Niveles de vitamina d y prevalencia de déficit de vitamina d en mujeres postmenopáusicas mayores de 50 años en Bogotá

Objetivo: Describir los niveles de vitamina D y calcular prevalencia de déficit de vitamina D en mujeres postmenopáusicas mayores de 50 años que asisten a consulta de medicina general en una muestra en de la ciudad de Bogotá durante el periodo 2013-2014. Pacientes y métodos: Realizamos un estudio descriptivo para estimar el déficit de VD en mujeres postmenopáusicas entre 50 y 80 años en la ciudad de Bogotá y la prevalencia de hipovitaminosis D. Durante el periodo octubre 2013 a octubre 2014 se analizaron 320 muestras, se identificaron las características socio-demográficas, patológicas y la exposición a radiación ultravioleta de cada participante. Se realizó un análisis descriptivo de las variables, se estableció su asociación con el déficit de vitamina D su aporte estadístico con al mismo. Resultados :El promedio de edad en la muestra fue de 61 años y el promedio de edad en la que reportaron la ultima menstruación fue a los 43 años. Con respecto a las características socio-demográficas 50% de las mujeres pertenecieron a los estratos 3 y 4, únicamente 11% de los pacientes realizaron una carrera universitaria y 73% de la mujeres fueron amas de casa. Con respecto a los niveles de vitamina D, 81% de los pacientes presentaron niveles anormales y el promedio de 25(OH)D en la población estudio fue de 19,81ng/ml. Conclusión: La prevalencia de déficit de vitamina D en mujeres bogotanas postmenopáusicas es significativo. Se requiere incrementar la exposición solar o dar suplencia con vitamina D para disminuir el riesgo de fracturas.

Eficacia clínica del Cinacalcet en hiperparatiroidismo primario

Objetivos: Realizar una revisión sistemática para evaluar la eficacia y seguridad del Cinacalcet en el control del calcio sérico y paratohormona en los pacientes con hiperparatiroidismo primario leve a moderado. Metodología: se realizó una revisión sistemática de la literatura, en las bases de datos de Pubmed, Cochrane, Embase, Clinical Trials tesis internacionales y publicaciones Iberolatinoamericana de artículos desde el 2002 hasta junio del 2014, en inglés y español, así como búsqueda secundaria en artículos de revisión. Resultados: Se incluyeron 7 estudios en la revisión (dos ensayos clínicos aleatorizados y cinco estudios abiertos), demostrando una disminución de -1,25 (-1,5, -1,01) (p<0,00001) del calcio sérico con el uso del Cinacalcet al compararlo con placebo. La disminución de la PTH fue inconsistente, al reportar una disminución significativa de la PTH sólo en un estudio; tampoco se observaron cambios en la densidad mineral ósea. Los efectos adversos reportados en los ECA reportaron RR= 0,86 (0,41-1,72). La hipocalcemia fue encontrada en 5 de los 6 estudios, respondiendo universalmente al ajuste del fármaco. Conclusiones: Se encontró una reducción del calcio sérico a niveles normales, sin cambios significativos en la PTH y en la densidad mineral ósea en pacientes con hiperparatiroidismo primario. Respecto a la seguridad no se encontraron efectos adversos serios, sin embargo las variables de mortalidad, reducción del riesgo de fracturas y el riesgo cardiovascular no ha sido adecuadamente evaluado en el hiperparatiroidismo primario.

Is a lower dose of vitamin D supplementation enough to increase 25(OH)D status in a sunny country?

