Hypercalciuria and hyperparathyroidism — is there always a connection?

Hypercalciuria is a pathological condition characterized by an excess of daily calcium excretion. A high concentration of urine calcium can initiate stone formation. There are several types of hypercalciuria, each requires an individual approach. In the absence of known causes of development, idiopathic hypercalciuria is a frequent dysmetabolic disorder defined as an excess urine calcium excretion with normocalcemia. Resorptive hypercalciuria most often develops due to primary hyperparathyroidism and is caused by elevated PTH and excess release of calcium from bone stores. A thiazide test can be used for differential diagnosis between these conditions. We present a series of clinical cases covered the thiazide test in outpatient practice. The definitive diagnosis is extremely important because it determines the optimal treatment strategy. Secondary hyperparathyroidism (an increase in parathyroid hormone as a result of vitamin D deficiency, chronic renal failure or other conditions) requires medical therapy, while the primary hyperparathyroidism is radically cured only after surgical intervention.Taking into account the prevalence of idiopathic hypercalciuria and primary hyperparathyroidism, it is actual to use the thiazide test more widely in clinical practice

Рис. 1. Развитие диффузной и узелковой гиперплазии ОЩЖ (по материалам [12])

Hyperparathyroidism is a disease characterized by excessive secretion of parathyroid hormone (PTH) in the chief cells of parathyroid glands. There are three types of hyperparathyroidism: primary, secondary, and tertiary depending on the cause of this disease. By the secondary hyperparathyroidism calcium-sensing receptors (CaSR) and vitamin D receptors (VDR) lead to disturbance of phosphorus-calcium exchange and to development of a parathyroid glands hyperplasia. Treatment of secondary hyperparathyroidism with vitamin D showed the efficiency not only in normalization of clinical laboratory indicators but also in involution of changes in parathyroid glands. We represent the clinical case of a patient with secondary hyperparathyroidism caused by hypovitaminosis D, parathyroid hyperplasia more than 1 cm. The long-term oral therapy with active vitamin D led to the positive dynamics of PTH levels, as well as complete reduction of parathyroid lesion

Carbohydrate and lipid metabolism disorders in women with primary hyperparathyroidism: results of cross-sectional study

Background: Patients with primary hyperparathyroidism (PHPT) have increased mortality risk predominantly attributed to cardiovascular disease. Taking the risk factors for cardiovascular disease into account, such as overweight, atherogenic dyslipidaemia, carbohydrate metabolism disorders and insulin resistance (IR), investigation on the the study of the state of carbohydrate and lipid metabolism in patients with PHPT will help to shed light on the pathogenic mechanisms of the disease and, perhaps, to complement the algorithm for selecting treatment strategies for patients with PHPT. Aims: To study the prevalence of carbohydrate and lipid metabolism disorders among patients with PHPT and to identify the relationship between these two disorders with the indicators of mineral metabolism. Materials and methods: A case-control study of a total of age-matched 256 female patients, 220 patients with PHPT and 36 healthy individuals. The group patients with PHPT were sub-divided into two groups, symptomatic and mild form of PHPT. To verify the form of PHPT, ultrasound examinations of the parathyroid glands and kidneys, two-energy x-ray absorptiometry, biochemical studies (concentration of total and ionised calcium, serum phosphorus and the activity of alkaline phosphatase) and assessment of parathyroid hormone concentration were performed. The relationship between form of PHPT and body weight were evaluated retrospectively according to the survey. Among the 109 participants with PHPT (symptomatic PHPT: 82 patients; mild PHPT: 27 patients) and healthy individuals, the biochemical and hormonal parameters of fat (lipid spectrum of blood) and carbohydrate metabolism (content of immunoreactive insulin, HOMA index, presence of fasting glycemia disorder, glucose tolerance disorders and type 2 diabetes mellitus) were evaluated. Results: The symptomatic PHPT was associated with low body mass index (BMI) while the mild PHPT with high BMI. During an oral glucose tolerance test, the postprandial glycemia in symptomatic PHPT was significantly higher than that in mild PHPT (p = 0.036). The content of immunoreactive insulin in the symptomatic PHPT was not correlated with the concentration of parathyroid hormone, but positively correlated with the concentration of ionised calcium in the blood (r = 0.31; p = 0.006). Patients with PHPT showed a direct positive correlation between BMI and IR index (r = 0.67; p < 0.001). It is shown that patients with PHPT have increased LDL content in the blood, and the actual blood lipid concentration is associated with the state of kidney function. Conclusions: The obtained data confirm the relationship between phosphorus–calcium metabolism disorders in PHPT and carbohydrate and lipid metabolism disorders. Prospective, controlled studies are warranted to better elucidate the causal relationships of mineral, carbohydrate and fat metabolism disorders in PHPT

