Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Megacolo/etiologia , Feocromocitoma/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Megacolo/diagnóstico por imagem , Feocromocitoma/complicações , Feocromocitoma/patologia , Feocromocitoma/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Calcitriol/análogos & derivados , Alcatrão/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Ceratolíticos/uso terapêutico , Psoríase/tratamento farmacológico , Adolescente , Adulto , Idoso , Calcitriol/uso terapêutico , Emulsões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Método Simples-CegoRESUMO
Fifty white female patients referred to a bone health care clinic were studied. Patients with a history of fracture were excluded. At the time of hip and spine dual-energy X-ray absorptiometry (DXA), those willing underwent portable dual-energy X-ray absorptiometry (pDXA) of the wrist. The mean age of the patients was 57 yr. Bone mineral density (BMD) assessment was performed on each patient at four different sites: posterior-anterior lumbar spine, nondominant hip, the distal radius and ulna, and the proximal radius and ulna of the nondominant arm. Comparison of the pDXA results with that of the conventional DXA results showed the highest correlation between pDXA of the distal radius and ulna (DR + U) and the DXA of the femoral neck and lumbar spine. By defining a pDXA (DR + U) T-score = -1 as a positive test and DXA T-score =-1 as the presence of disease, we obtained a specificity of 93% and a sensitivity of 82% for decreased lumbar spine bone density (positive predictive value 97% and the negative predictive value 70%) and a specificity of 100% and a sensitivity of 83% (positive predictive value is 100% and the negative predictive value is 70%) for decreased femoral neck bone density.
RESUMO
A 72-yr-old white female who had previously enjoyed excellent health presented with global bone and muscle pain, and chronic fatigue. Her evaluation revealed an increased sedimentation rate and mild anemia, and a diagnosis of polymyalgia rheumatica was made. Prednisone therapy was of little benefit. A laboratory evaluation revealed mild hypocalcemia, marked hypophosphatemia, elevated alkaline phosphatase, normal 25- hydroxyvitamin D, and undectable 1,25-dihydroxyvitamin D. A diagnosis of oncogenic osteomalacia was made and the patient received calcitriol and neutraphos therapy. The patient's initial bone density by dual energy X-ray absorptiometry of the lumbar spine was 0.847 g/cm2 (T score -1.96) and of the femoral neck was 0.669 gm/cm2 (T score -2.89). After 40 mo of treatment with calcitriol and neutraphos, the bone mineral density of the lumbar spine and hip rose dramatically by 47.8 and 59.1%, respectively. Although oncogenic osteomalacia is a very rare metabolic bone disease, its recognition and appropriate treatment can have a dramatic effect not only on the bone mineral density of the patient, but also on the patient's general health and feeling of well-being.