Menstrual disorders and premenstrual symptoms in adolescents: prevalence and relationship to serum calcium and vitamin D concentrations.

There have been several studies evaluating the association between vitamin and mineral status and menstrual disturbance. In the present study, we aimed to assess the relationship between the menstrual bleeding pattern and premenstrual syndrome (PMS) symptoms with serum 25-hydroxyvitamin D, and calcium levels in adolescent girls. A cross-sectional study was carried out in 897 high school girls from northeastern Iran. The prevalence of hypocalcaemia, normal serum calcium and hypercalcaemia was 27.1, 59.8 and 13.1%, respectively. The menstrual flow of participants differed significantly between the calcium status groups (p = .005). There was no significant association between the symptoms of PMS, as assessed by the questionnaire and serum vitamin D status, or serum calcium concentrations, apart from the irritability. There appears to be an association between serum calcium, menstrual blood loss and irritability in adolescent girls. Impact statement What is already known on this subject? Several studies have evaluated the association of vitamin and mineral status with menstrual disturbance, although these relationships are not consistent, specifically among calcium and vitamin D levels with a menstrual bleeding pattern. What do the results of this study add? In the present study, we investigated the correlation of menstrual bleeding patterns and PMS with calcium and vitamin D levels in a large population in adolescent girls. We found that the level of calcium was associated with the level of menstrual blood loss and irritability. However, no significant association was observed between the menstrual bleeding pattern or the PMS symptoms with a vitamin D status. What are the implications of these findings for future clinical practise/research? Further studies are required to assess the value of a calcium adequate intake or a calcium supplementation for the amelioration of PMS and a better understanding the role of calcium in PMS.

Psychosis in a primary hyperparathyroidism patient with mild hypercalcemia: A case report.

INTRODUCTION: Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia and an elevated level of serum parathyroid hormone (PTH). PHPT presents with a complex set of renal, skeletal, and neuropsychological symptoms. Parathyroidectomy (PTX) is a radical treatment that is recommended for all physically symptomatic patients with PHPT. However, psychiatric symptoms are not considered as an indication for surgery. There remains an important issue from the view of perioperative management of whether PTX should be performed with the presence of uncontrolled psychiatric symptoms or deferred until severe psychiatric symptoms have been controlled. We report a case of mild hypercalcemia that caused severe psychosis in PHPT, which improved dramatically following PTX and resulted in successful postoperative management. PATIENT CONCERN: Our patient was a 68-year-old Japanese woman. She was diagnosed with PHPT, which was triggered by mild hypercalcemia. She was due to receive an operation for osteoporosis and kidney stones. She had severe psychosis, despite medication. Blood examinations revealed mild hypercalcemia (10.4 mg/dL, 8.8-10.1 mg/dL) and elevated serum levels of intact PTH (184.0 pg/mL, 10-65 pg/mL). DIAGNOSIS: She was diagnosed with severe psychosis caused by mild hypercalcemia in PHPT. INTERVENTIONS: Although she was treated with 37.5 mg quetiapine and 2 mg risperidone daily, she was excessively sedated and rejected oral treatment. Therefore, we decided to perform the operation. OUTCOMES: Immediately following surgery, serum levels of calcium, and intact PTH were normalized. Her psychotic symptoms ceased completely 5 days after surgery. CONCLUSION: We emphasize that PHPT presents with various severe psychiatric symptoms, even in mild hypercalcemia. Psychiatric symptoms may be the only salient symptoms in PHPT, and thus clinicians should suspect PHPT in patients with psychiatric symptoms and mild hypercalcemia. Furthermore, PTX is recommended for PHPT-even in the presence of severe uncontrolled psychiatric symptoms, which carries risks for postoperative management-because psychiatric symptoms are expected to improve and good postoperative management is possible.

[Psychiatric disorders in elderly patients caused by disturbed calcium metabolism]. / Ausgeprägte Störungen des Kalziumstoffwechsels als Ursache psychischer Störungen bei Alterspatienten.

We report on three patients admitted to psychiatric hospital due to mental disorder in the context of marked pathology of calcium metabolism: a 69 years old male patient with known major depression developed pronounced deterioration of his mental state with distinct hypercalcemia due to parathyroid adenoma, a 90 years old male patient came to treatment with organic affective und delirious symptomatology caused by severe hypercalcemia due to bronchial carcinoma, and a 79 years old female patient was admitted for mixed depressive and anxiety syndrome with profound hypocalcemia and -magnesaemia originating in malabsorption syndrome due to Crohn's disease. Although all patients had received general medical care previously the relevance of their metabolic disorders with regard to their psychopathology had not been ascertained. In all cases treatment of disturbed electrolyte metabolism resulted in an at least temporary improvement of their psychiatric symptomatology. Our case reports referring to elderly patients with multimorbidity underscore the etiological relevance of disturbed calcium metabolism with regard to a broad spectrum of psychiatric syndromes.

An Atypical Presentation of Primary Hyperparathyroidism in an Adolescent: A Case Report of Hypercalcaemia and Neuropsychiatric Symptoms Due to a Mediastinal Parathyroid Adenoma.

