investigations must be done to look for all secondary causes because sometimes, as seen in our patient, you may find more than one.Methods:A 74 year old gentleman presented to the rheumatology clinic for assessment of osteoporosis. He had been recently diagnosed with coeliac disease. DXA scan showed a T score of -3.5 at the lumbar spine, -2.5 at the left hip and a low Z score of -2.9. He had not sustained any fractures in the past. There was no history of corticosteroid exposure and no parental history of hip fracture or osteoporosis. He drank up to 21 units of alcohol a week and was an ex-smoker. He was managing a gluten-free diet. His testosterone and vitamin D levels were normal. Serum electrophoresis, done as part of the osteoporosis workup, revealed a diagnosis of multiple myeloma. He then developed back pain and given his new diagnosis of myeloma, prompt investigations were carried out. A skeletal survey showed T7 fracture and a subsequent MRI scan showed impending cord compression, which were treated successfully with radiotherapy. He underwent chemotherapy and autologous stem cell transplantation for his myeloma.He recently had an OGD following one week post gluten rechallenge after an established gluten free diet. His biopsy shows no evidence of coeliac disease. Interestingly, the stem cell transplantation did not only treat our patient’s myeloma, but also his coeliac disease.Results:Z-score is a useful indicator of possible secondary osteoporosis. A score of −2.0 or less is below the expected range for age and should prompt careful scrutiny for an underlying cause.Coeliac disease is a gluten-sensitive enteropathy and a known cause for secondary osteoporosis. It likely causes bone loss by secondary hyperparathyroidism from vitamin D deficiency. Multiple myeloma is a disease of aging adults resulting in osteolytic and/or osteoporotic bone disease through increased bone resorption and decreased bone formation from pro-inflammatory cytokines. While coeliac disease patients are at increased risk of all malignancies, association with multiple myeloma is rare, but has been described.Conclusion:This case highlights the importance of evaluating for secondary causes for low bone mineral density and often, one may find more than one contributory factor. It also shows that a Z-score of −2.0 could help identify patients with a secondary cause for osteoporosis and those who would especially benefit from a thorough history and examination.References:[1]Sahin, Idris & Demir, Cengiz & Alay, Murat & Eminbeyli, Lokman. (2011). The Patient Presenting with Renal Failure Due to Multiple Myeloma Associated with Celiac Disease: Case Report. UHOD - Uluslararasi Hematoloji-Onkoloji Dergisi. 21. 10.4999/uhod.09087.[2]İpek, Belkiz & Aksungar, Fehime & Tiftikci, Arzu & Coskun, Abdurrahman & Serteser, Mustafa & Unsal, Ibrahim. (2016). A rare association: celiac disease and multiple myeloma in an asymptomatic young patient. Turkish Journal of Biochemistry. 41. 10.1515/tjb-2016-0053.[3]Swaminathan K, Flynn R, Garton M, Paterson C, Leese G. Search for secondary osteoporosis: are Z scores useful predictors? Postgrad Med J. 2009 Jan;85(999):38-9. doi: 10.1136/pgmj.2007.065748. PMID: 19240287.Disclosure of Interests:None declared.

scholarly journals Lipoprotein glomerulopathy associated with the Osaka/Kurashiki APOE variant: two cases identified in Latin America

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Joaquim Nelito da Silveira-Neto ◽  
Guilherme Jinson de Oliveira Ahn ◽  
Precil Diego Miranda de Menezes Neves ◽  
Vinicius Augusto Ferreira Baptista ◽  
Stanley de Almeida Araújo ◽  
...  
Keyword(s):  
Latin America ◽  
Family History ◽  
Kidney Disease ◽  
Genetic Analysis ◽  
Apolipoprotein E ◽  
Total Cholesterol ◽  
Kidney Biopsy ◽  
Lipoprotein Glomerulopathy ◽  
History Of ◽  
Secondary Causes

