Management of hypovitaminosis D in patients with primary hyperparathyroidism.

AIM: Epidemiological studies suggest that vitamin D deficiency is common in patients with primary hyperparathyroidism (PHPT). They have higher levels of serum parathyroid hormone (PTH) and markers of bone turnover and fractures are more frequent than vitamin D-replete patients. However, there are concerns that Vitamin D repletion might exacerbate pre-existent hypercalcaemia. Therefore, we aimed to determine if vitamin D replacement improved biochemical indices of calcium metabolism without worsening underlying hypercalcaemia. SUBJECTS AND METHODS: This is a prospective, observational study based on routine clinical practice, set up in a secondary care centre. 45 consecutive patients with mild biochemical hypercalcaemia due to PHPT and hypovitaminosis D were enrolled. The mean age of the cohort was 61 years (range 25-85 years), predominately Asian (32 patients) and female (41 patients). They received 20,000 IU of oral cholecalciferol, once a week, for 3 months. Calcium, phosphate, alkaline phosphatase and PTH were measured at baseline, 4, 8 and 12 weeks following treatment. Vitamin D levels were obtained at baseline and at 12 weeks, after they completed their treatment. RESULTS: Vitamin D levels normalised at week 12 (mean ± SD, 18.8 ± 9.4 versus 76 ± 20 nmol/L, p = 0.0001) and PTH levels improved following treatment completion (21.2 ± 10 versus 16.2 ± 6 pmol/L, p = 0.026). There was no significant increase in serum calcium levels during vitamin D supplementation. CONCLUSIONS: High doses of oral cholecalciferol normalised vitamin D levels without worsening underlying hypercalcaemia in individuals with PHPT.

Weight gain during the treatment of thyrotoxicosis using conventional thyrostatic treatment.

OBJECTIVE: Patients often lose considerable weight prior to the diagnosis of thyrotoxicosis. Regaining weight with treatment of thyrotoxicosis until hormone levels normalise is expected. This study was aimed to determine whether patients continued to put on weight once they were euthyroid. STUDY DESIGN AND METHOD: The records of 60 consecutive euthyroid patients were studied. All patients were rendered euthyroid on thyrostatic medication alone. Patients on a block and replacement regime, those who developed transient hypothyroidism on treatment or other diagnoses causing weight gain were excluded. RESULTS: The mean age of study group was 46.13 yr (21-73). Male:female ratio was 5:55. 36 (60%) patients had diagnosis of Graves' disease. On initial presentation weight was 67.75 kg (SEM 2.1) with body mass index (BMI) of 25.8. Patients took 6.7 months (mean) to become euthyroid. Mean weight when euthyroid was 71.61 kg (range 46-125). Even after becoming euthyroid, patient continued to gain weight at 3, 6, and 9 months and mean weight gain was 2.04 kg (SD 18.14) at 3 months (p=0.003). This weight gain was not related to patients' age, gender, BMI, duration or dose of treatment required to achieve euthyroidism. Diagnosis of Graves' disease and non-smoking status independently predicted weight gain. CONCLUSION: We have demonstrated that patients with thyrotoxicosis continue to gain weight for at least 6 months even after becoming euthyroid. Patients with Graves' disease were more likely to gain weight compared to others. Smokers gained least weight. Preventing this weight gain warrants further investigation.

A case of parathyroid carcinoma with severe hungry bone syndrome and review of literature.

We present a 45 year old female who was initially seen by Rheumatologist with long standing knee pain affecting her mobility. She was found to be severely hypercalcaemic and exhibited features suggestive of parathyroid carcinoma (palpable neck mass, extremely high parathyroid hormone, high alkaline phosphatase, concomitant presence of renal disease and skeletal involvement). Hence she was referred for parathyroidectomy. Postoperatively she developed profound hypocalcaemia with markedly raised serum alkaline phosphatase, requiring intensive intravenous calcium and oral vitamin D supplements, consistent with the development of hungry bone syndrome (HBS). HBS is a complication of parathyroid surgery where the correction of primary hyperparathyroidism is associated with rapid bone remineralisation, causing severe and prolonged hypocalcaemia. HBS is relatively rare but has to be considered in the differential diagnosis of postoperative hypocalcaemia particularly in severe cases. In the current report, we discuss pathogenesis, clinical course and management of HBS.

Determination of ten rare-earth elements and yttrium in silicate rocks by ICP-AES without separation and preconcentration.

Lanthanum, cerium, neodymium, samarium, europium, gadolinium, dysprosium, erbium, ytterbium, lutetium and yttrium have been determined in 8 international rock standards by inductively coupled plasma atomic emission spectrometry (ICP-AES) without prior ion-exchange separation and preconcentration. The results for La, Ce, Nd, Eu, Dy, Yb and Y were in good agreement with the reported values, whereas those for Sm, Gd, Er and Lu were less accurate. However, the results for Sm, Gd, Er and Lu can also be used for studies of petrogenesis.

Analytical applications of Zr(IV) and Ti(IV) arsenophosphates as ion-exchangers.

The distribution of 27 metal ions between zirconium and titanium arsenophosphate and demineralized water, perchloric acid and nitric acid has been studied. On the basis of the results, several binary and ternary separations can be designed. The data have been used in application of these materials to the analysis of certain alloys and rocks.