ABSTRACT
Hypophosphatemic osteomalacia first presenting in adulthood is a rare disease. It is characterized by decreased serum phosphate, renal phosphate wasting, elevated alkaline phosphatase, and osteomalacia. The authors present a case with typical constellation of an oncogenic (tumor-induced) osteomalacia, the possible differential diagnosis, diagnostic evaluation, and complete healing after tumor resection. The new concepts of hereditary and acquired hypophosphatemic osteomalacia are discussed helping us understand this rare disease.
Subject(s)
Bone Neoplasms/complications , Giant Cell Tumor of Bone/complications , Hypophosphatemia/etiology , Osteomalacia/etiology , Paraneoplastic Syndromes/diagnosis , Adult , Biopsy , Bone Neoplasms/diagnosis , Bone Neoplasms/pathology , Bone Neoplasms/surgery , Diagnosis, Differential , Fibroblast Growth Factors/blood , Follow-Up Studies , Giant Cell Tumor of Bone/diagnosis , Giant Cell Tumor of Bone/pathology , Giant Cell Tumor of Bone/surgery , Humans , Hypophosphatemia/diagnosis , Male , Metatarsus , Osteolysis/etiology , Parathyroid Hormone/blood , Radiography, Abdominal , Ribs/pathology , Time Factors , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The thyrotropin-releasing hormone (TRH) stimulation test is widely used as a screening procedure in subfertile patients to identify subclinical hypothyroidism. However, its usefulness in daily clinical practice has not been proven, despite more than 30 years of use. MATERIAL AND METHODS: We analyzed data from a cohort of 371 consecutive female subfertility patients, who were screened with an intravenous TRH test when they came for the first evaluation. All patients with positive thyroid peroxidase antibodies, basal TSH <1.5 mU/l, known thyroid disease or actual thyroid medication were not screened and excluded from the analysis. RESULTS: We found a good correlation between basal and stimulated levels of thyroid-stimulating hormone (TSH). Basal TSH and the difference between stimulated and basal TSH did not correlate with prolactin levels. Definition of a positive TRH test (difference of 15 or 20 mU/l) did not have sufficient sensitivity and specificity, as confirmed by analysis of receiver operating characteristic curves, to identify subclinical hypothyroidism. CONCLUSION: TRH stimulation testing is not helpful to identify patients with subclinical hypothyroidism and should not be part of initial screening in this group.
Subject(s)
Hypothyroidism/diagnosis , Infertility, Female/diagnosis , Infertility, Female/metabolism , Thyrotropin-Releasing Hormone/metabolism , Adult , Cohort Studies , Female , Humans , ROC Curve , Retrospective Studies , Sensitivity and Specificity , Thyrotropin/metabolismABSTRACT
At the human maternal-fetal interface, the decidua forms a dense matrix that is believed to limit trophoblast invasion. We investigated whether the metastasis suppressor KAI1 (CD82) is expressed at the maternal-fetal interface. Immunohistochemistry showed strong expression of KAI1 in decidual cells, whereas trophoblast cells were negative for KAI1. In luteal phase endometrium, KAI1 was present in decidualizing endometrial stromal cells. We investigated whether KAI1 expression in endometrial stromal cells is regulated by the decidualizing stimuli cAMP and progesterone or by the cytokine interleukin (IL)-1beta. Western blot analysis revealed induction of KAI1 protein by cAMP analog, but not by progesterone, in a delayed fashion. In contrast, IL-1beta rapidly stimulated KAI1 expression at the transcript level and at the protein level. Cultured decidual cells from term placenta expressed a basal level of KAI1 protein that was elevated on cAMP stimulation. Silencing of KAI1 by RNA interference attenuated expression of decorin, a decidual product implicated in limiting trophoblast invasion. This study shows for the first time the expression of KAI1 in decidual cells at the human maternal-fetal interface, where the metastasis suppressor might participate in intercellular communication with trophoblast cells and the control of trophoblast invasion.
