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Serum 25-hydroxyvitamin D (25OHD) concentrations in hospitalized adults with community-acquired pneumonia (CAP): preliminary results
Abstracts
305
Rehabilitation treatment during hospitalization included the use of a continuous passive mobilizer and progressive gait training. Recovery of articular mobility and of the ability to walk were observed. Conclusion: The physiopathology of HO remains unclear. It may be associated with local inflammation affecting mesenchymal stem cells transformation into osteoblasts. Different treatments have been described such as bisphosphonates, surgery and radiotherapy. We present this case to underscore the importance of a multidisciplinary treatment in patients with this rare and invalidating pathology.
in winter vs. summer: patients with severe deficiency (47.4% vs. 2.5%; p b 0.0001), deficiency (94.7% vs. 17.1%; p b 0.0001), insufficiency (100% vs. 61%; p = 0.001). No patients had levels of sufficiency in winter vs. 39% in summer. Obese patients (n = 22) had lower levels of 25OHD than non-obese (n = 38) [18.0 ± 9.1 vs. 23.4 ± 10.3 ng/ml; p = 0.04]. According to BMI and season, obese had lower 25OHD than non-obese in winter [8.9 ± 1.4 vs. 11.8 ± 3.9 ng/ml; p = 0.03], and in summer [22.2 ± 7.9 vs. 28.7 ± 7.6 ng/ml; p = 0.01]. Conclusions: High-risk pregnant in third trimester have vitamin D levels significantly lower in winter than in summer and in obese than in non-obese. Pregnant with obesity in winter should be considered as high risk of vitamin D deficiency.
doi:10.1016/j.bone.2017.03.032
doi:10.1016/j.bone.2017.03.034
Código: 45 Atypical femoral fracture and primary hyperparathyroidism A.V. Kitaigrodsky, M. Diehl, L. Plantalech, G. Carabelli, A.M. Galich Hospital Italiano de Buenos Aires, Argentina
Código: 47 Glutamine: A protective amino acid for the intestinal calcium absorption L. Moine, G. Díaz de Barboza, A. Pérez, N. Tolosa de Talamoni Cátedra de Bioquímica y Biología Molecular, Facultad de Ciencias Médicas, INICSA (CONICET/UNC), Argentina
Atypical femoral fractures (AFF) associated with bisphosphonates (BP) are considered as stress fractures in a bone with low turnover. The association of primary hyperparathyroidism (PHP) and AFF is unusual. We report a case of AAF and simultaneous PHP. Case report: A 70 year-old female consulted for osteoporosis evaluation. She had pain in hands, thighs, knees and hips. Medication: ibandronate and calcium for 5 years, esomeprazole, meloxicam. Laboratory (LAB): PTH 189 (8.7–77.1 pg/ml) 25 OH vitamin D (VD) 16 (N 30 ng/ml) serum calcium (Ca) 10.2 (8.5–10.5 mg/dl) phosphatemia (P) 2.1 (2.7–4.5mg/dL) C-telopeptide (CTX) 0.526 (b0.570 ng/ml) urinary calcium (CaU) 200 (b 250 mg/d). DXA (T-Score) L1L4 − 2.7 femoral neck −1.8. The BP were suspended. After 2 months, she evolved with left complete AFF corrected by surgery and right incomplete AFF. Bone scintigraphy: cortical uptake in both femoral diaphysis. PHP was diagnosed two months later. LAB: PTH 125 Ca 11.1 VD 25 P 3.1 alkaline phosphatase (ALP) 135 (31-100 IU/L) bone alkaline phosphatase (BAP) 37 (3.8– 22.6 IU/L) CTX 0.930 CaU 278. Renal ultrasound: microlithiasis. Cervical ultrasound: lower left parathyroid 22 × 13 mm. Tc-Sestamibi-scan: increased uptake in the same location. Parathyroidectomy was performed. Pathology confirmed parathyroid adenoma. She was discharged with cholecalciferol, calcium and calcitriol. Four months after surgery generalized pain was improved. LAB: PTH 54 VD 32 Ca 9.6 P 3.4 ALP 78 BAP 10 CTX 0.255 CaU 108. X-ray: left femoral fracture consolidation without progression of the right AFF. Discussion: Most AFF cases are linked to low bone turnover related to BP use. In AFF pathogenesis, mechanical factors as the tibiofemoral angle were proposed. Cortical porosity is increased in PHP. We propose that a conjunction of these factors could have caused the AFF.
