Images – Penile pain in the setting of end-stage renal disease: An unusual anatomic location for calciphylaxis

In this report, we present a case of penile calciphylaxis, an extremely rare and serious condition occurring in association with dysregulation of systemic calcium metabolism in the setting of chronic renal impairment. Calciphylaxis can occur at various body sites and is associated with diffuse vascular calcifications in small and medium-sized arteries of the involved tissues. Penile calciphylaxis has a grim prognosis. Calciphylaxis is an important etiologic differential diagnosis for penile necrosis and penile pain in patient’s being treated with dialysis for end-stage kidney disease. Diagnosis of penile calciphylaxis is possible via clinical and radiological evaluations. Medical management may alleviate symptoms; however surgical interventions may be necessary, and histological studies may allow for definitive classification.

Endocrinology in pregnancy

This chapter covers both the normal and abnormal changes to the endocrine system during pregnancy. It begins with the thyroid in pregnancy, covering maternal hyperthyroidism, hyperemesis gravidarum, overt and subclinical maternal hypothyroidism, post-partum thyroid dysfunction, and fetal thyroid diseases owing to maternal thyroid disorders. Calcium metabolism, thyroid cancer, hypoparathyroidism, and lactation associated osteoporosis. Secondly, the pituitary gland in pregnancy is focused on, covering prolactinoma, Cushing’s Syndrome, acromegaly, non-functioning pituitary adenoma, hypopituitarism, and Diabetes Insipidus. Pre-existing adrenal disorders during pregnancy and alterations to management are also included.

Fahr syndrome, rare cause of neuropsychiatric manifestations in children: A two cases report

Fahr syndrome is a rare anatomo-clinical entity in pediatrics. Associating calcifications of the basal ganglia with phospho-calcium metabolism disorders, most often resulting in neuropsychiatric symptoms. In our study, the discovery of this syndrome in our two patients was fortuitous thanks to the typical radiological appearance, associated with the clinical picture they initially presented, hence the interest of brain imaging in the diagnosis of this syndrome.

Vitamin D Supplementation in Sarcoidosis: A Double-Edged Sword

Sarcoidosis is complicated by disordered vitamin D and calcium metabolism, which has important implications on disease activity and bone health. Although the majority of the patients with sarcoidosis are typically deficient in 25-hydroxyvitamin D, repletion of vitamin D is controversial in light of the hypercalcemia risk. Presently, there are no clear guidelines regarding vitamin D supplementation as a part of osteoporosis prevention in patients with vitamin D deficiency and sarcoidosis. We report a patient with sarcoidosis who presented with severe hypercalcemia following vitamin D supplementation and review the debated role of vitamin D supplementation in vitamin D-deficient sarcoid patients.

Mineral metabolism and COVID-19: is there a connection?

Due to global spread of COVID-19, the search for new factors that could influence its clinical course becomes highly important. This review summarize the relevant publications on the association between immune system and the main regulators of mineral homeostasis including. In addition, we have highlighted the various aspects of phosphorus-calcium metabolism related to the acute respiratory diseases and in particular to COVID-19. The data about the calcium-phosphorus metabolism in SARS-CoV-2 infection is required to understand the possible clinical implications and to develop new therapeutic and preventive interventions.

Blood lead levels, calcium metabolism and bone-turnover among automobile technicians in Sagamu, Nigeria: Implications for elevated risk of susceptibility to bone diseases

Lead is an occupational toxicant and a recognised health threat particularly in developing countries. Hence, this study explored the interaction of blood lead level (BLL), a conventional marker of lead exposure, with indices of calcium metabolism and biomarkers of bone-turnover in 120 adult male automobile technicians (AT) with ≥ 1 year duration in professional practice. The AT as well as the control group, which comprised 120 age, body-size and socio-economically matched male administrative workers, were recruited from Sagamu, South West Nigeria. Levels of blood lead, serum indices of calcium metabolism [total calcium (tCa), ionised calcium (iCa), phosphate, albumin, magnesium (Mg) and 25-Hydroxycholecalceferol (25-OHCC)], biomarkers of bone formation [bone alkaline phosphatase (BALP) and osteocalcin (OC)] and biomarkers of bone resorption [tartarate-resistant acid phosphatase-5b (TACRP-5b) and urinary hydroxyproline (UHYP)] were determined in all participants. The BLL, 25-OHCC, TRACP-5b and UHYP significantly increased while tCa and iCa significantly reduced in AT compared to control. However, no significant difference was observed in phosphate, albumin, Mg, BALP and OC in AT compared to control. Interestingly, BLL demonstrated a significant negative association with tCa and iCa but a significant positive association with 25-OHCC, TRACP-5b and UHYP. However, BLL did not show significant association with phosphate, albumin, Mg, BALP and OC. Increased lead exposure as well as altered calcium metabolism and bone-turnover demonstrated by the automobile technicians may be suggestive of lead-induced accelerated bone demineralisation. These workers may be predisposed to high risk of increased susceptibility to bone diseases if this sub-clinical picture is sustained.