Calcium and vitamin D are essential nutrients for bone metabolism Vitamin D can either be obtained from dietary sources or cutaneous synthesis. The study was conducted in subtropic weather; therefore, some might believe that the levels of solar radiation would be sufficient in this area. To evaluate calcium and vitamin D supplementation in postmenopausal women with osteoporosis living in a sunny country. A 3-month controlled clinical trial with 64 postmenopausal women with osteoporosis, mean age 62 +/- A 8 years. They were randomly assigned to either the supplement group, who received 1,200 mg of calcium carbonate and 400 IU (10 mu g) of vitamin D(3,) or the control group. Dietary intake assessment was performed, bone mineral density and body composition were measured, and biochemical markers of bone metabolism were analyzed. Considering all participants at baseline, serum vitamin D was under 75 nmol/l in 91.4% of the participants. The concentration of serum 25(OH)D increased significantly (p = 0.023) after 3 months of supplementation from 46.67 +/- A 13.97 to 59.47 +/- A 17.50 nmol/l. However, the dose given was limited in effect, and 86.2% of the supplement group did not reach optimal levels of 25(OH)D. Parathyroid hormone was elevated in 22.4% of the study group. After the intervention period, mean parathyroid hormone tended to decrease in the supplement group (p = 0.063). The dose given (400 IU/day) was not enough to achieve 25(OH)D concentration, considered optimal for bone health.

Mechanisms underlying the long-term regulation of NHE3 by parathyroid hormone

The activity of the Na(+)/H(+) exchanger NHE3 is regulated by a number of factors including parathyroid hormone (PTH). In the current study, we used a renal epithelial cell line, the opossum kidney (OKP) cell, to elucidate the mechanisms underlying the long-term effects of PTH on NHE3 transport activity and expression. We observed that NHE3 activity was reduced 6 h after addition of PTH, and this reduction persisted almost unaltered after 24 h. The decrease in activity was associated with diminished NHE3 cell surface expression at 6, 16, and 24 h after PTH addition, total cellular NHE3 protein at 16 and 24 h, and NHE3 mRNA abundance at 24 h. The lower levels of NHE3 mRNA were associated to a small, but significant, decrease in mRNA stability. Additionally, by analyzing the rat NHE3 gene promoter activity in OKP cells, we verified that the regulatory region spanning the segment -152 to +55 was mildly reduced under the influence of PTH. This effect was completely abolished by the presence of the PKA inhibitor KT 5720. In conclusion, long-term exposure to PTH results in reduction of NHE3 mRNA levels due to a PKA-dependent inhibitory effect on the NHE3 promoter and a small reduction of mRNA half-life, and decrease in the total amount of protein which is preceded by endocytosis of the apical surface NHE3. The decreased NHE3 expression is likely to be responsible for the reduction of sodium, bicarbonate, and fluid reabsorption in the proximal tubule consistently perceived in experimental models of PTH disorders.

Metabolic assessment in patients with urinary lithiasis

INTRODUCTION: Metabolic investigation in patients with urinary lithiasis is very important for preventing recurrence of disease. The objective of this work was to diagnose and to determine the prevalence of metabolic disorders, to assess the quality of the water consumed and volume of diuresis as potential risk factors for this pathology. PATIENTS and METHODS: We studied 182 patients older than 12 years. We included patients with history and/or imaging tests confirming at least 2 stones, with creatinine clearance > 60 mL/min and negative urine culture. The protocol consisted in the collection of 2, 24-hour urine samples, for dosing Ca, P, uric acid, Na, K, Mg, Ox and Ci, glycemia and serum levels of Ca, P, Uric acid, Na, K, Cl, Mg, U and Cr, urinary pH and urinary acidification test. RESULTS: 158 patients fulfilled the inclusion criteria. Among these, 151 (95.5%) presented metabolic changes, with 94 (62.2%) presenting isolated metabolic change and 57 (37.8%) had mixed changes. The main disorders detected were hypercalciuria (74%), hypocitraturia (37.3%), hyperoxaluria (24.1%), hypomagnesuria (21%), hyperuricosuria (20.2%), primary hyperparathyroidism (1.8%) secondary hyperparathyroidism (0.6%) and renal tubular acidosis (0.6). CONCLUSION: Metabolic change was diagnosed in 95.5% of patients. These results warrant the metabolic study and follow-up in patients with recurrent lithiasis in order to decrease the recurrence rate through specific treatments, modification in alimentary and behavioral habits.

