Severe vitamin D deficiency in Hawai'i: a case report.

Severe vitamin D deficiency would appear unlikely to occur in Hawai'i, which has abundant year-round sun exposure. This case report of a woman with no obvious risk factors for vitamin D deficiency who was found to have severe vitamin D deficiency and coexisting primary hyperparathyroidism should alert health care providers to be more aware of vitamin D deficiency in Hawai'i.

Improved hypercalcemia after debulking of uremic tumoral calcinosis in a parathyroidectomized patient.

Uremic Tumoral Calcinosis (UTC) is a rare complication of chronic kidney disease on dialysis, characterized by large periarticular calcification. Among some cases, hypercalcemia with no conventional etiologies has been reported. We present a case of UTC in which hypercalcemia occurred after parathyroidectomy and introduction of low-calcium containing dialysate. Work-up of hypercalcemia did not reveal any conventional etiology, but hypercalcemia resolved after debulking of the tumor. This change in serum calcium gives us an insight into the mechanism of hypercalcemia, occasionally seen among cases with UTC.

The metabolic effects of troglitazone in patients with diabetes and end-stage renal disease.

Thiazolidinediones (TZD) are effective agents for the treatment of hyperglycemia, and appear ideal in diabetic patients with progressive or end-stage renal disease because of its predominant hepatic clearance. Troglitazone, the first available TZD for clinical use, was withdrawn due to safety concerns; however, studies completed with this agent can provide a better understanding of the class effect of TZDs. This study was an open-label, controlled clinical trial examining the safety and efficacy of troglitazone in type 2 diabetic patients with end-stage renal disease (ESRD). Twelve subjects were randomized to parallel study groups and treated for 6 mo with or without troglita-zone at a maximum dose of 600 mg/d in addition to continuing their previous diabetes medications (insulin or sulfonylurea). The results showed no significant differences in glycemic control with or without troglit-azone treatment for 6 mo. However, there was a significant reduction in insulin dosage with troglitazone treatment (22.9 +/- 7.3 units/d) than without troglita-zone treatment (54 +/- 12.9 units/d) (p < 0.05), as well as the change in the insulin dosage from baseline between the two groups (troglitazone, -8.4 units vs control, +4.3 units, p < 0.05). Weight changes and aspartate amino-transferase levels greater than 1.5 times the upper limit of normal were not observed in participants of either treatment group. This study demonstrates that troglit-azone was safe and effective for the treatment of hyper-glycemia in patients requiring dialysis, and strongly supports the clinical use of currently available TZDs in diabetic patients with renal failure.