Glutamine (GLN) is an important source of energy for the enterocytes. It also has antiapoptotic and antioxidant properties, but its mechanisms of action are not completed elucidated. We have previously demonstrated that 1 g/kg b.w. of GLN prevents the inhibition of the intestinal Ca2 + absorption caused by menadione (MEN), a pro-oxidant drug of clinical use. Since several investigations have proposed that high doses of GLN might produce undesirable effects, in the present work we have aimed to study the protective role of lower doses of GLN on the inhibition of intestinal Ca2 + absorption caused by MEN and to analyze the underlying mechanisms. To do this, four week old chicks were fed a commercial diet. Different times and doses of GLN were assayed prior administration with 2,5 μmol/kg b.w. of MEN per i.p. via. Chicks treated with vehicle were employed as controls. The data showed that 0.5 g/kg b.w. of GLN 30 min earlier than the MEN administration was the lowest dose and time to prevent the inhibition of the intestinal Ca2 + absorption caused by MEN. GLN avoided the O− 2 production and allowed the maintenance of GSH content to similar values of control ones. In addition, GLN blocked the increment in the SOD and CAT activities triggered by MEN. Regarding the apoptosis, GLN avoided the enhancement of TUNEL positive cells produced by the quinone. GLN blocked the increase in FAS and FASL and prevented the decrease in the calbindin D28 k, all effects produced by MEN. In conclusion, the administration of a dose of 0.5 g/kg b.w. of GLN prior to MEN treatment protects the intestinal Ca2 + absorption by avoiding the cell death of enterocytes through preservation of the antioxidant defenses and blocking of the extrinsic apoptotic pathway.
doi:10.1016/j.bone.2017.03.035
doi:10.1016/j.bone.2017.03.033
Código: 46 Seasonal variation in vitamin D levels and relationship with obesity in high-risk pregnant J. Mansur, E. Giacoia, P. Costanzo CEO La Plata, Hospital Nacional Posadas, CICEMO, Argentina Introduction: Maternal obesity is a risk factor for vitamin D deficiency and determine maternal-fetal pathology. In our country there are seasonal variations of vitamin D levels, but it is not clear if both factors increase the risk of vitamin D deficiency. Aim: To compare vitamin D levels in high-risk pregnant seasonal variation and body mass index (BMI). Method: Cross-sectional study. Patients were evaluated in the third trimester of pregnancy. It was considered age, BMI, season and 25OHvitaminD (25OHD) measurement. Patients don’t receive prior supplement. Obesity was defined as BMI ≥ 30 kg/m2. According 25OHD (ng/ml) level was defined severe deficiency: ≤10, deficiency: 10.1–19.9, insufficiency: 20–29.9 and sufficiency ≥ 30. In statistical analysis t-test, chi square and linear regression were used. Results: 60 pregnant in third trimester (31.2 ± 4.3 weeks) were included. The mean age was 30.1 ± 6.3 years. 25OHD values were lower in winter (n = 19) vs. summer (n = 41) [10.7 ± 3.5 vs. 26.3 ± 8.2 ng/ml; p b 0.0001]. There were differences according 25OHD score
Código: 48 Serum 25-hydroxyvitamin D (25OHD) concentrations in hospitalized adults with community-acquired pneumonia (CAP): preliminary results M.L. Brance, J. Miljevic, M. Lagrutta, R. Tizziani, B. Paradiso, G.P. Grossi, P. Toni, R. Parodi, A. Greca, E. Valentini, A. Trepat, J. Zaccardi, J. Moro, B. Finuci Curi, N. Tamagnone, M. Ramirez, J. Severini, P. Chiarotti, F. Consiglio, R. Piñesky, A. Guelfi, J. Kilstein, E. Street, D. Moretti, V. Oliveto, M. Mariño, J. Manera, L.R. Brun Association of Internal Medicine of Rosario, Argentina Several studies have shown an association between vitamin D deficiency and increases susceptibility to respiratory tract infections. The aim of this study was to evaluate the serum 25OHD concentrations in hospitalized adults with CAP in Rosario, Argentina. An observational study with 176 hospitalized adults with CAP over 18 years from Rosario city (32°52′18″S) Argentina were carried out from July 2015 to April 2016. The results are expressed as mean ± EE. 141 patients (57.72 ± 1.68 years old), were included (56% women), 25OHD (ng/ml): 11.67 ± 0.64 (51.8%: b10 ng/ml, 36.2%: 10–20 ng/ml, 9.9%: 20–30 ng/ml, 2.1%: N 30 ng/ml). 25OHD correlated with age (r = − 0.23; p = 0.0067) and higher 25OHD were found in male (female: 10.44 ± 0.74l, male: 13.23 ± 1.079, p = 0.03). Due to the characteristics of the pathology under study, 56% were in winter, 30.5% spring, 1.4% summer and 12.1% autumn.
