Calciphylaxis of the temporal artery simulating temporal arteritis

Calciphylaxis is characterized by intense deposition of calcium in small blood vessels, skin, and other organs, described mainly in patients with chronic renal insufficiency, renal transplant of parathyroid dysfunction. To date, there are only seven cases described in literature of calciphylaxis mimicking giant cell arteritis (GCA). In this review, we present the eighth case pathologically documented.

PARATHYROID STATUS AND ITS ASSOCIATION WITH HAEMOGLOBINOPATHIES AMONG TYPE 2 DIABETES MELLITUS IN SOUTHERN NIGERIA

Background: Endocrine action is integrative and an endocrine dysfunction of one gland is known to affect other endocrine glands. Parathyroid glands are associated with the beta cell function. Thus, insulin resistance observed in type 2 diabetes mellitus (T2DM) may be associated with alterations of parathyroid hormones and their metabolic pathways. These have been reported to have a genetic root, postulated to be aberrant haemoglobin gene resulting in haemoglobin variants. This has not been fully explored in sub-Saharan Africa, which has significant population of haemoglobin variants. Aim: The aim of this study was to evaluate the status of parathyroid dysfunction and its association with haemoglobinopathies among Sub-Saharan Africans with type 2 diabetes mellitus. Method: A total of 204 individuals aged 25 – 80 years which comprised 100 T2DM and 104 Controls without T2DM were enrolled from a tertiary hospital, in Ibadan, Nigeria and environs.10mL intravenous blood was obtained from each participant. Parathyroid Hormone (PTH) was measured using enzyme linked immunosorbent assay (ELISA). Calcium, Phosphate, Albumin and Fasting Plasma Glucose (FPG) were analysed spectrophotometrically. Haemoglobin A2 (HbA2), Haemoglobin A (HbA), Haemoglobin C (HbC) and Haemoglobin S (HbS) and Glycated haemoglobin (HbA1c) were determined by High Performance Liquid Chromatography (HPLC) method using Variant Haemoglobin Testing System (Bio-Rad Variant II). Data analysed using appropriate statistical analysis were significant at p<0.05. Results: Normal parathyroid function, hyperparathyroidism and hypoparathyroidism were present in 93% vs 96%, 3% vs 0.96% and 4% vs 6.73% in T2DM and controls respectively. T2DM and controls with AA and Non AA had 62% vs 31% normoparathyroidism, 3% vs 0% hyperparathyroidism and 2% vs 2% hypoparathyroidism respectively. The association between parathyroid gland disorder in T2DM and controls with the various haemoglobin variants was not significant (p>0.05) but the difference between parathyroid function in the control group with and without Beta Thalassaemia Trait was significant (p<0.05). Conclusion: Hypoparathyroidism and hyperparathyroidism were revealed in Type 2 Diabetes Mellitus and control individuals with haemoglobin genotype AA (HbAA). Hypoparathyroidism was also found among controls with Beta Thalassaemia Trait. Timely identification of these disorders may be helpful in appropriate therapeutic regimen to facilitate bone growth, prevent fractures and complications of parathyroid gland in these individuals. KEYWORDS: Haemoglobin Variants, Parathyroid Dysfunction, Type 2 Diabetes Mellitus (T2DM).

Risk Factors and Management of Osteoporosis Post-Transplant

Bone and mineral disorders are common after organ transplantation. Osteoporosis post transplantation is associated with increased morbidity and mortality. Pathogenesis of bone disorders in this particular sub set of the population is complicated by multiple co-existing factors like preexisting bone disease, Vitamin D deficiency and parathyroid dysfunction. Risk factors include post-transplant immobilization, steroid usage, diabetes mellitus, low body mass index, older age, female sex, smoking, alcohol consumption and a sedentary lifestyle. Immunosuppressive medications post-transplant have a negative impact on outcomes, and further aggravate osteoporotic risk. Management is complex and challenging due to the sub-optimal sensitivity and specificity of non-invasive diagnostic tests, and the underutilization of bone biopsy. In this review, we summarize the prevalence, pathophysiology, diagnostic tests and management of osteoporosis in solid organ and hematopoietic stem cell transplant recipients.

