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

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

Challenges in differential diagnosis between primary and secondary forms of hyperparathyroidism

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

A view at sarcopenia by endocrinologist

Sarcopenia is one of the syndromes that significantly affects the health and life of the patient. Sarcopenia is a polyetiological syndrome with a complex, insufficiently studied pathogenesis, in which endocrine factors play a leading role. Comorbidity of elderly patients creates difficulties in differential diagnosis of existing pathology. The combination of sarcopenia with various endocrine pathologies, such as obesity, osteoporosis, hypothyroidism, hypoparathyroidism, vitamin D deficiency leads to a more severe course of disease and a worse prognosis for the quality and life expectancy of the patient. In this case, in some situations, the patient's condition can be improved by assessing pathogenetic causes and their elimination. Thus, the endocrinologist should pay more attention to the sarcopenia syndrome and its correction, as well as for its prevention at the earliest stages