- Email: [email protected]
Coexisting primary hyperparathyroidism and thyroid toxic adenoma
609 SERUN LEVELS OF PROCOLLAGEN TYPE 1 CkRBOXY-TBRNINAL BXTENSION PEPTIDE IN NSTABOLIC BONE DISEASES. P.Na& S.Gonnelli,E.Maioli,D.Aqnusdei.M.B.Franci, C.Gl'iari. Institute of Internal Medicine, University of SiK, Italy. Serum levels of type 1 procollagencarboxy-terminal extension peptide (PICP) have been proposed as a new biochemical marker of bone formation. However, in patients with metabolic bone diseases, few data on the correlationbetween PICP and the biochemicalestimatesof bone turnover are available.We measured serum levels of PICP, alkaline phosphatase (Al.Ph.), osteocalcin (BGP), and urinary excretion of hydroxyproline (HOP/Cr) in: 101 patients (age 58.St7.9 SD) with established untreated postmenopausal osteoporosis (PMO); 27 patients (age 65+-10.3) with Paget’s bone disease (PBD); 10 young adult subjects (age 40.9?6.1)with low bone mass (YLM); and 7 patients (age 33.5t16.7) with osteogenesis imperfecta (01). Serum PICP levels were measured by a double antibody radioirnmunoassay (FARMOSDiagnostica, Finland) with an intra- and inter-assayvariations of 3.1% and 4.9% respectively. Results are reported in the table below :
608 PLASMA OF WALKER255 CONTAINS PARATHORMONE
CARCINOSARCOMA BEARING RATS RELATED PEPTIDE. 5. lo as.E.M. Dfaq de la Unkls Metabblica.
Walker-256 (W256) osrcfnossrcoma (an experimental model of humoral hypercalcemis of malignancy) or Yoshkfa solid sarcoma (a nonhypercalcamfa produofng tumor) were im@anted SUbCUtaneoUsly tomale albinoWi$tar rats(abwt2!iO g).Healthy. ageand sex malched. ratswere used aa contrds. A sample of blood from each animal was obtained fourteen days after tumor implant. Analiquotof blood was separated for Ihe daterminatlon _-._. of serum calcium by atomic absorptlometry. EDTA (7.2 mg/ml) and Trasyfd (400 KllJ/mi) were lmmedf&ly added 10 e&h remslnlno blood samde and plasma was kept at -2tX for psrathormone r&ted &tic&? (F+TH&) dete&instion, W258 tumors were removed from rats and weighed. In two rats, who survived from surgical excisionof their tumorsa new determfnatlon of serum calcium and plasma PTHrP levds were performed 24 h after surgery. Due to the fact that human and rat PTHrP show a 100% homdogy In their ffrst 48 eminoackl sequence, PTHrP levels ware determined by a commorcfally avaflable RtA (lncstar) which emdovrd an sntl-human PTHrP l-40 as flmt antbody. (Mean t SD, mg/dl, 14.8 t 1.2, r-i-s)‘th& In controls (9.5 t 0.5, i!=a p
_. 5.Ei~1.5 7.122.4 3.9to.4 5.7*3.5
li.4t4.7. 3B.djz24.2 8.0522.9 17.2k15.4
_._.
24.725.2 30.6*10.2 22.3t5.6 24.3t0.7
In PM0 group, PICP significantly correlate?. with BGP (p
610 LONG-TERM
(
i47147 PBD 3111177 YLM 99r29 01 53129 PM0
611 EFFECT OF MEDICAL VERSUS SURGICAL IDlSMfHPTl Unidad Metab
MANAGEMENT
IN
COEXISTING PRIMARY HYPERPARATHYROIDISM AND THYROID TOXIC ADENCNA. F. Lorg. C. Di Cairano, F. D*Ubaldo. G. Miracapillo. M.Nobili, R, Falbo. Endocrinology unit, Institute of Internal Medicine, University of Siena, Italy. The coexistence of primary hyperparathyroidism and hyperthyroidism is a rare condition, only about fifty casea having been described in literature. The combination of thyroid toxic adenoma and parathyroid adenoma is even more rare, since only 15 cases have been reported thus far. We present two cases of thyroid toxic adenama and coexistent primary hyperparathyroidism. Both patients, a man aged 67 years and a 66 year-old woman, presented with thyratoxicosis ard asymptomatic hypercalcemia; both were found to have high level? of serum immunoreactive parathyroid hormone. Treatment with methimazole was effective in restoring euthyroidism, whereas hypercalcemia persisted until surgery was performed. The problems encountered in the diagnosis of both conditions are described in detail, with particuiar reference to the relatively frequent occurrence of hypercalcemia during the clinical course of thyrotoxicosis even in the absence of hyperparathyroidism. The question of the possible relationship between the two conditions is also considered.
