High prevalence of vitamin D deficiency among healthy Saudi Arabian men: relationship to bone mineral density, parathyroid hormone, bone turnover markers, and lifestyle factors.

SUMMARY: In this cross-sectional study, the prevalence of vitamin D deficiency [serum 25-hydroxyvitamin D (25(OH)D) <50 nmol/L] was 87.8% among Saudi Arabian men. There was a linear inverse relationship between serum 25(OH)D and intact parathyroid hormone (PTH) levels, but without a threshold of 25(OH)D at which intact PTH values plateaued. INTRODUCTION: Vitamin D insufficiency and/or deficiency has now reached epidemic proportions and has been linked to low bone mineral density (BMD), some lifestyle factors, and obesity in adults. This relationship is not well documented in Saudi Arabian men. This study examines the relationship between vitamin D status, intact parathyroid hormone (intact PTH), and lifestyle factors among Saudi Arabian men. METHODS: This cross-sectional study involved 834 men aged 20-74 years living in Jeddah area who were randomly selected and medically examined. Men had their BMD (lumbar spine (L1-L4) and neck femur), 25(OH)D, intact PTH, and other parameters measured according to detailed inclusion criteria. RESULTS: Deficiency (25(OH)D<50 nmol/L) and insufficiency (≥50-75 nmol/L) were present in 87.8% and 9.7%, respectively. Deficiency was common among older and obese men with no education and sedentary lifestyle sampled during summer and spring. Serum 25(OH)D showed an inverse linear relationship with intact PTH, but there was no threshold of serum 25(OH)D at which PTH levels plateaued. There was a positive correlation between BMD values at both lumbar spine (L1-L4) (P < 0.023) and neck femur (P < 0.036) and serum 25(OH)D levels, respectively. CONCLUSIONS: Functionally significant vitamin D deficiency affects BMD and bone turnover markers among Saudi Arabian men and is largely attributed to older age, obesity, sedentary lifestyle, no education, poor exposure to sunlight, smoking, and poor dietary vitamin D supplementation. The data suggest that an increase in PTH cannot be used as a marker for vitamin D deficiency.

Decreased serum sclerostin levels in patients with primary hyperparathyroidism: a cross-sectional and a longitudinal study.

UNLABELLED: Decreased serum sclerostin was evident in patients with primary hyperparathyroidism and was inversely related to parathyroid hormone (PTH). Sclerostin normalized earlier than biochemical bone turnover markers (BTMs) following parathyroidectomy. INTRODUCTION: There is limited information on the changes of serum sclerostin in conditions with chronic PTH excess in humans. The main objectives of the present study were to: (1) examine cross-sectionally the changes of serum sclerostin levels in patients with primary hyperparathyroidism (PHPT), (2) study the time course changes in serum sclerostin in PHPT patients following parathyroidectomy (PTX) followed up longitudinally for 12 months, and (3) compare the changes in serum sclerostin to that of BTMs. METHODS: We studied 60 PHPT patients and compared them with 74 PTX patients together with 268 age- and sex-matched healthy controls. Also, we followed 27 PTX patients longitudinally at 2, 4, 6, 10, 30, 60, 180, and 360 days postoperatively. Serum sclerostin, BTMs, and minerals were measured. Also, bone mineral density was determined by dual energy X-ray absorptiometry. RESULTS: Patients with PHPT exhibited significantly lower mean serum sclerostin [mean, in picomoles per liter; 95% confidence interval (CI)] (28.98; 27.94-30.03) than that obtained for PTX patients (37.01; 35.75-38.27) and healthy controls (46.22; 45.13-47.31) (P < 0.0001, for each case), respectively. Serum PTH inversely correlated with serum sclerostin (r = -0.651, P < 0.0001). Serum sclerostin was normalized in PTX patients by the tenth day postoperatively and remained within the expected reference range thereafter. CONCLUSIONS: Significantly decreased serum sclerostin was evidenced in PHPT patients as compared with PTX and euparathyroid controls. The inverse PTH and sclerostin relationship suggests that sclerostin is downregulated by PTH in humans. Serum sclerostin normalized earlier than BTMs following parathyroidectomy.

Sister Mary Joseph's nodule of the umbilicus: is it always of gastric origin? A review of eight cases at different sites of origin.

OBJECTIVE: The aim of this analysis was to evaluate our management and outcome of eight cases of Sister Mary Joseph's Nodule of the umbilicus (SMJN). METHODS: Between 2002 and 2009, we collected eight cases of SMJN and their clinical data were studied in a retrospective manner. RESULTS: The mean age of the patients was 50.6 years (range, 34-58). There were three males and five females. Five cases were discovered preoperatively during an abdominal examination and in the remaining three patients, the umbilical nodule was noticed during surgery. Most patients presented with abdominal pain. Various signs were discovered during clinical examination. Exhaustive investigations done included ultrasound, computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, gastrointestinal endoscopy, mammogram, bone scan, and a panel of tumor markers. The primary tumors were gastric adenocarcinoma (two patients), ovarian adenocarcinoma (two patients), pancreatic carcinoma (one patient), colonic adenocarcinoma (one patient), gallbladder adenocarcinoma (one patient), and cholangiocarcinoma (one patient). As the disease was advanced and metastatic in all patients, only palliative therapy was offered. All patients died within a short period after clinical presentation, ranging from four to 58 weeks (mean, 20 weeks). CONCLUSION: SMJN is a rare manifestation of a variety of advanced malignancies, usually of gastrointestinal origin. A majority of the patients present at a late stage and many harbor distant metastases. The patient's survival is very short (mean, 20 weeks) leading to a poor outcome. We believe that if the primary cancer is discovered at an early stage, the prognosis may improve.

Gigantic jejunal leiomyosarcoma.

Jejunal leiomyosarcoma is a rare neoplasm. We report a case of gigantic leiomyosarcoma of the jejunum in a 30-year old man who presented with abdominal distension, pain and constipation. Computerized tomography scan revealed a giant tumor filling the entire abdominal cavity. Fine needle aspiration cytology was suspicious. At laparotomy, a huge jejunal leiomyosarcoma measuring 30 x 25 x 19 cm and weighing 13 kg was completely excised. To the best of our knowledge, this is the first case of a giant jejunal leiomyosarcoma.

Pancreatic tuberculosis: A rare occurence.

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