Adapted from Minisola et al 26 Parathyroid hormone mediated Sporadic (adenoma, hyperplasia, or carcinoma) Familial (multiple endocrine neoplasia 1, 2a, or 4, hyperparathyroidism jaw tumour syndrome, ...familial isolated hyperparathyroidism, familial hypocalciuria hypercalcaemia) Ectopic parathyroid hormone in malignancy (rare) "Tertiary" hyperparathyroidism Malignancy Humoral hypercalcaemia of malignancy (parathyroid hormone related protein) Local osteolysis (cytokines, chemokines, parathyroid hormone related protein) Ectopic parathyroid hormone in malignancy (rare) Calcitriol related hypercalcaemia Vitamin D related Granulomatous disease (for example, sarcoidosis, tuberculosis, berylliosis, coccidiodomycosis, histoplasmosis, leprosy, inflammatory bowel disease, foreign body granuloma) Vitamin D intoxication (vitamin D supplements, metabolites, or analogues) Endocrine disorders Thyrotoxicosis Adrenal insufficiency Pheochromocytoma VIPoma (Verner-Morrison) syndrome Drugs Thiazide diuretics Lithium Milk-alkali syndrome (calcium and antacids) Vitamin A Parathyroid hormone Other Coexisting malignancy and primary hyperparathyroidism Immobilisation Acute renal failure Chronic renal failure treated with calcium and calcitriol or vitamin D analogues Renal transplant Parathyroid hormone mediated hypercalcaemia Parathyroid related causes of hypercalcaemia comprise primary (including the various genetic forms) and tertiary hyperparathyroidism. Different treatments need to be considered in people with hypercalcaemia from other causes, such as vitamin D intoxication or granulomatous disorders. Since in these cases, the underlying cause is an increased production of calcidiol, drugs that enhance vitamin D metabolism, such as glucocorticoids, are indicated.
The coronavirus disease 2019 (COVID-19) pandemic triggered significant disruptions in health care systems around the world, with a particularly heavy impact on patients with chronic diseases. A ...number of studies have shown an immediate decrease in on-time denosumab therapy at the start of COVID-19 pandemic. However, independent of the "emergency" that occurred during the COVID-19 pandemic, there are other situations in which denosumab is discontinued. In such situations, it is important to have a programmed strategy to optimize care while limiting the risk for unwanted outcomes.
Tumor-induced osteomalacia (TIO) is a rare, acquired condition of phosphate wasting due to phosphaturic mesenchymal tumors. Because the incidence and prevalence of TIO is unknown, we conducted an ...observational cohort study using national Danish health registers for the period 2008 to 2018 to obtain such information. The study also aimed to describe the demographics of the TIO population and the prognosis. The operational definition was based on hypophosphatemia or adult osteomalacia diagnoses, combined with prescriptions used in the initial management and procedures consistent with advanced imaging used for locating tumors. The incidence of TIO in Denmark was found to be below 0.13 per 100,000 person years for the total population of the country and 0.10 per 100,000 in adult-onset disease. The prevalence of TIO was estimated to be no more than 0.70 per 100,000 persons for the total population and 0.43 per 100,000 in adults. In 2018, there were a maximum of nine new cases of TIO in Danish adults. Mortality was low but few patients fulfilled the protocol cure criterion during the observation period. TIO has no ICD-10 code and limitations to the study include lack of information on serum biochemistry and on the use of phosphate supplements. Strengths include the use of long-term longitudinal, national hospital and prescription data from a country with universal healthcare. Given the very small patient population with TIO and the known delay to diagnosis and cure, management of patients with suspected TIO should be centralized.
Urinary excretion of total OHPr, an index of bone resorption, was evaluated in 68 normal subjects (25 males and 43 females) aged 19-83 years. In 49 of them non-dialyzable OHPr(ndOHPr), which reflects ...bone matrix formation, was also determined. Total urinary OHPr, expressed as mg/24 h, significantly decreased with advancing age in both sexes: however by means of multiple regression analysis no correlation was found after correction of OHPr behaviour for changes in creatinine clearance. On the contrary ndOHPr was inversely correlated with age (r = -0,56, p less than 0,001) even when creatinine clearance was held constant (p less than 0,05). The findings obtained seem to show that a decrease in osteogenetic activity is also responsible for the physiological ageing bone loss.
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