Body fat and cholecalciferol supplementation in elderly homebound individuals

Vitamin D deficiency, observed mainly in the geriatric population, is responsible for loss of bone mass and increased risk of bone fractures. Currently, recommended doses of cholecalciferol are advised, but since there are few studies evaluating the factors that influence the serum levels of 25-hydroxyvitamin D (25(OH)D) following supplementation, we analyzed the relationship between the increase in serum 25(OH)D after supplementation and body fat. We studied a group of 42 homebound elderly subjects over 65 years old (31 women) in order to assess whether there is a need for adjustment of the doses of cholecalciferol administered to this group according to their adipose mass. Baseline measurements of 25(OH)D, intact parathyroid hormone and bone remodeling markers (osteocalcin and carboxy-terminal fraction of type 1 collagen) were performed. Percent body fat was measured by dual-energy X-ray absorptiometry. The patients were divided into three groups according to their percent body fat index and were treated with cholecalciferol, 7,000 IU a week, for 12 weeks. The increases in serum levels of 25(OH)D were similar for all groups, averaging 7.46 ng/mL (P < 0.05). It is noteworthy that this increase only shifted these patients from the insufficiency category to hypovitaminosis. Peak levels of 25(OH)D were attained after only 6 weeks of treatment. This study demonstrated that adipose tissue mass does not influence the elevation of 25(OH)D levels following vitamin D supplementation, suggesting that there is no need to adjust vitamin D dose according to body fat in elderly homebound individuals.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Disciplina de EndocrinologiaUNIFESP, EPM, Disciplina de EndocrinologiaSciEL

Granulocytic sarcoma presented as a reactivation of chronic myeloid leukemia after allogenic marrow transplantation

The authors report the case of a chronic myeloid leukemia (CML) patient submitted to allogenic bone marrow transplantation, who had probably never entered complete remission. The disease was reactivated as a granulocytic sarcoma, next to a platinum plate installed to correct a tibia fracture 11 years earlier. Its final event was a myeloid Ph1+ blastic crisis that was unsuccessfully treated with high doses of sc interferon and citarabine.Os autores relatam um caso de leucemia mielóide crônica tratada com transplante alogênico de medula óssea e que provavelmente nunca entrou em remissão completa da doença. A paciente apresentou reativação como sarcoma granulocítico junto a uma placa de platina instalada há 11 anos, após fratura de tíbia. Descrevem também outras manifestações de recidiva e término em crise blástica mielóide Ph1+ sem sucesso tratada com altas doses de interferon se e citarabina.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

Primary hyperparathyroidism is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in Western countries but still predominantly as a symptomatic disease in developing countries. The objective of this retrospective study was to describe the diagnostic presentation profile, parathyroidectomy indication and post-surgical bone mineral density follow-up of patients with primary hyperparathyroidism seen at a university hospital. We found 115 patients (92 women, median age 56 years) with primary hyperparathyroidism diagnosed during the last 20 years. We defined symptomatic patients based on the presence of any classical symptom affecting bone, kidney or the neuromuscular system. Surgical criteria followed the guidelines of the National Institutes of Health regarding asymptomatic primary hyperparathyroidism. Symptomatic patients and patients meeting surgical criteria for parathyroidectomy were 66 and 93% of the sample, respectively. Median calcium and parathyroid hormone values were 11.9 mg/dL and 189 pg/mL, respectively. After surgical treatment, 97% of patients were cured, with increases in bone mineral density of 19.4% in the lumbar spine and 15.7% in the femoral neck 3 years after surgery. Greater bone mass increases were detected in pre-menopausal women, men, and in symptomatic and younger patients, both in the lumbar spine and femoral neck. Our results support the previous findings of a predominantly symptomatic disease with a presentation profile that could be mainly related to a delayed diagnosis. Nevertheless, genetic and racial backgrounds, and nutritional factors such as calcium and vitamin D deficiency may play a role in the clinical presentation of primary hyperparathyroidism of Brazilian patients.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaInstituto FleuryUNIFESP, EPMSciEL

Changes in clinical and laboratory findings at the time of diagnosis of primary hyperparathyroidism in a University Hospital in São Paulo from 1985 to 2002

