Ca&Bone

[Is there any association between the location of the parathyroid adenoma and the presence of nephrolithiasis in primary hyperparathyroidism?]

CSUPOR EMŐKE, TÓTH EDIT, MÉSZÁROS SZILVIA, FERENCZ VIKTÓRIA, SZŰCS János, LAKATOS Péter, HORÁNYI János, PERNER Ferenc, HORVÁTH CSABA

FEBRUARY 20, 2003

Ca&Bone - 2003;6(01)

[INTRODUCTION - The majority of patients with primary hyperparathyroidism recurrently produce kidney stones, while the rest have other clinical manifestations (metabolic bone disease, acute pancreatitis, depression, etc.).The aim of this study was to examine whether there is any association between the clinical symptoms and the location of adenoma. PATIENTS AND METHODS - The records of 91 patients (10 males, 81 females, mean age: 61.9 years, range: 20-70 ys) operated for primary hyperparathyroidism between 1995 and 2000 were retrospectively evaluated. One patient was excluded from the study because of parathyroid cancer. Nephrolithiasis was noted in 55 cases and other clinical symptoms in 35 cases. The diagnosis of pHPT was confirmed by the surgery, which also determined the precise location of the adenoma. RESULTs - In the kidney stone group, the adenoma was located in the left inferior parathyroid gland in 50 cases (91 %), (χ2=67.5, p<0,00001), in the left superior parathyroid gland in 2 patients, while in 3 patients multiple hyperplasia was found. In the group without nephrolithiasis the adenoma was located in the right inferior parathyroid gland in 24 patients (69 %), (χ2=43.9, p<0,0001), while in 3 patients each it was detected in the left and right superior parathyroid gland, respectively. Multiple hyperplasia was also observed in 3 patients and ectopic location in 2 patients. CONCLUSION - The results raise the possibility that the clinical manifestation of the pHPT, i.e., whether it is or is not accompanied with nephrolithiasis, may be influenced by the location of the adenoma.This suggests that either the biological effects of the parathyroid hormone or its biologically active hormone fragments are different according to in which of the four glands it is produced.Therefore, we recommend that in patients with kidney stones where the preoperative imaging fails to reveal the location of the adenoma, during surgery the search for the adenoma should be started at the left inferior parathyroid gland.]

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Ca&Bone

[7th Congress of OROM]

SOMOGYI Péter

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[Dear Colleagues and Readers!]

HORVÁTH CSABA

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[National Fracture Prevention and Risk Reduction Programme]

SOMOGYI Péter, LAKATOS Péter, POÓR Gyula, HORVÁTH CSABA

[Prevention of fractures due to osteoporosis is of crucial importance given the high mortality associated with these fractures, especially with those of the hip and vertebrae. Patients with fractures often lose their independence or require institutionalization. Osteoporosis is a special disease in that even though its public health significance is well known only 10% of patients are medically treated.There are 900,000 patients with osteoporosis in Hungary, out of which about 130,000 to 150,000 are currently treated. In April 2003 a new fracture prevention programme was launched.The aim of the programme is to prevent subsequent fractures in patients with fractures of the distal radius, proximal humerus, hip and vertebrae by thorough examination, risk assessment and therapy if necessary in the osteoporosis centres and in the traumatological units associated with them.The National Fracture Prevention and Osteoporosis Risk Reduction Programme has been adapted from Glasgow, Scotland, and is the first of its kind that aims to cover a whole country.]

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[Paget’s disease of the bones]

DONÁTH Judit

[The author provides a summary of the current knowledge on Paget’s disease. Recently, the greatest advances have been made in the fields of genetics and therapy.The incidence of the disease is far greater than the number of cases diagnosed. Current research focuses on proving the virus hypothesis of etiology as well as on genetic causes.Various new biochemical markers have become available, but serum alkaline phosphatase is still the most widely used parameter. Radiological studies remain the gold standard for the diagnosis of Paget’s disease. Clinical trials of the most recent bisphosphonates are ongoing.]

Ca&Bone

[Hypophosphatasia]

MÉSZÁROS SZILVIA, GYŐRI Gabriella, MAGDICS Mária, LAKATOS Péter, HORVÁTH CSABA

[INTRODUCTION - The authors describe a rare metabolic bone disorder causing a differencial diagnostic problem in a 44- year-old female patient. CASE REPORT - The patient has had a history of lower back and hip pain for 30 years, as a cause of which vitamin-D resistant rickets had been diagnosed and short-term vitamin-D therapy was applied several times. The laboratory tests of the patient (weight: 41 kg, hight: 142 cm) showed decreased levels of serum alkaline phosphatase and parathyroid hormone, normal serum calcium and ionized calcium, and an elevated phosphate concentration. On X-ray examination of the bones, calcified disci under the V. and XII. dorsal vertebrae, a pathologic curve of both femoral diaphyses and a Looser line among other degenerative changes were noted. CONCLUSION - The clinical, laboratory and radiological findings supported the authors’ diagnosis of hypophosphatasia. The clinical and diagnostic findings of hypophosphatasia may also be suggestive of hypoparathyreosis with consecutive disturbance of vitamin-D activation.The differenciation of the two disorders is essential for adequate treatment.]

