Palliative treatment of uncontrollable hypercalcemia due to parathyrotoxicosis: denosumab as rescue therapy

Parathyroid carcinoma is a rare disease leading to severe hypercalcemia due to hyperparathyroidism. Surgery is the primary treatment option. A more progressive form of the disease is characterized by parathyrotoxicosis, and subsequent hypercalcemia is the most common cause of death. We report a case presenting with severe hypercalcemia due to parathyrotoxicosis from parathyroid carcinoma treated for the first time using the monoclonal antibody denosumab as a rescue therapy and present long-term follow-up data. The 71-year-old patient presented with severe hypercalcemia due to metastatic parathyroid carcinoma. Despite undergoing treatment with bisphosphonates, cinacalcet hydrochloride, and forced diuresis, the patient's condition deteriorated rapidly due to resistant hypercalcemia. Surgery performed because of spinal metastasis and forced diuresis lowered calcium levels, albeit they remained in the hypercalcemic range and significantly increased when forced diuresis was stopped. Considering a palliative situation to overcome hypercalcemia, we decided to administer denosumab, a monoclonal antibody that binds to the receptor activator of nuclear factor-kappa B ligand. After a single subcutaneous administration of 60 mg denosumab, calcium levels normalized within one day. Subsequent denosumab injections led to permanent control of serum calcium for more than 2 years despite rising parathyroid hormone levels and repeated surgeries. Together with recent cases in the literature supporting our observation, we believe that denosumab is relevant for future trials and represents an effective tool to control hypercalcemia in patients with advanced stages of parathyroid cancer

Leptin and Physical Activity in Adult Patients with Anorexia Nervosa: Failure to Demonstrate a Simple Linear Association

High physical activity (PA) in patients with anorexia nervosa (AN) is hypothesized to be, at least in part, a consequence of hypoleptinemia. However, most studies on the association of leptin and PA in AN were performed in adolescents or young adults, and PA was generally measured with subjective tools. We aimed to explore the association of leptin and PA in adults with AN using an objective technique to quantify PA. Using a cross-sectional, observational design, we analyzed body fat (bioelectrical impedance), PA (accelerometry, SenseWear™ armband) and plasma leptin (ELISA) in 61 women with AN (median age: 25 years, range: 18–52 years; median BMI: 14.8 ± 2.0 kg/m2) at the start of hospitalization. Results indicated a mean step count per day of 12,841 ± 6408 (range: 3956–37,750). Leptin was closely associated with BMI and body fat (ρ = 0.508 and ρ = 0.669, p < 0.001), but not with steps (ρ = 0.015, p = 0.908). Moreover, no significant association was observed between BMI and steps (ρ = 0.189, p = 0.146). In conclusion, there was no simple, linear association of leptin and PA, highlighting the need for more complex and non-linear models to analyze the association of leptin and PA in adults with AN in future studies

Evaluation of a portable armband device to assess resting energy expenditure in patients with anorexia nervosa

BACKGROUND: In women with anorexia nervosa (AN), resting energy expenditure (REE) is decreased due to reduced energy intake and severe underweight. The assessment of REE allows estimating individual metabolic downregulation and better understanding body weight regulatory mechanisms in severely underweight patients with AN. However, REE predictive equations are known to have considerable shortcomings in patients with AN. Our aim was to evaluate a portable armband device (SenseWear armband [SWA]; BodyMedia, Inc, Pittsburgh, PA) for the assessment of REE against the measurement with indirect calorimetry (IC) as the reference method. METHODS: We assessed REE simultaneously by IC and SWA in 50 women with AN at the start of inpatient therapy and calculated REE using 2 predictive equations. RESULTS: Reliable data for IC measurement were obtained for 34 patients (age: 27.0 +/- 8.0 years; body mass index: 14.4 +/- 2.0 kg/m(2)). REE assessed with SWA was overestimated by 23% +/- 27% compared with REE measured by IC (1166 +/- 174 vs 979 +/- 198 kcal/d, P < .001). REE estimation with SWA gave an accurate prediction within 10% deviation of REE measured with IC in 35% of the patients. In contrast, REE calculated with 2 predictive equations underestimated REE measured with IC by -26% +/- 17% and -5% +/- 20%, respectively. CONCLUSIONS: A mean difference of 187 kcal/d between both techniques for the assessment of REE may be of methodological relevance. Therefore, SWA and IC are not interchangeable methods for the assessment of REE in underweight females with AN

The Role of Objectively Measured, Altered Physical Activity Patterns for Body Mass Index Change during Inpatient Treatment in Female Patients with Anorexia Nervosa

Increased physical activity (PA) affects outcomes in patients with anorexia nervosa (AN). To objectively assess PA patterns of hospitalized AN patients in comparison with healthy, outpatient controls (HC), and to analyze the effect of PA on Body Mass Index (BMI) change in patients with AN, we measured PA in 50 female patients with AN (median age = 25 years, range = 18–52 years; mean BMI = 14.4 ± 2.0 kg/m2) at the initiation of inpatient treatment and in 30 female healthy controls (median age = 26 years, range = 19–53 years; mean BMI = 21.3 ± 1.7 kg/m2) using the SenseWear™ armband. Duration of inpatient stay and weight at discharge were abstracted from medical records. Compared with controls, AN patients spent more time in very light-intensity physical activity (VLPA) (median VLPA = 647 vs. 566 min/day, p = 0.004) and light-intensity physical activity (LPA) (median LPA = 126 vs. 84 min/day, p &lt; 0.001) and less time in moderate-intensity physical activity (MPA) (median MPA = 82 vs. 114 min/day, p = 0.022) and vigorous physical activity (VPA) (median VPA = 0 vs. 16 min/day, p &lt; 0.001). PA and BMI increase were not associated in a linear model, and BMI increase was mostly explained by lower admission BMI and longer inpatient stay. In a non-linear model, an influence of PA on BMI increase seemed probable (jack knife validation, r2 = 0.203; p &lt; 0.001). No direct association was observed between physical inactivity and BMI increase in AN. An altered PA pattern exists in AN patients compared to controls, yet the origin and consequences thereof deserve further investigation