In contrast to most developed countries, most patients with primary hyperparathyroidism in Brazil are still symptomatic at diagnosis. However, we have been observing a change in this pattern, especially in the last few years. We evaluated 104 patients, 77 females and 27 males aged 11-79 years (mean: 54.4 years), diagnosed between 1985 and 2002 at a University Hospital. Diagnosis was made on the basis of clinical findings and of high total and/or ionized calcium levels, high or inappropriate levels of intact parathyroid hormone and of surgical findings in 80 patients. Patients were divided into three groups, i.e., patients diagnosed from 1985 to 1989, patients diagnosed from 1990 to 1994, and patients diagnosed from 1995 to 2002. The number of new cases diagnosed/year increased from 1.8/year in the first group to 6.0/year in the second group and 8.1/year in the third group. The first group comprised 9 patients (mean serum calcium ± SD, 13.6 ± 1.6 mg/dl), 8 of them (88.8%) defined as symptomatic. The second group comprised 30 patients (mean calcium ± SD, 12.2 ± 1.63 mg/dl), 22 of them defined as symptomatic (73.3%). The third group contained 65 patients (mean calcium 11.7 ± 1.1 mg/dl), 34 of them symptomatic (52.3%). Patients from the first group tended to be younger (mean ± SD, 43.0 ± 15 vs 55.1 ± 14.4 and 55.7 ± 17.3 years, respectively) and their mean serum calcium was significantly higher (P < 0.05). All of symptomatic patients independent of group had higher serum calcium levels (12.4 ± 1.53 mg/dl, N = 64) than asymptomatic patients (11.4 ± 1.0 mg/dl, N = 40). Our data showed an increase in the percentage of asymptomatic patients over the years in the number of primary hyperparathyroidism cases diagnosed. This finding may be due to an increased availability of diagnostic methods and/or to an increased awareness about the disease.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPM, Depto. de MedicinaUNIFESP, EPM, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoSciEL

Fractures of the proximal femur: correlation with vitamin D receptor gene polymorphism

Fractures are the feared consequences of osteoporosis and fractures of the proximal femur (FPF) are those that involve the highest morbidity and mortality. Thus far, evaluation of bone mineral density (BMD) is the best way to determine the risk of fracture. Genetic inheritance, in turn, is one of the major determinants of BMD. A correlation between different genotypes of the vitamin D receptor (VDR) and BMD has been recently reported. On this basis, we decided to determine the importance of the determination of VDR genotype in the presence of an osteoporotic FPF in a Brazilian population. We studied three groups: group I consisted of 73 elderly subjects older than 65 years (78.5 ± 7.2 years) hospitalized for nonpathological FPF; group II consisted of 50 individuals older than 65 years (72.9 ± 5.2 years) without FPF and group III consisted of 98 young normal Brazilian individuals aged 32.6 ± 6.6 years (mean ± SD). Analysis of VDR gene polymorphism by restriction fragment length polymorphism (RFLP) was performed by PCR amplification followed by BsmI digestion of DNA isolated from peripheral leukocytes. The genotype distribution in group I was 20.5% BB, 42.5% Bb and 37% bb and did not differ significantly from the values obtained for group II (16% BB, 36% Bb and 48% bb) or for group III (10.2% BB, 47.6% Bb and 41.8% bb). No differences in genotype distribution were observed between sexes or between the young and elderly groups. We conclude that determination of VDR polymorphism is of no practical use for the prediction of FPF. Other nongenetic factors probably start to affect bone mass, the risk to fall and consequently the occurrence of osteoporotic fractures with advancing age.A01Universidade Federal de São Paulo (UNIFESP)Hospital do Servidor Público Estadual de São PauloUNIFESPSciEL

Diagnosis of hyperglycemia in a cohort of Brazilian subjects

Fleury Inst, Ctr Diabet, BR-04344070 São Paulo, BrazilUniversidade Federal de São Paulo, Mol Endocrinol Lab, Escola Paulista Med, São Paulo, BrazilINSERM U695, Paris, FranceUniversidade Federal de São Paulo, Mol Endocrinol Lab, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Análise do polimorfismo gênico do receptor de vitamina D e sua correlação com densidade mineral óssea em uma população de portadores de diabetes mellitus insulino-dependente