306
Abstracts
25OHD in winter-spring (10.82% ± 0.56) were lower than summer-autumn (17.09 ± 2.87) (p = 0.03). Higher 25OHD levels were found with lower severity CURB65 score (low risk = 12.05 ± 0.82, medium-high risk = 10.62 ± 1.01 ng/ml, p = 0.11) and Charlson Comorbidity Index (CCI) (0 = 12.73 ± 1.03, ≥1 = 10.36 ± 0.83, p = 0.03). 25OHD correlated with CURB65 score (r = −0.17; p = 0.03), CCI (r = −0.17, p = 0.03) and with the 10 years life expectative (%) calculated with age and CCI (r = 0.20; p = 0.01). It is concluded that hospitalized adults with CAP have lower 25OHD levels and would be associated with more CAP severity.
doi:10.1016/j.bone.2017.03.036
Código: 51 Parathyroid incidentalomas: New diagnosis, new problem. Our incidence J.L. Mansur, L. Ivankovic, F. Torchiari Center of Endocrinology ano Osteoporosis, La Plata, Argentina Parathyroid incidentalomas (PI) were published in 1967 to describe findings during neck surgeries. The description of PI as ultrasound (US) finding occurred in 1999 when Frasoldati found it in 2,3 % of US. With Fine Needle Aspiration (FNA) only 24% correspond to parathyroid tissue. It is ignored if these images have pathological hierarchy and can be an early stage of primary hyperparathyroidism (HPT) or nonfunctioning masses just like other incidentalomas. Method: Medical records of patients with thyroid US performed between 2009 and 2015 were retrospectively evaluated, looking for patients with IP. The US were conducted with a Sono Site M-Turbo with high resolution transducer (10 MHz). Serum calcium, PTH and Vitamin D was evaluated in all patients. Results: There were IP diagnosed in 24 women (4.0%). 21 had Hypothyroidism and Hashimoto thyroiditis and 3 had thyroid nodules. An ovoid hypoechoic image was observed in extrathyroid topography compatible with a parathyroid gland in 10 cases, and two or more (bilateral) in 14 cases. 9 patients had prior US in others center reported as normal. In the evolution US was repeated in 13 patients, confirming same images. Serum calcium and PTH were normal in 23, with follow-up in almost all. One of them, with an image of 6 mm, had slightly elevated PTH and normal serum calcium and Vitamin D. In the evolution the serum calcium increases, MIBI scintigraphy was positive, and underwent surgery with the result of a parathyroid adenoma. Conclusion: The finding of IP seems frequent, depending on the equipment used and the experience of the sonographer. Our incidence of 4% (unconfirmed parathyroid by biopsy) is higher than the few existing publications. Most patients were unchanged in US or laboratory, but one patient developed an HPT, so monitoring is essential.