P1422CATHEPSIN-K IS A POWERFUL DIAGNOSTIC BIOMARKER IN PARATHYROIDECTOMIZED DIALYSIS PATIENTS

Background and Aims Cathepsin-K (Cts-K) is a lysosomal cysteine protease mainly involved in bone remodeling and resorption. Although it is largely released by lung cells, osteoclasts and macrophages, increasing current evidence suggests that the parathyroids may somewhat regulate Cts-K balance. We therefore analyzed Cts-K in a cohort of 85 chronic HD patients (mean age 67+/-12, median dialysis vintage 3.2 yrs), also including some individuals who were previously parathyroidectomized. Method Cts-K serum levels were measured before a mid-week dialysis session together with standard biochemical parameters. Twenty-six healthy subjects matched for age and gender served as controls. Patients were further stratified according to whether they were parathyroidectomized or not. Results Cts-K levels were statistically higher in HD patients than in controls (median 340, IQR 170-835 vs. 190 IQR 20-120 pg/mL, p&lt;0.0001) and significantly associated with ALP (r=0.50, p&lt;0.001), CRP (r=0.46,p&lt;0.001) and PTH (r=0.24,p=0.02). Patients with previous parathyroidectomy (n=8) had significantly lower levels of Cts-K (942.3 vs 46.2 pg/mL, p&lt;0.0001). At ROC analyses, Cts-K showed an excellent diagnostic profile in distinguishing parathyroidectomized patients (AUC 0.977, best Cts-K cutoff&lt; 100 pg/mL; sens. 100%, spec. 93%; Figure 1). Of note, although slightly inferior, the AUC of Cts-K was not statistically different to that of PTH (p=0.11 for comparison of ROC curves). Conclusion Cathepsin-K may represent a potential candidate biomarker for diagnosing and managing MBD complications, particularly those related to parathyroid dysfunction. Its exact biological role in these conditions deserves further examination.

Fluorescent nanosensor for in situ detection of phosphate and alkaline phosphatase in mice with parathyroid dysfunction

A composite nanosensor based on Zr(iv)-MOFs and PNPP was developed, which successfully applied for the in situ fluorescence imaging of phosphate and ALP levels in mice with parathyroid dysfunction.

Characterization of Calcium Homeostasis in Lithium-Treated Patients Reveals Both Hypercalcaemia and Hypocalcaemia

Introduction Prevalence studies demonstrate that a significant proportion of lithium-treated patients develop hypercalcaemia (3–30%). Lithium-associated hyperparathyroidism (LHPT) is poorly defined, and calcium homeostasis may be affected in a more complicated fashion than purely by elevated PTH secretion. The current study aims to examine in detail calcium homeostasis principally with regard to lithium duration. Methods Medical records of 297 lithium-treated patients (193 women, 104 men; median age 58 years) were examined, and information on gender, age, lithium treatment duration and calcium homeostasis was obtained. The median treatment duration with lithium was 16 (1.5–45) years. Results A total of 8504 calcium values were retrieved. Before initiation of lithium treatment, serum calcium was on average 2.33 mmol/l (2.02–2.60). During the treatment period, 178 patients (60%) remained normocalcaemic, 102 (34%) developed hypercalcaemia or were strongly suspected of LHPT, 17 (6%) had 3 or more intermittent episodes of hypocalcaemia. Forty-one per cent of patients with suspected or confirmed LHPT had low (<4 mmol) 24-h urine calcium levels. The success rate after 33 parathyroidectomies was 35%, hyperplasia being diagnosed in 75% of extirpated glands. Conclusions The prevalence of hypercalcaemia during lithium treatment is very high. In addition, hypocalcaemic episodes appear to occur frequently, possibly reflecting a more complicated parathyroid dysfunction than previously known. Long-term surgical results are unsatisfactory. LHPT biochemical profile is different from that of primary hyperparathyroidism and is in some ways similar to familial hypocalciuric hypercalcaemia.

Intrathyroidal Parathyroid Cyst: An Unusual Neck Mass

Parathyroid cyst (PC) is a very rare condition. A case of intrathyroidal PC is being reported here in a 53-year-old woman who presented to the endocrine clinic with slowly progressive painless left anterior neck swelling for 1 year with no symptoms of thyroid or parathyroid dysfunction and no compressive symptoms. Ultrasound of the thyroid showed a well-defined cystic lesion measuring 4.7 × 3.6 cm in maximum diameter with internal echoes within the cyst located in the left lobe of the thyroid gland. Fine needle aspiration revealed colorless clear fluid with a high concentration of parathyroid hormone. The patient underwent left hemithyroidectomy at her request. Histopathology revealed parathyroid tissue with unilocular cyst and thyroid tissue with goitrous changes. She was in remission, and there was no evidence of thyroid or parathyroid dysfunction after surgery.