Pacientes portadores de diabetes mellitus insulino-dependente (DMID) apresentam um risco aumentado de desenvolver osteoporose. Dentre os fatores geneticos relacionados ao desenvolvimento de osteoporose, uma possivel associacao entre o polimorfismo genico do receptor de vitamina D (VDR) e densidade mineral ossea (DMO) foi descrita em algumas populacoes. Nos caracterizamos o polimorfismo genico do VDR em uma populacao adulta brasileira saudavel e num grupo portador de DMID e correlacionamos tais achados com os valores densitometricos encontrados em ambos os grupos. A analise densitometrica incluiu o calculo da densidade mineral ossea aparente em coluna lombar (DMOAL) com o objetivo de reduzir a influencia de parametros antropometricos sobre os valores densitometricos. Recrutamos 94 voluntarios adultos brasileiros saudaveis (63 mulheres e 31 homens), idade media (± SD) de 32.4 ± 6.5 anos (variando de 18 a 49 anos) e 78 pacientes com DMID (33 mulheres e 45 homens) diagnosticado antes dos 18 anos de idade, idade media (± SD) de 23.3 ± 5.5 anos (variando de 18 a 39 anos). O genotipo do VDR foi determinado por amplificacao por PCR seguido de diGestão do DNA isolado de leucocitos de sangue periferico, utilizando-se a enzima de restricao BsmI. O grupo portador de DMID apresentou uma menor DMO e DMOAL do que o grupo controle. A microalbuminuria apresentou uma correlacao negativa com DMO em ambos os sitios analisados (coluna lombar: r = -0.30, p = 0.002; colo femoral: r = -0.40, p < 0.001) e com DMOAL (r = -0.27, p = 0.01). A distribuicao dos genotipos do VDR no grupo controle revelou 43 Bb (45.7 %), 39 bb (41.5 %) e 12 BB (12.8 %). Esta distribuicao foi semelhante no grupo portador de DMID: 39 Bb (50 %), 26 bb (33.3 %) e 13 BB (16.7 %). No grupo controle, diferentemente do que foi relatado pela maioria dos estudos recem publicados, os individuos portadores do genotipo BB apresentaram uma maior DMO em colo femoral (p = 0.03) e uma maior DMOAL (p = 0.04) que os individuos bb. Por outro lado, no grupo diabetico, pacientes portadores do genotipo BB (apesar de terem um menor tempo de duracao de DMID que os pacientes Bb e bb) apresentaram uma menor DMO em L2-L4 e em colo femoral quando comparados com pacientes bb (p = 0.02) e uma menor DMO em L2-L4 quando comparados com pacientes Bb (p = 0.01). Este estudo de associacao sugere uma influencia do polimorfismo genico do VDR na DMO de pacientes portadores de DMIDBV UNIFESP: Teses e dissertaçõe

Secreção de paratormônio intacto durante hipercalcemia induzida em indíviduos normais e em portadores de doença paratiroidianas de hiperfunção

BV UNIFESP: Teses e dissertaçõe

Primary hyperparathyroidism presenting with a single symptomatic osteolytic lesion

Symptomatic primary hyperparathyroidism is still very frequent in Brazil. Unfortunately, the correct diagnosis is usually made late in the course of the disease, and many patients with this disorder present with evident bone disease. After successful parathyroidectomy, these patients usually recover bone mass, but this improvement can be variable. We present the case of a patient with primary hyperparathyroidism whose clinical presentation was heralded by a single right ischio-pubic lytic lesion. Rapid recovery of bone mass was seen in this patient.UNIV FED SAO PAULO,ESCOLA PAULISTA MED,DEPT MED,DIV ENDOCRINOL,BR-04023002 SAO PAULO,SP,BRAZILUNIV FED SAO PAULO,ESCOLA PAULISTA MED,DEPT MED,DIV ENDOCRINOL,BR-04023002 SAO PAULO,SP,BRAZILWeb of Scienc