doi:10.1016/j.bone.2017.03.037
Código: 52 Effects of treatment with calcitriol (CT) or vitamin d (VD) IN primary hyperparathyroidism (PHPT) B.M. Perez, M.P. Podestá, G. Córdoba-Figueroa, R. Serrano-Salinas, M. Pavlove, S. Karlsbrum, H. Salerni Endocrinology Division Durand, Hospital, CICEMO, CABA, Argentina CT has a direct regulatory role on parathyroid cells. VD and CT are possible treatments in PHPT with low 25OHD, with potential risk of hypercalcemia, different in their pharmacologic profile. Objective: To determine the biochemical effects of CT or VD supplementation in PHPT. Design: Retrospective. Sixteen PHPT aged 62 ± 6 years treated with CT 0,34 ± 0,12 mcg/night for 74 ± 60 days and a comparable group of 17 PHPT aged 59 ± 10 years treated with vitamin D2 or D3 4100 ± 2000 UI/day for 211 ± 152 days. Exclusion criteria: prior treatment with VD, other disorders of calcium metabolism or drugs. Serum and urine assays at baseline and during therapy were considered. Figures are expressed as mean±SD or median (Q1–Q3) as appropriate. Paired t-test, Wilkoxon test and regressions were used. Results: No clinically relevant elevations of calcium, calciuria or cretinine were seen with VD (ionized calcium 5.7 ± 0.2 mg/dl to 5.8 ± 0.2 p = 0.047, Calciuria 232 ± 124 mg/24 h to 338 ± 184 p = 0,08). PTH and alkaline phosphatase (ALP) tend to reduce (PTH 1.7 quotient value/upper normal limit -UNL- [1.1–2.6] to 1.4 [1.1–2.3] p = 0.07, ALP 1 UNL [0.86–1.2] to 1 [0.9–1.3] p = 0.09). There was a significant increase of 25OHD (18 ± 8 ng/ml to 34 ± 8 p ≤ 0.01). CT was not related to clinically relevant increase in serum or urine calcium or creatinine either (calcemia 10 ± 0.5 mg/dl to 10.4 ± 0.5 to p = 0.015, Calciuria 252 ± 125 mg/24 h to 326 ± 148 p = 0,13). No significant change of 25OHD or ALP was seen. PTH had a median reduction of 20% (1.3 UNL [1.1–1.9] to 1.1 UNL [0.7–1.8], p = 0.028), independently of how long the therapy was (R2 0.09, P 0,3). Conclusions: VD and CT are equally safe in the treatment of PHPT with low 25OHD. CT is better reducing PTH while VD is more physiological.
doi:10.1016/j.bone.2017.03.038
305
Rehabilitation treatment during hospitalization included the use of a continuous passive mobilizer and progressive gait training. Recovery of articular mobility and of the ability to walk were observed. Conclusion: The physiopathology of HO remains unclear. It may be associated with local inflammation affecting mesenchymal stem cells transformation into osteoblasts. Different treatments have been described such as bisphosphonates, surgery and radiotherapy. We present this case to underscore the importance of a multidisciplinary treatment in patients with this rare and invalidating pathology.
in winter vs. summer: patients with severe deficiency (47.4% vs. 2.5%; p b 0.0001), deficiency (94.7% vs. 17.1%; p b 0.0001), insufficiency (100% vs. 61%; p = 0.001). No patients had levels of sufficiency in winter vs. 39% in summer. Obese patients (n = 22) had lower levels of 25OHD than non-obese (n = 38) [18.0 ± 9.1 vs. 23.4 ± 10.3 ng/ml; p = 0.04]. According to BMI and season, obese had lower 25OHD than non-obese in winter [8.9 ± 1.4 vs. 11.8 ± 3.9 ng/ml; p = 0.03], and in summer [22.2 ± 7.9 vs. 28.7 ± 7.6 ng/ml; p = 0.01]. Conclusions: High-risk pregnant in third trimester have vitamin D levels significantly lower in winter than in summer and in obese than in non-obese. Pregnant with obesity in winter should be considered as high risk of vitamin D deficiency.