To assess tho role of mrdicel mensgemsnt in some cases of patients with HPT ws heve molyred specific symptoms, biochsmfcsl variables and bona mineral content in 54 cases with persistent hypercalcemia and elevated serum IPTHIMl command with 74 surgicelly treated patientsfSlfollowad for at least five ytsrsf .52 P3.5 In&l Follow-up fnitid Follow up 61.4il4.5 Aue(~ersf 44.1 * 13.9 Gender M-17 F-37 Mm25 F=48 61.1 Rtnol stonssf%f 7.4 67.6 8 Fractures(%) 7.4 6.8 1.33 Peptic ulcer{%) 14.81 5:s 17.56 2.6 Hypertmsionf%l 20.37 20.37 24.3 16.6 Biochemistry Calciumfmmolfil 2.61 to.1 6 2.7OkO.16 3.02t0.3 2.46+0.22 Phorphoruslmgldl~ 2.66 r0.47 2.72 to.59 2.55r0.6 3.44tO.73 Atk.Ph.fU/Ll 107.St10.1 124.8t14.4 151.8*10.9 86.0i4.6 iPTHfpmol/L) 243.4i232 153.5t141.5 390.4t252.6 Ccrlml/min) 88.7g22.2 85.3e31.6 85.2e25.2 91.8t;::O 0.24 r0.09 0.18+ 0.07 Ca.E.l.tml/minl 0.28+0.14 0.13&0.08 0.038 i .Ol 0.030 f .02 Urfnarv HvplCr 0.06Oi.09 0.02Oi.01 Bona Miner& Content Radius{*rcorrt -0.94 i 1.04 -1.19 i 1.09 -1.05 f 1 .ll -0.88 f 1.15 lumborfr-score) -1 .BQ h 1.27 -2.06i 1.18 -3.162 1.02 -2.08&0.58 CONClUSIONS:Medical mana9emenr of selected HPT patients controls cfinifal symptoms with no significant changes in biochemicaldata or renal function. LOSS Of hone miners1 content at cortical or trabecula- bone could helo to monitor Ihe efficacy of therapeutic measures in these patients and UI some cases the surgical approach.
228
608 PLASMA OF WALKER255 CONTAINS PARATHORMONE
CARCINOSARCOMA BEARING RATS RELATED PEPTIDE. 5. lo as.E.M. Dfaq de la Unkls Metabblica.
Walker-256 (W256) osrcfnossrcoma (an experimental model of humoral hypercalcemis of malignancy) or Yoshkfa solid sarcoma (a nonhypercalcamfa produofng tumor) were im@anted SUbCUtaneoUsly tomale albinoWi$tar rats(abwt2!iO g).Healthy. ageand sex malched. ratswere used aa contrds. A sample of blood from each animal was obtained fourteen days after tumor implant. Analiquotof blood was separated for Ihe daterminatlon _-._. of serum calcium by atomic absorptlometry. EDTA (7.2 mg/ml) and Trasyfd (400 KllJ/mi) were lmmedf&ly added 10 e&h remslnlno blood samde and plasma was kept at -2tX for psrathormone r&ted &tic&? (F+TH&) dete&instion, W258 tumors were removed from rats and weighed. In two rats, who survived from surgical excisionof their tumorsa new determfnatlon of serum calcium and plasma PTHrP levds were performed 24 h after surgery. Due to the fact that human and rat PTHrP show a 100% homdogy In their ffrst 48 eminoackl sequence, PTHrP levels ware determined by a commorcfally avaflable RtA (lncstar) which emdovrd an sntl-human PTHrP l-40 as flmt antbody. (Mean t SD, mg/dl, 14.8 t 1.2, r-i-s)‘th& In controls (9.5 t 0.5, i!=a p
_. 5.Ei~1.5 7.122.4 3.9to.4 5.7*3.5
li.4t4.7. 3B.djz24.2 8.0522.9 17.2k15.4
_._.