Abstract Background Lipoprotein glomerulopathy (LPG) is a rare autosomal dominant disease caused by mutations in APOE, the gene which encodes apolipoprotein E. LPG mainly affects Asian individuals, however occasional cases have also been described in Americans and Europeans. Herein we report two unrelated Brazilian patients with LPG in whom genetic analyses revealed the APOE-Osaka/Kurashiki variant. Case presentation - case 1 A 29-year-old Caucasian male sought medical attention with complaints of face swelling and foamy urine for the last 3 months. He denied a family history of kidney disease, consanguinity, or Asian ancestry. His tests showed proteinuria of 12.5 g/24 h, hematuria, serum creatinine 0.94 mg/dL, albumin 2.3 g/dl, total cholesterol 284 mg/dL, LDL 200 mg/dL, triglycerides 175 mg/dL, and negative screening for secondary causes of glomerulopathy. A kidney biopsy revealed intraluminal, laminated deposits of hyaline material in glomerular capillaries consistent with lipoprotein thrombi. These findings were confirmed by electron microscopy, establishing the diagnosis of LPG. His apolipoprotein E serum level was 72 mg/dL and genetic analysis revealed the APOE pathogenic variant c.527G > C, p.Arg176Pro in heterozygosis, known as the Osaka/Kurashiki mutation and positioned nearby the LDL receptor binding site. Case 2 A 34-year-old Caucasian man sought medical assessment for renal dysfunction and hypertension. He reported intermittent episodes of lower-limb edema for 3 years and a family history of kidney disease, but denied Asian ancestry. Laboratorial tests showed BUN 99 mg/dL, creatinine 10.7 mg/dL, total cholesterol 155 mg/dL, LDL 79 mg/dL, triglycerides 277 mg/dL, albumin 3.1 g/dL, proteinuria 2.7 g/24 h, and negative screening for secondary causes of glomerulopathy. His kidney biopsy was consistent with advanced chronic nephropathy secondary to LPG. A genetic analysis also revealed the Osaka/Kurashiki variant. He was transplanted a year ago, displaying no signs of disease relapse. Conclusion We report two unrelated cases of Brazilian patients with a diagnosis of lipoprotein glomerulopathy whose genetic assessment identified the APOE-Osaka/Kurashiki pathogenic variant, previously only described in eastern Asians. While this is the second report of LPG in Latin America, the identification of two unrelated cases by our medical team raises the possibility that LPG may be less rare in this part of the world than currently thought, and should definitely be considered when nephrotic syndrome is associated with suggestive kidney biopsy findings.

scholarly journals A rare pediatric case of cluster headaches after cardiac catheterization in a patient with an isolated innominate artery

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110236
Author(s):  
Kimberley Yu ◽  
Madeline Chadehumbe
Keyword(s):  
Aortic Arch ◽  
Cardiac Catheterization ◽  
Innominate Artery ◽  
Dopamine Antagonists ◽  
Autonomic Tone ◽  
Pediatric Case ◽  
Cluster Headaches ◽  
Insight Into ◽  
Secondary Causes ◽  
Isolated Innominate Artery

While cluster headaches are classified and considered a primary headache disorder, secondary causes of cluster headaches have been reported and may provide insight into cluster headaches’ potential pathophysiology. The mechanisms underlying this headache phenotype are poorly understood, and several theories have been proposed that range from the activation within the posterior hypothalamus to autonomic tone dysfunction. We provide a review of reported cases in the literature describing secondary causes after cardiac procedures. We will present a novel pediatric case report of a 16-year-old boy with an isolated innominate artery who presented with acute new-onset headaches 8 h following cardiac catheterization of the aortic arch with arteriography and left pulmonary artery stent placement. The headaches were characterized by attacks of excruciating pain behind the left eye and jaw associated with ipsilateral photophobia, conjunctival injection, rhinorrhea, with severe agitation and restlessness. These met the International Classification of Headache Disorders-3 criteria for episodic cluster headaches. The headaches failed to respond to non-steroidal anti-inflammatory medications, dopamine antagonists, and steroids. He showed an immediate response to treatment with oxygen. This unique case of cluster headaches following cardiac catheterization in a pediatric patient with an isolated innominate artery may provide new insight into cluster headaches’ pathogenesis. We hypothesize that the cardiac catheterization induced cardiac autonomic changes that contributed to the development of his cluster headaches. The role of aortic arch anomalies and procedures in potential disruption of the autonomic tone and the causation of cluster headaches is an area requiring further study.

scholarly journals Causes of Resistant Hypertension Detected by a Standardized Algorithm

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Livia Beatriz Santos Limonta ◽  
Letícia dos Santos Valandro ◽  
Flávio Gobis Shiraishi ◽  
Pasqual Barretti ◽  
Roberto Jorge da Silva Franco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Secondary Hypertension ◽  
Control Blood Pressure ◽  
Primary Level ◽  
Standardized Protocol ◽  
Frequent Use ◽  
Drug Classes ◽  
Treatment Of Hypertension ◽  
Secondary Causes

Resistant hypertension (RH) is characterized by blood pressure above 140 × 90 mm Hg, despite the use, in appropriate doses, of three antihypertensive drug classes, including a diuretic, or the need of four classes to control blood pressure. Resistant hypertension patients are under a greater risk of presenting secondary causes of hypertension and may be benefited by therapeutical approach for this diagnosis. However, the RH is currently little studied, and more knowledge of this clinical condition is necessary. In addition, few studies had evaluated this issue in emergent countries. Therefore, we proposed the analysis of specific causes of RH by using a standardized protocol in Brazilian patients diagnosed in a center for the evaluation and treatment of hypertension. The management of these patients was conducted with the application of a preformulated protocol which aimed at the identification of the causes of resistant hypertension in each patient through management standardization. The data obtained suggest that among patients with resistant hypertension there is a higher prevalence of secondary hypertension, than that observed in general hypertensive ones and a higher prevalence of sleep apnea as well. But there are a predominance of obesity, noncompliance with diet, and frequent use of hypertensive drugs. These latter factors are likely approachable at primary level health care, since that detailed anamneses directed to the causes of resistant hypertension are applied.

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