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[Comparison of osteodensitometric and quantitative bone ultrasound parameters among patients with pseudopseudohypoparathyroidism, pseudohypoparathyroidism type Ia and primary hyperparathyroidism]

CSUPOR EMŐKE, SZABOLCS István, FERENCZ VIKTÓRIA, GÓTH Miklós, IVÁN Gabriella, GYŐRI Gabriella, KOVÁCS LÁSZLÓ, TÓTH EDIT, MÉSZÁROS SZILVIA, HORVÁTH CSABA

[INTRODUCTION - Parathyroid hormone (PTH) excretion is increased both in primary hyperparathyroidism (pHPT) and in pseudohypoparathyroidism type Ia (PHP Ia). Pseudo-pseudohypoparathyroidism (P-PHP) is considered to be the normocalcemic form of pseudohypoparathyroidism type Ia. Our aim was to assess bone mineral content and bone quality as well as to determine whether these parameters are related to PTH levels in the above mentioned disorders. PATIENTS AND METHOD - 10 patients with pseudopseudohypoparathyroidism (P-PHP, age: 41.6 ±5.4 ys) were compared to 10 patients with primary hyperparathyroidism (pHPT) and to 10 healthy subjects, matched for age and gender. Moreover, nine patients with pseudohypoparathyroidism type Ia (PHP, age: 34.2 ±5.43 ys) were compared to nine age- and gender-matched patients with primary hyperparathyroidism and to nine healthy controls, respectively.The occurrence of previous bone fractures was recorded and bone mass was measured (by dual photon absorptiometry on the axial bones and by single photon absorptiometry on the forearm). Quantitative ultrasound (QUS) examination was performed both on the calcaneus by broadband ultrasound attenuation (BUA, dB/MHz) and speed of sound (SOS, m/s) measurements and on the proximal phalanges by amplitude-dependent speed of sound (AdSOS, m/s) measurements. In addition, some laboratory parameters of calcium metabolism were tested. RESULTS - No difference was found between PHP Ia and pHPT in bone mass.The lowest value was observed at the radius. Among the QUS parameters, pathologically low AdSOS was found at the phalanges in PHP Ia and it was lower than in pHPT patients, whereas at the calcaneus BUA showed a similar tendency. Bone mass did not significantly differ between P-PHP and healthy controls, it was decreased, however, at the forearm in the patients. Pathological AdSOS was found in P-PHP, which was lower than in pHPT. SOS at the calcaneus was lower in P-PHP than in pHPT, though it was not considered pathological. Laboratory results were typical for the diseases and the radiological examinations confirmed the diagnosis. Bone fractures occurred in three and two patients with PHP Ia and P-PHP, respectively, while no fractures were recorded in the pHPT and healthy groups. CONCLUSION - Bone loss among patients with PHP Ia is considered to be the impact of PTH excess on bone tissue.The deterioration of bone quality and architecture may play a role in the development of bone fractures.]

Ca&Bone

[Renal stone formation after parathyroidectomy in patients with primary hyperparathyroidism]

BERCZI Csaba, BALÁZS György, LUKÁCS Géza, TÓTH Csaba

[INTRODUCTION - The incidence of renal stone formation was studied in patients with primary hyperparathyroidism after parathyroidectomy. PATIENTS AND METHODS - Ninety-two patients operated on for hyperparathyroidism were included in the study. In Group 1 the patients (n=44) had kidney stones before parathyroidectomy. Patients with no history of nephrolithiasis (n=48) before the operation were assigned to Group 2. After the operation the occurrence of renal stones was assessed for both groups.The presence of any association between the recurrence of renal stones and various clinical parameters was analysed. RESULTS - The serum concentration of Ca and parathormone decreased to the normal range in both groups after the operation. Stone formation was observed in nine cases in five patients during follow-up. All five patients belonged to Group 1.Thirty-three % of these recurrent stones were diagnosed within the first year and 89% within 5 years. Statistical analysis did not reveal any significant association between recurrent stone formation and gender, age, preoperative serum levels of Ca and parathormone or the histology of parathyroid glands. CONCLUSION - The incidence of recurrent renal stones after successful parathyroidectomy significantly decreased in patients with primary hyperparathyroidism.]

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[About the care of patients with hyperuricaemia and gout]

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