24.725.2 30.6*10.2 22.3t5.6 24.3t0.7
In PM0 group, PICP significantly correlate?. with BGP (p
610 LONG-TERM
(
i47147 PBD 3111177 YLM 99r29 01 53129 PM0
611 EFFECT OF MEDICAL VERSUS SURGICAL IDlSMfHPTl Unidad Metab
MANAGEMENT
IN
COEXISTING PRIMARY HYPERPARATHYROIDISM AND THYROID TOXIC ADENCNA. F. Lorg. C. Di Cairano, F. D*Ubaldo. G. Miracapillo. M.Nobili, R, Falbo. Endocrinology unit, Institute of Internal Medicine, University of Siena, Italy. The coexistence of primary hyperparathyroidism and hyperthyroidism is a rare condition, only about fifty casea having been described in literature. The combination of thyroid toxic adenoma and parathyroid adenoma is even more rare, since only 15 cases have been reported thus far. We present two cases of thyroid toxic adenama and coexistent primary hyperparathyroidism. Both patients, a man aged 67 years and a 66 year-old woman, presented with thyratoxicosis ard asymptomatic hypercalcemia; both were found to have high level? of serum immunoreactive parathyroid hormone. Treatment with methimazole was effective in restoring euthyroidism, whereas hypercalcemia persisted until surgery was performed. The problems encountered in the diagnosis of both conditions are described in detail, with particuiar reference to the relatively frequent occurrence of hypercalcemia during the clinical course of thyrotoxicosis even in the absence of hyperparathyroidism. The question of the possible relationship between the two conditions is also considered.
To assess tho role of mrdicel mensgemsnt in some cases of patients with HPT ws heve molyred specific symptoms, biochsmfcsl variables and bona mineral content in 54 cases with persistent hypercalcemia and elevated serum IPTHIMl command with 74 surgicelly treated patientsfSlfollowad for at least five ytsrsf .52 P3.5 In&l Follow-up fnitid Follow up 61.4il4.5 Aue(~ersf 44.1 * 13.9 Gender M-17 F-37 Mm25 F=48 61.1 Rtnol stonssf%f 7.4 67.6 8 Fractures(%) 7.4 6.8 1.33 Peptic ulcer{%) 14.81 5:s 17.56 2.6 Hypertmsionf%l 20.37 20.37 24.3 16.6 Biochemistry Calciumfmmolfil 2.61 to.1 6 2.7OkO.16 3.02t0.3 2.46+0.22 Phorphoruslmgldl~ 2.66 r0.47 2.72 to.59 2.55r0.6 3.44tO.73 Atk.Ph.fU/Ll 107.St10.1 124.8t14.4 151.8*10.9 86.0i4.6 iPTHfpmol/L) 243.4i232 153.5t141.5 390.4t252.6 Ccrlml/min) 88.7g22.2 85.3e31.6 85.2e25.2 91.8t;::O 0.24 r0.09 0.18+ 0.07 Ca.E.l.tml/minl 0.28+0.14 0.13&0.08 0.038 i .Ol 0.030 f .02 Urfnarv HvplCr 0.06Oi.09 0.02Oi.01 Bona Miner& Content Radius{*rcorrt -0.94 i 1.04 -1.19 i 1.09 -1.05 f 1 .ll -0.88 f 1.15 lumborfr-score) -1 .BQ h 1.27 -2.06i 1.18 -3.162 1.02 -2.08&0.58 CONClUSIONS:Medical mana9emenr of selected HPT patients controls cfinifal symptoms with no significant changes in biochemicaldata or renal function. LOSS Of hone miners1 content at cortical or trabecula- bone could helo to monitor Ihe efficacy of therapeutic measures in these patients and UI some cases the surgical approach.
228