The case of oncogenic hypophosphatemic osteomalacia

Osteomalacia is a systemic bone disease, characterized by an excessive accumulation of non-mineralized osteoid and an imbalance in the organic matrix formation and mineralization. A rare cause of disease is tumor-induced osteomalacia, most often due to phosphaturic mesenchymal tumors (PMT). Usually there are benign small tumors, affecting the soft tissues and bones of any location. The basic pathogenesis of underlying oncogenic osteomalacia is a decreased renal tubular reabsorption of phosphate consequent to hyperproduction of fibroblast growth factor 23 in PMT. Clinical features are nonspecific, the average period from the symptoms onset to diagnosis reaches 3 years and at least 5 years before surgical treatment. Finding the tumour is crucial, as complete removal is curative. We present a clinical case of tumor-induced osteomalacia due to PMT required the complex differential diagnosis with other rare diseases

Joint and muscle involvement in primary hyperparathyroidism

In addition to the classical symptoms such as osteoporosis, renal stones and gastric ulcers primary hyperparathyroidism (PHPT) could be presented with non-classical manifestations, including muscle and joint pathology. Moreover, in some cases the articular and neuromuscular impairment might be the main signs of the disease. Despite the long research history the true prevalence of these PHPT complications remains unknown. Discrepancies in studies results may be due the non-specific and different symptoms that patients complain about, various study design, uncorrected comorbid conditions, the different PHPT populations, a wide methods variety in the assessment of neuromuscular and articular involvement. However, the underestimated muscle dysfunction and joint damage can lead to decreased quality of life and disability, primarily from fragility fractures. In the majority of the studies parathyroidectomy improved muscle strength, but there is no clear results for articular manifestations. Basic research and large randomized control trials are limited. The main goal of this review is to summarize currently available data on muscle and joint involvement in patients with PHPT

Opportunities in multimodal neuroimaging for optimizing thrombolytic therapy for ischemic stroke

The main purpose of examination of patients before thrombolytic therapy for ischemic stroke (IS) is to timely identify contraindications to the use of recombinant tissue plasminogen activator.Objective: to estimate opportunities and benefits in applying multimodal magnetic resonance imaging (MRI) to improve clinical outcomes in acute stroke, among other processes, by enhancing the efficiency and safety of thrombolytic therapy.Patients and methods. The clinical experience of the S.M. Kirov Military Medical Academy in using multimodal MRI of the brain since 2004 was analyzed in patients with stroke.Results. Comprehensive assessment of the results of perfusion-weighted MRI of the brain and those of transcranial Doppler ultrasound identified five clinically significant variants of perfusion changes in IS: normal perfusion; postischemic hyperemia; persistent hypoperfusion; acute pathological hyperperfusion, and unrecovered perfusion. With an irreversible tissue damage volume of >60 cm3 on day 1 of stroke, as evidenced by diffusion-weighted MRI, the odd ratio for cerebral edema in the acutest period of the disease is 39.4% (95% CI 2.57–2436; p<0.05). The risk of hemorrhagic transformation increases with a measured diffusion coefficient in the area of the nucleus of developing nonlacunar infarct <35×10-5 mm2/sec within the first 24 hours after disease onset (p<0.005).Conclusion. The data of local clinical practice and the results of international clinical trials show that multimodal MRI of the brain is a reliable tool for the detailed evaluation of the expected efficiency and safety of thrombolytic therapy for IS. When persistent hypoperfusion is detected, the determination of perfusion-diffusion mismatch is of no informative value in deciding on whether thrombolytic therapy can be performed. Estimating the volume of pathological changes on diffusion-weighted images and the measured diffusion coefficient in the area of the nucleus of developing nonlacunar infarct in the measured diffusion coefficient maps allows the risk of major intracranial complications due to IS to be identified

