ABSTRACT
Background: Among males, osteoporosis is less common than in women, but can also be a health issue. Aim: To report the frequency and clinical manifestations of osteoporosis among males referred to perform a bone densitometry. Material and Methods: All densitometries performed during one year at a clinical institution were analyzed and those corresponding to males aged over 18 years were selected to review the clinical record of the patient. Osteoporosis was defined as a bone mineral density T score < -2.5 among males aged over 50 years or a Z score below -2.0 and a history of osteoporotic fracture among males aged less than 50 years. Results: Of 5792 densitometries performed, 439 (8 percent) corresponded to males aged more than 18 years. Among these 156 (82 percent aged more than 50 years) had an abnormal densitometry. Seventy patients had osteoporosis, (67 percent only by DXA) and the rest had an osteoporotic fracture. Mean age and body mass index of the latter was 62 +/- 15 years and 25.9+/- 3 kg/m2, respectively. Forty two percent had osteoporosis in the spine, 35 percent in the hip and 23 percent in both sites. Thirty six of the 70 patients with osteoporosis (51 percent) had a history of osteoporotic fracture in column, hip, wrist and other sites in 55, 11, 8 and 26 percent respectively. Seventy eight percent of these patients were aged more than 50 years. The most common causes of osteoporosis were idiopathic in21 percent, induced by glucocorticoids in 20 percent, associated with vitamin D deficiency in 16 percent and associated to chronic renal failure in 14 percent. Conclusions: One of six male referred for bone densitometry have osteoporosis, usually associated with other underlying diseases. In half of these patients, osteoporosisis severe.
Subject(s)
Humans , Male , Adult , Middle Aged , Bone Density , Densitometry/methods , Osteoporosis/diagnosis , Osteoporosis/epidemiology , Osteoporosis/etiologyABSTRACT
We report a 59-year-old man with a history of hypertension, recurrent renal stones and a severe hypercalcemia of 14.9 mg/dl with a serum phosphorus of 2.4 mg/dl and a serum albumin of 3.6 g/dl. Physical examination showed a 4 cm left cervical nodule, consistent with the diagnosis of thyroid nodule. Parathyroid hormone (PTH) levels were 844 pg/mL (normal 15-65 pg/ml) and a cervical ultrasound examination disclosed a solid nodule in the lower left lobe of 40 x 30 x 25 mm, adjacent to the thyroid parenchyma. Abdominal ultrasound revealed bilateral renal stones. Parathyroid scintigraphy showed a high uptake of the left lower parathyroid mass and a bone densitometry showed bone density t scores of -1.2 in the spine, -2.0 in the right femoral neck and -3.5 in the distal radius. A review of his medical record revealed the presence of hypercalcemia for at least 4 years. He was admitted for hydration and administration of 4 mg zoledronic acid iv. At 24 hours, serum calcium dropped to 11.0 mg/dl, and a left thyroid lobectomy was performed including the lower left parathyroid gland. The pathology report showed a 22.6 g parathyroid adenoma. Intraoperatory PTH descended > 50%, consistent with successful parathyroidectomy. At 7 days after surgery serum calcium was 8.8 mg/dl, phosphorus 2.1 mg/dl, alkaline phosphatase 166 U/L, albumin 3.9 g/dL, PTH 230 pg/ml and 25-OH vitamin D 12.4 ng/ml. This finding was interpreted as secondary hyperparathyroidism due to vitamin D deficiency and “hungry bone”, being less likely the presence of residual or metastatic parathyroid tissue. A cholecalciferol load was administered, with significant descent of PTH.
Subject(s)
Humans , Male , Middle Aged , Adenoma/complications , Hyperparathyroidism, Primary/etiology , Parathyroid Neoplasms/complications , Parathyroid Hormone/blood , RecurrenceABSTRACT
Background: Cat-scratch disease is common among children. Among adults the disease is less often considered in the differential diagnosis of enlarged lymph nodes and fever. Aim: To report the clinical and laboratory features of eight patients with cat-scratch disease. Material and methods: Review of the medical records of eight patients (aged 22 to 57 years, six males) with a serological diagnosis of cat-scratch disease (an IgG titer over 1:256, by immunofluorescence). Results: Only five patients recalled having had contact with cats. Seven had fever and weight loss. Six had excessive sweating and five had chills. Seven had painfully enlarged lymph nodes mainly in submandibular and axillary regions. All had an increased C reactive protein and six had elevated erythrocyte sedimentation rate. Five had leukocytosis and four an elevated serum lactate dehydrogenase. The disease subsided in all, even in one patient that did not receive antimicrobials. Conclusions: Cat-scratch disease should be considered in the differential diagnosis of adult patients with lymph adenitis and fever.