doi:10.1016/j.bone.2017.03.032
doi:10.1016/j.bone.2017.03.034
Código: 45 Atypical femoral fracture and primary hyperparathyroidism A.V. Kitaigrodsky, M. Diehl, L. Plantalech, G. Carabelli, A.M. Galich Hospital Italiano de Buenos Aires, Argentina
Código: 47 Glutamine: A protective amino acid for the intestinal calcium absorption L. Moine, G. Díaz de Barboza, A. Pérez, N. Tolosa de Talamoni Cátedra de Bioquímica y Biología Molecular, Facultad de Ciencias Médicas, INICSA (CONICET/UNC), Argentina
Atypical femoral fractures (AFF) associated with bisphosphonates (BP) are considered as stress fractures in a bone with low turnover. The association of primary hyperparathyroidism (PHP) and AFF is unusual. We report a case of AAF and simultaneous PHP. Case report: A 70 year-old female consulted for osteoporosis evaluation. She had pain in hands, thighs, knees and hips. Medication: ibandronate and calcium for 5 years, esomeprazole, meloxicam. Laboratory (LAB): PTH 189 (8.7–77.1 pg/ml) 25 OH vitamin D (VD) 16 (N 30 ng/ml) serum calcium (Ca) 10.2 (8.5–10.5 mg/dl) phosphatemia (P) 2.1 (2.7–4.5mg/dL) C-telopeptide (CTX) 0.526 (b0.570 ng/ml) urinary calcium (CaU) 200 (b 250 mg/d). DXA (T-Score) L1L4 − 2.7 femoral neck −1.8. The BP were suspended. After 2 months, she evolved with left complete AFF corrected by surgery and right incomplete AFF. Bone scintigraphy: cortical uptake in both femoral diaphysis. PHP was diagnosed two months later. LAB: PTH 125 Ca 11.1 VD 25 P 3.1 alkaline phosphatase (ALP) 135 (31-100 IU/L) bone alkaline phosphatase (BAP) 37 (3.8– 22.6 IU/L) CTX 0.930 CaU 278. Renal ultrasound: microlithiasis. Cervical ultrasound: lower left parathyroid 22 × 13 mm. Tc-Sestamibi-scan: increased uptake in the same location. Parathyroidectomy was performed. Pathology confirmed parathyroid adenoma. She was discharged with cholecalciferol, calcium and calcitriol. Four months after surgery generalized pain was improved. LAB: PTH 54 VD 32 Ca 9.6 P 3.4 ALP 78 BAP 10 CTX 0.255 CaU 108. X-ray: left femoral fracture consolidation without progression of the right AFF. Discussion: Most AFF cases are linked to low bone turnover related to BP use. In AFF pathogenesis, mechanical factors as the tibiofemoral angle were proposed. Cortical porosity is increased in PHP. We propose that a conjunction of these factors could have caused the AFF.
Glutamine (GLN) is an important source of energy for the enterocytes. It also has antiapoptotic and antioxidant properties, but its mechanisms of action are not completed elucidated. We have previously demonstrated that 1 g/kg b.w. of GLN prevents the inhibition of the intestinal Ca2 + absorption caused by menadione (MEN), a pro-oxidant drug of clinical use. Since several investigations have proposed that high doses of GLN might produce undesirable effects, in the present work we have aimed to study the protective role of lower doses of GLN on the inhibition of intestinal Ca2 + absorption caused by MEN and to analyze the underlying mechanisms. To do this, four week old chicks were fed a commercial diet. Different times and doses of GLN were assayed prior administration with 2,5 μmol/kg b.w. of MEN per i.p. via. Chicks treated with vehicle were employed as controls. The data showed that 0.5 g/kg b.w. of GLN 30 min earlier than the MEN administration was the lowest dose and time to prevent the inhibition of the intestinal Ca2 + absorption caused by MEN. GLN avoided the O− 2 production and allowed the maintenance of GSH content to similar values of control ones. In addition, GLN blocked the increment in the SOD and CAT activities triggered by MEN. Regarding the apoptosis, GLN avoided the enhancement of TUNEL positive cells produced by the quinone. GLN blocked the increase in FAS and FASL and prevented the decrease in the calbindin D28 k, all effects produced by MEN. In conclusion, the administration of a dose of 0.5 g/kg b.w. of GLN prior to MEN treatment protects the intestinal Ca2 + absorption by avoiding the cell death of enterocytes through preservation of the antioxidant defenses and blocking of the extrinsic apoptotic pathway.