Ionic liquids at electrified interfaces

Until recently, “room-temperature” (<100–150 °C) liquid-state electrochemistry was mostly electrochemistry of diluted electrolytes(1)–(4) where dissolved salt ions were surrounded by a considerable amount of solvent molecules. Highly concentrated liquid electrolytes were mostly considered in the narrow (albeit important) niche of high-temperature electrochemistry of molten inorganic salts(5-9) and in the even narrower niche of “first-generation” room temperature ionic liquids, RTILs (such as chloro-aluminates and alkylammonium nitrates).(10-14) The situation has changed dramatically in the 2000s after the discovery of new moisture- and temperature-stable RTILs.(15, 16) These days, the “later generation” RTILs attracted wide attention within the electrochemical community.(17-31) Indeed, RTILs, as a class of compounds, possess a unique combination of properties (high charge density, electrochemical stability, low/negligible volatility, tunable polarity, etc.) that make them very attractive substances from fundamental and application points of view.(32-38) Most importantly, they can mix with each other in “cocktails” of one’s choice to acquire the desired properties (e.g., wider temperature range of the liquid phase(39, 40)) and can serve as almost “universal” solvents.(37, 41, 42) It is worth noting here one of the advantages of RTILs as compared to their high-temperature molten salt (HTMS)(43) “sister-systems”.(44) In RTILs the dissolved molecules are not imbedded in a harsh high temperature environment which could be destructive for many classes of fragile (organic) molecules

Clinical, laboratory and instrumental methods of pre-surgical diagnosis of the parathyroid glands cancer

Backgraund. When defining symptomatic primary hyperparathyroidism (PHPT), differential diagnosis between a benign and malignant neoplasm of parathyroid glands (PG) may be challenging. The diagnosis of carcinoma or a benign tumor determines the extent of the surgical intervention and further observation tactics. Aims. The purpose of the study is to determine the clinical and laboratory and instrumental predictors of PG cancer. Materials and methods. A retrospective study included 385 patients with PHPT (273 with adenomas of the PG, 66 with hyperplasia, and 19 patients with cancer of the PG), who had been examined and operated from 2000 to 2014. The primary goal of the study was to define the level of ionized calcium (Ca++), parathyroid hormone (PTH), and the volume of the tumor PG specific for cancer of the PG. The level of parathyroid hormone (PTH) was determined by electrochemoluminescent method on the Roche analyzer Cobas 6000; ionized calcium (Ca++) ion-selective method. The size of the PG was determined by the ellipse formula: V(cm3) = (A B C) 0.49 by ultrasound investigation using the Valuson E8 device from General Electric. Results. The group of patients with PG carcinoma showed the increased level of Ca++ of more than 1.60 mmol/l (p = 0.004) and increased level of PTH of more than 600 pg/ml (p = 0.03). The size of tumors of more than 6 cm3 is more typical to malignant neoplasm compared to the adenoma of the PG (p = 0.01). Conclusions. The group of patients with PHPT that are at risk of having PG carcinoma include individuals that have a combination of the following indicators: PTH levels of more than 600 pg/ml, an increase in ionized calcium of more than 1.60 mmol/l, the tumor size of more than 6 cm3

Photoconductivity of ionic thermotropic liquid crystal with semiconductor nanoparticles

The characteristics of photocurrent are investigated in new nanocomposites of cadmium octanoate with semiconductor nanoparticles (NPs) as well as in pure matrix of the cadmium octanoate. CdS NPs are synthesized inside the cadmium octanoate matrix during one-step chemical reaction. The photoconductivity in these nanocomposites has been detected in wide temperature range. The photocurrent exhibits nonlinear behavior over all different mesophases of the nanocomposites. Two types of near-electrode processes that occur depending on the value of applied voltage are considered to explain the nonlinear dependence of the current-voltage characteristics