Hiperparatireoidismo em gatos com hipertireoidismo experimental

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Densitometria óptica radiográfica na avaliação do hiperparatireoidismo secundário nutricional induzido em gatos jovens

O trabalho teve por objetivos verificar as alterações da densidade mineral óssea e as alterações bioquímicas, no hiperparatireoidismo secundário nutricional. Foram utilizados 10 gatos, sem raça definida, com idade inicial entre 2 e 3 meses e peso médio de 820 gramas. Após um período de adaptação de 10 dias, eles foram submetidos a uma dieta composta por coração bovino moído e cru durante 60 dias, sendo os exames efetuados no final do período de adaptação e a cada 15 dias. Empregou-se o método de densitometria óptica em imagens radiográficas, do rádio e ulna direitos. Não foi observada diferença estatística na densidade mineral óssea entre o final do período de adaptação e com 15 dias de alimentação com carne de coração. Aos 30 dias, houve uma diminuição significante estatisticamente, que se manteve no mesmo patamar aos 45 e 60 dias. em nenhum momento de observação ocorreu diferença estatística nos níveis séricos de cálcio e fósforo. Os níveis séricos de fosfatase alcalina variaram e estavam acima dos valores normais no 45º e 60º dia da dieta. Foi possível concluir que a densitometria óptica em imagens radiográficas é um método eficiente de avaliação da desmineralização óssea, ao passo que as análises bioquímicas séricas de cálcio, fósforo e fosfatase alcalina são de valor limitado.

Possible association between Carney complex and multiple endocrine neoplasia type 1 phenotypes

Complexo de Carney (CNC) e neoplasia endócrina múltipla tipo 1 (MEN1) são formas de neoplasias endócrinas múltiplas de herança autossômica dominante. O diagnóstico do CNC ocorre quando dois critérios maiores (lentiginose, doença nodular pigmentosa primária das adrenais, mixomas cardíacos e cutâneos, acromegalia, neoplasia testicular, carcinoma de tireóide) são observados e/ou um critério maior associado a um critério suplementar (familiar afetado, mutação do gene PRKAR1A) ocorre. Por outro lado, o diagnóstico de MEN1 dá-se pela detecção de dois ou mais tumores localizados na glândula hipofisária, paratireóide e/ou células pancreáticas. O presente caso descreve um homem de 55 anos, com diagnóstico de acromegalia, hiperparatireoidismo primário e carcinoma papilífero de tireóide, exibindo critérios diagnósticos para as duas condições descritas. Embora possa ter ocorrido apenas uma associação esporádica, ou a acromegalia per se tenha predisposto ao carcinoma papilífero, novos mecanismos moleculares podem estar envolvidos.

Avaliação eletroneuromiográfica em gatos normais e submetidos ao hiperparatireoidismo secundário nutricional

O trabalho teve por objetivos estudar a condução nervosa motora e a transmissão neuromuscular e eletromiografia de repouso em gatos normais (grupo I), submetidos a hiperparatireoidismo secundário nutricional (grupo II). Para estudo normativo (grupo I), foram utilizados 10 gatos, aparentemente saudáveis, sem raça definida, sendo seis machos e quatro fêmeas, com idades entre 4 e 5 meses e peso médio de 1,67kg. No grupo II, empregaram-se 10 gatos, sem raça definida, sendo cinco machos e cinco fêmeas, com idade aproximada inicial entre 2 e 3 meses e peso inicial médio de 820 gramas. Após um período de adaptação de 10 dias, foram alimentados por 60 dias com coração bovino moído e cru, visando a indução de hiperparatireoidismo secundário nutricional. Foi possível concluir que latência, amplitude e velocidade de condução nervosa motora e os achados eletromiográficos das atividades insercional e espontânea de gatos com hiperparatireoisdismo secundário nutricional, apresentaram um padrão similar aos de gatos normais da mesma idade. Para estimulações repetitivas a 3Hz, observou-se tendência global a decremento dos potenciais de ação musculares compostos e a 10 Hz houve tendência de incremento ou decremento; entretanto, tais variações apresentaram-se dentro dos limites de normalidade.