doi:10.1016/j.bone.2017.03.035
doi:10.1016/j.bone.2017.03.033
Código: 46 Seasonal variation in vitamin D levels and relationship with obesity in high-risk pregnant J. Mansur, E. Giacoia, P. Costanzo CEO La Plata, Hospital Nacional Posadas, CICEMO, Argentina Introduction: Maternal obesity is a risk factor for vitamin D deficiency and determine maternal-fetal pathology. In our country there are seasonal variations of vitamin D levels, but it is not clear if both factors increase the risk of vitamin D deficiency. Aim: To compare vitamin D levels in high-risk pregnant seasonal variation and body mass index (BMI). Method: Cross-sectional study. Patients were evaluated in the third trimester of pregnancy. It was considered age, BMI, season and 25OHvitaminD (25OHD) measurement. Patients don’t receive prior supplement. Obesity was defined as BMI ≥ 30 kg/m2. According 25OHD (ng/ml) level was defined severe deficiency: ≤10, deficiency: 10.1–19.9, insufficiency: 20–29.9 and sufficiency ≥ 30. In statistical analysis t-test, chi square and linear regression were used. Results: 60 pregnant in third trimester (31.2 ± 4.3 weeks) were included. The mean age was 30.1 ± 6.3 years. 25OHD values were lower in winter (n = 19) vs. summer (n = 41) [10.7 ± 3.5 vs. 26.3 ± 8.2 ng/ml; p b 0.0001]. There were differences according 25OHD score
Código: 48 Serum 25-hydroxyvitamin D (25OHD) concentrations in hospitalized adults with community-acquired pneumonia (CAP): preliminary results M.L. Brance, J. Miljevic, M. Lagrutta, R. Tizziani, B. Paradiso, G.P. Grossi, P. Toni, R. Parodi, A. Greca, E. Valentini, A. Trepat, J. Zaccardi, J. Moro, B. Finuci Curi, N. Tamagnone, M. Ramirez, J. Severini, P. Chiarotti, F. Consiglio, R. Piñesky, A. Guelfi, J. Kilstein, E. Street, D. Moretti, V. Oliveto, M. Mariño, J. Manera, L.R. Brun Association of Internal Medicine of Rosario, Argentina Several studies have shown an association between vitamin D deficiency and increases susceptibility to respiratory tract infections. The aim of this study was to evaluate the serum 25OHD concentrations in hospitalized adults with CAP in Rosario, Argentina. An observational study with 176 hospitalized adults with CAP over 18 years from Rosario city (32°52′18″S) Argentina were carried out from July 2015 to April 2016. The results are expressed as mean ± EE. 141 patients (57.72 ± 1.68 years old), were included (56% women), 25OHD (ng/ml): 11.67 ± 0.64 (51.8%: b10 ng/ml, 36.2%: 10–20 ng/ml, 9.9%: 20–30 ng/ml, 2.1%: N 30 ng/ml). 25OHD correlated with age (r = − 0.23; p = 0.0067) and higher 25OHD were found in male (female: 10.44 ± 0.74l, male: 13.23 ± 1.079, p = 0.03). Due to the characteristics of the pathology under study, 56% were in winter, 30.5% spring, 1.4% summer and 12.1% autumn.
306
Abstracts
25OHD in winter-spring (10.82% ± 0.56) were lower than summer-autumn (17.09 ± 2.87) (p = 0.03). Higher 25OHD levels were found with lower severity CURB65 score (low risk = 12.05 ± 0.82, medium-high risk = 10.62 ± 1.01 ng/ml, p = 0.11) and Charlson Comorbidity Index (CCI) (0 = 12.73 ± 1.03, ≥1 = 10.36 ± 0.83, p = 0.03). 25OHD correlated with CURB65 score (r = −0.17; p = 0.03), CCI (r = −0.17, p = 0.03) and with the 10 years life expectative (%) calculated with age and CCI (r = 0.20; p = 0.01). It is concluded that hospitalized adults with CAP have lower 25OHD levels and would be associated with more CAP severity.
