Hyponatremia as a leading sign of hypopituitarism

We report the case of a 67-year-old man admitted to our hospital in an obtunded state. We found that a severe hyponatremia (115 mEq/L) was the cause of patient's status. In turn, hyponatremia was due to hypopituitarism (nonfunctioning macroadenoma). Mild to moderate hyponatremia had been previously detected in this patient, but it was overlooked. Correction of hyponatremia and treatment replacement therapy for central hypothyroidism and hypocortisolism restored a satisfactory clinical condition before discharge. The clinical onset of hypopituitarism is often characterized by mild nonspecific symptoms especially in older people, and it is often overlooked. Hypoglycemia can be another clue to undiagnosed hypopituitarism, and in the reported case, suspicious episodes of hypoglycemia occurred in the months preceding admission. Furthermore, several physicians consider hyponatremia as a normal consequence of aging. Although hyponatremia is a common electrolyte disorder in the elderly, physicians should not forget that it could be the leading manifestation of hypopituitarism. Hypopituitarism may be easily diagnosed, but clinical suspicion is needed. Because of the excess mortality associated with hypopituitarism, hormone assays should be included in the initial diagnostic work-up of hyponatremia. Keywords: Electrolyte balance, Hyponatremia, Hypopituitarism, Adrenal insufficiency, Elderl

Vitamin D status and the relationship with bone fragility fractures in HIV-infected patients: A case control study

HIV-infected patients show high risk of fracture. The aims of our study were to determine the prevalence of vertebral fractures (VFs) and their associations with vitamin D in HIV patients. 100 patients with HIV infection and 100 healthy age-and sex-matched controls were studied. Bone mineral density was measured by quantitative ultrasound at the non-dominant heel. Serum osteocalcin and C-terminal telopeptide of collagen type 1 served as bone turnover markers. Bone ultrasound measurements were significantly lower in patients compared with controls (Stiffness Index (SI): 80.58 ± 19.95% vs. 93.80 ± 7.10%, respectively, p < 0.001). VFs were found in 16 patients and in 2 controls. HIV patients with vertebral fractures showed lower stiffness index (SI) (70.75 ± 10.63 vs. 83.36 ± 16.19, respectively, p = 0.045) and lower vitamin D levels (16.20 ± 5.62 vs. 28.14 ± 11.94, respectively, p < 0.02). The majority of VFs (87.5%) were observed in HIV-infected patients with vitamin D insufficiency, and regression analysis showed that vitamin D insufficiency was significantly associated with vertebral fractures (OR 9.15, 95% CI 0.18-0.52, p < 0.04). VFs and are a frequent occurrence in HIV-infected patients and may be associated with vitamin D insufficiency

Psychological factors may impacton postmenopausal women fracture risk

Anxiety and osteoporosis are common diseases and major public health problems. The association between  anxiety levels and bone loss was poorly investigated, thus we aimed to explore whether anxiety severity could be considered as an independent fracture risk. In a setting of postmenopausal women we measured anxiety levels by Hamilton Anxiety Rating Scale (HAMA), depressive symptoms by Beck Depression Inventory and evaluated quality of life by the 36-Item Short Form Health Survey (SF-36) questionnaire. Women with higher anxiety levels showed lower BMD at lumbar spine and femoral neck, and exhibited a poorer quality of life after grouping our population in tertiles of HAMA score. Anxiety levels were predictive of reduced BMD after correcting for other known clinical risk of fractures

Skin Involvement and Pulmonary Hypertension Are Associated with Vitamin D Insufficiency in Scleroderma

Vitamin D status has been linked to immune system and autoimmune disorders; in fact, low levels of vitamin D are common in many autoimmune disorders. The aims of our study were to assess the prevalence of vitamin D insufficiency and the possible correlation with clinical parameters in systemic sclerosis (SSc). We recruited 40 patients (38 female and two male) with scleroderma and 40 healthy controls matched for age and gender. Demographic and clinical parameters were recorded and the 25-hydroxivitamin D3 serum levels were measured. Serum 25-hydroxivitamin D3 levels were significantly lower in patients with systemic sclerosis than in the control group. The prevalence of 25-hydroxivitamin D3 insufficiency was 50% in the patients and 22.5% in the control group. A statistically significant association was observed between the insufficiency of 25-hydroxivitamin D3 and skin involvement (p = 0.02) and echocardiography systolic pulmonary artery pressure >35 mmHg (p = 0.02). Our data show that the systemic sclerosis group has significantly lower serum 25-hydroxivitamin D3 concentrations compared to the control group; skin involvement and pulmonary hypertension are associated with vitamin D3 insufficiency

Quality of life in postmenopausal women: which role for vitamin D?

Quality of life (QoL) represents a dramatic issue in an aging population. Vitamin D has been consistently associated with several diseases. Thus, vitamin D may be considered a hallmark of health status. Our aim was to investigate whether vitamin D could be a determinant of self-perceived quality of life. The 36-Item Short Form Health Survey (SF-36) for quality of life, the Hamilton Anxiety Rating Scale (HAM-A), the Beck Depression Inventory II edition (BDI-II), in addition with multiple clinical risk factors for fractures and FRAX score, BMD at lumbar spine and femoral neck, were evaluated in a group of 177 postmenopausal women referring to an outpatients clinic for the prevention of osteoporosis. Serum levels of vitamin D [25(OH)D], indicative of vitamin D status, were detected by high-performance liquid chromatography. Scores of each dimension of the SF-36 were significantly related with the measurements of anxiety and depression by HAM-A and BDI-II respectively. Moreover role emotional, vitality, general health and bodily pain were significantly associated with vitamin D status. However, at a stepwise multiple regression analysis the physical component summary, obtained from SF-36, was not independently predicted from vitamin D. In conclusion we found an association between vitamin D status and QoL, thus we suggest physicians to consider vitamin D levels as a marker of QoL. Further studies testing the impact of vitamin D administration in improving QoL over time are needed