Unusually rapid growth of brown tumour in the mandible after parathyroidectomy associated with the presence of a supernumerary parathyroid gland

The aim of this study is to report the case of a quick growing brown tumour in the jaw after a parathyroidectomy due to the presence of a rare fifth parathyroid gland. The patient had chronic renal disease and the diagnosis was tertiary hyperparathyroidism. Thirty days after the parathyroidectomy, the patient returned with a significant increase in the tumour size. The suspicion of a supernumerary gland was confirmed by parathyroid scintigraphy. The treatment of brown tumour is dependent on the treatment of the hyperparathyroidism. However, curettage should be considered if a large lesion is disturbing mastication. In conclusion, this case should attract the attention of general practitioner dentists, since they may be the first professionals who have contact with the patient with a brown tumour in the jaws. Likewise, this case emphasises the importance of knowing the type of hyperparathyroidism involved to allow for effective treatment planning. © 2011 European Association for Cranio-Maxillo-Facial Surgery.

Frequency of multiple endocrine neoplasia type 1 in a group of patients with pituitary adenoma: genetic study and familial screening

The purpose of this study it was to evaluate the frequency of Multiple Endocrine Neoplasia type 1 (MEN1) in patients with pituitary adenoma and to perform genetic analysis and familial screening of those individuals afflicted with MEN1. 144 patients with pituitary adenoma at Botucatu Medical School, UNESP-Univ Estadual Paulista, were assessed retrospectively for MEN1 during the years of 2005-2011. The patients were evaluated for the presence of primary hyperparathyroidism (PHP) and enteropancreatic tumors. Genetic analysis was performed for the individuals with clinically diagnosed MEN1. Thirteen patients met the diagnostic criteria for MEN1, but three individuals belong to the same family and they were considered as a single MEN1 event, revealing 7.7 % frequency of MEN1 in this patient group. Genetic analysis showed MEN1 mutations in four index cases: IVS4+1 G>A, IVS3-6 C>T, c.1547insC and a new D180A mutation. One patient did not agree to participate in the genetic study and another one was referred for follow up in other hospital. Only polymorphisms were found in the other individuals, one of which was novel. We identified a high frequency of MEN1 in pituitary adenoma patients. Since PHP is one of the most common MEN1 tumor and patients are mostly asymptomatic, we suggest that all pituitary adenoma patients have their calcium profile analyzed. © 2013 Springer Science+Business Media New York.

Avaliação metabólica em litíase urinária: papel do magnésio e sódio urinários como fatores de risco na litogênese

Pós-graduação em Bases Gerais da Cirurgia - FMB

Marcadores do metabolismo ósseo e homeostase do cálcio no hipertireoidismo felino

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influência dos marcadores inflamatórios sobre a evolução do estado nutricional e progressão da calcificação cardiovascular em pacientes portadores de doença renal crônica tratados por hemodiálise

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Frequency of various types of neoplasia in a group of acromegalic patients

OBJECTIVE: To determine the frequency of colon cancer, primary hyperparathyroidism, thyroid tumor, and skin cancer in all acromegalic patients in follow-up at the Clinics Hospital - Botucatu Medical School, from 2005 to 2011. SUBJECTS AND METHODS: These patients were evaluated retrospectively for colon cancer, primary hyperparathyroidism, dermatological, and thyroid tumors. RESULTS: Of 29 patients included at the beginning of the study, two were excluded. Among 19 patients submitted to colonoscopy, one presented colon adenocarcinoma (5%). Thyroid nodules were present in 63% of patients, and papilliferous carcinoma was confirmed in two patients (7,7%). Four patients were confirmed as having primary hyperparathyroidism (15%). The most common dermatologic lesions were thickened skin (100%), acrochordons (64%), epidermal cysts (50%), and pseudo-acanthosis nigricans (50%). Only one patient presented basal cell carcinoma. CONCLUSION: Although a small number of acromegalic patients was studied, our findings confirm the high frequency of thyroid neoplasias and primary hyperparathyroidism in this group of patients.