doi:10.1016/j.bone.2017.03.036
Código: 51 Parathyroid incidentalomas: New diagnosis, new problem. Our incidence J.L. Mansur, L. Ivankovic, F. Torchiari Center of Endocrinology ano Osteoporosis, La Plata, Argentina Parathyroid incidentalomas (PI) were published in 1967 to describe findings during neck surgeries. The description of PI as ultrasound (US) finding occurred in 1999 when Frasoldati found it in 2,3 % of US. With Fine Needle Aspiration (FNA) only 24% correspond to parathyroid tissue. It is ignored if these images have pathological hierarchy and can be an early stage of primary hyperparathyroidism (HPT) or nonfunctioning masses just like other incidentalomas. Method: Medical records of patients with thyroid US performed between 2009 and 2015 were retrospectively evaluated, looking for patients with IP. The US were conducted with a Sono Site M-Turbo with high resolution transducer (10 MHz). Serum calcium, PTH and Vitamin D was evaluated in all patients. Results: There were IP diagnosed in 24 women (4.0%). 21 had Hypothyroidism and Hashimoto thyroiditis and 3 had thyroid nodules. An ovoid hypoechoic image was observed in extrathyroid topography compatible with a parathyroid gland in 10 cases, and two or more (bilateral) in 14 cases. 9 patients had prior US in others center reported as normal. In the evolution US was repeated in 13 patients, confirming same images. Serum calcium and PTH were normal in 23, with follow-up in almost all. One of them, with an image of 6 mm, had slightly elevated PTH and normal serum calcium and Vitamin D. In the evolution the serum calcium increases, MIBI scintigraphy was positive, and underwent surgery with the result of a parathyroid adenoma. Conclusion: The finding of IP seems frequent, depending on the equipment used and the experience of the sonographer. Our incidence of 4% (unconfirmed parathyroid by biopsy) is higher than the few existing publications. Most patients were unchanged in US or laboratory, but one patient developed an HPT, so monitoring is essential.
doi:10.1016/j.bone.2017.03.037
Código: 52 Effects of treatment with calcitriol (CT) or vitamin d (VD) IN primary hyperparathyroidism (PHPT) B.M. Perez, M.P. Podestá, G. Córdoba-Figueroa, R. Serrano-Salinas, M. Pavlove, S. Karlsbrum, H. Salerni Endocrinology Division Durand, Hospital, CICEMO, CABA, Argentina CT has a direct regulatory role on parathyroid cells. VD and CT are possible treatments in PHPT with low 25OHD, with potential risk of hypercalcemia, different in their pharmacologic profile. Objective: To determine the biochemical effects of CT or VD supplementation in PHPT. Design: Retrospective. Sixteen PHPT aged 62 ± 6 years treated with CT 0,34 ± 0,12 mcg/night for 74 ± 60 days and a comparable group of 17 PHPT aged 59 ± 10 years treated with vitamin D2 or D3 4100 ± 2000 UI/day for 211 ± 152 days. Exclusion criteria: prior treatment with VD, other disorders of calcium metabolism or drugs. Serum and urine assays at baseline and during therapy were considered. Figures are expressed as mean±SD or median (Q1–Q3) as appropriate. Paired t-test, Wilkoxon test and regressions were used. Results: No clinically relevant elevations of calcium, calciuria or cretinine were seen with VD (ionized calcium 5.7 ± 0.2 mg/dl to 5.8 ± 0.2 p = 0.047, Calciuria 232 ± 124 mg/24 h to 338 ± 184 p = 0,08). PTH and alkaline phosphatase (ALP) tend to reduce (PTH 1.7 quotient value/upper normal limit -UNL- [1.1–2.6] to 1.4 [1.1–2.3] p = 0.07, ALP 1 UNL [0.86–1.2] to 1 [0.9–1.3] p = 0.09). There was a significant increase of 25OHD (18 ± 8 ng/ml to 34 ± 8 p ≤ 0.01). CT was not related to clinically relevant increase in serum or urine calcium or creatinine either (calcemia 10 ± 0.5 mg/dl to 10.4 ± 0.5 to p = 0.015, Calciuria 252 ± 125 mg/24 h to 326 ± 148 p = 0,13). No significant change of 25OHD or ALP was seen. PTH had a median reduction of 20% (1.3 UNL [1.1–1.9] to 1.1 UNL [0.7–1.8], p = 0.028), independently of how long the therapy was (R2 0.09, P 0,3). Conclusions: VD and CT are equally safe in the treatment of PHPT with low 25OHD. CT is better reducing PTH while VD is more physiological.
doi:10.1016/j.bone.2017.03.038