Psychiatric disorders are rare clinical manifestations of hypercalcaemia in the pediatric population, are relatively more frequent during adolescence and are often overlooked in cases of severe hypercalcaemia. We described the case of a 17-year-old girl affected by anorexia nervosa, depression and self-harm with incidental detection of moderate hypercalcaemia. Clinical, laboratory and instrumental tests demonstrated that hypercalcaemia was secondary to primary hyperparathyroidism (PHPT) due to a mediastinal parathyroid adenoma in the thymic parenchyma. After parathyroidectomy with robot-assisted surgery, we observed the restoration of calcium and PTH levels in addition to an improvement in psychiatric symptoms. This case demonstrates that serum calcium concentration should be evaluated in adolescents with neurobehavioural symptoms and in cases of hypercalcaemia PHPT should be excluded. Surgery represents the cornerstone of the management of PHPT and may contribute to improving quality of life and psychological function in these patients. However, the complexity of neurological involvement in cases of hypercalcaemia due to PHPT requires further investigations to establish the real impact of this condition on the neurocognitive sphere.

The forgotten electrolyte, when hypercalcaemia manifest as gait instability and altered mental status.

An altered mental status presents a diagnostic challenge for many clinicians. Described here is a case of primary hyperparathyroidism not initially suspected until after a thorough neurological and infectious cause were excluded. A 60-year-old woman presented with altered mental status and gait instability. Her family noticed progressive gait instability and mood swings for the past 4 months. Initial imaging and laboratory values were unable to explain her symptoms. On transfer out of the intensive care unit, her corrected calcium was found to be 13.3 mg/dL with an elevated parathyroid hormone. Her hypercalcaemia was refractory to medical management. Ultrasound found a 2 cm nodule, which was surgically removed and found to be a parathyroid adenoma. Her calcium normalised and neurological deficits subsided. Hypercalcaemia can lead to a constellation of symptoms that include the classical 'stones, bones, abdominal moans and psychic groans' and electrolyte derangements should be considered in the differential of altered mental status.

Callosal morphology concurs with neurobehavioral and neuropathological findings in two neurodevelopmental disorders.

To integrate neuroimaging, neuropathologic, and neuropsychological findings, computer-assisted morphometry was applied to magnetic resonance images of the corpus callosum in adolescents with Down and Williams syndromes and in control subjects. Callosa of subjects with Down syndrome were distinctively rounded in form, consistent with Down syndrome brachycephaly. These callosa also showed decreased widths throughout their rostral fifth, which serves frontal lobe projections. This finding correlates with the hypocellularity and hypofrontality of neocortex in subjects with Down syndrome and with their neuropsychological profile of frontal lobe dysfunction. Callosa of subjects with Williams syndrome generally resembled control specimens, in congruence with their frontal lobe structure and better preserved frontal lobe function. These results represent a convergence of findings across levels of neuroscientific investigation.

Williams syndrome: features in late childhood and adolescence.

Nine children with the Williams syndrome were evaluated for physical, neurodevelopmental, and behavioral characteristics to record the natural history of this disorder. The study subjects, who ranged in age from 10 years to 20 years, generally showed lower than expected cognitive functioning with four of the nine functioning in the severely retarded range. However, all the children showed uneven developmental profiles, compared to measured IQ, with reading abilities exceeding the expected level and visual-motor skills deficient for overall performance expectations. All but one child had evidence of supravalvular aortic stenosis on echocardiography, but there was little morbidity from cardiovascular disease in this group of patients. Although all had grown at or below the fifth percentile in early childhood, seven now were above the fifth percentile for height. Personality attributes that characterize younger children with Williams syndrome persisted in this group of older children.

Temperament in Williams syndrome.

Anecdotal reports suggest that children with Williams syndrome are loquacious, affectionate, charming, open, and gentle. The temperament, or behavioral style, of individuals with Williams syndrome was assessed using standard temperament scales of parental response. Children with Williams syndrome appear, on average, to display higher activity, lower rhythmicity, greater approach, lower adaptability, greater intensity, more negative mood, less persistence, greater distractibility, and lower threshold to arousal than will average children. Older children with Williams syndrome will likely be viewed as "difficult." Despite this overrepresentation in the "difficult" cluster, on average, this population differs from the usual population of "difficult" children in being approaching, rather than displaying a tendency to withdraw. Parents of a child with Williams syndrome should be apprised of potentially negative temperament characteristics, relieved of the burden of responsibility for having a difficult child who "should" be easy, and counselled, when appropriate, regarding the efficacy of modification of parent-child interactions with children having the difficult temperament.

Self-rated psychiatric symptoms in patients operated on because of primary hyperparathyroidism and in patients with long-standing mild hypercalcemia.

Self-rated psychiatric symptoms were investigated in 30 patients referred for surgery because of primary hyperparathyroidism (HPT) (serum calcium, 2.87 +/- 0.21 mmol/L) in 38 subjects detected in a health screening, with 15 years of mild hypercalcemia and probable HPT (serum calcium, 2.66 +/- 0.09 mmol/L), and in 38 normocalcemic control subjects. The psychiatric symptomatology was evaluated by use of the Hopkins Symptom Checklist (HSCL-56), a self-rating symptom scale. The patients with verified HPT had the highest mean HSCL score, 89.1 +/- 20.1 before surgery, compared with 76.6 +/- 17.0 (p less than 0.01) in the health survey hypercalcemic patients and 73.8 +/- 16.0 (p less than 0.001) in the controls. The factors for anxiety, depression, and cognitive symptoms were the most pronounced in the HPT patients and were also increased among the mildly hypercalcemic persons of the health survey, compared with the controls. Somatic symptoms such as headache, back pain, chest pain, and weakness were equally common in HPT and in the controls, and measurements of isometric muscle strength of knee extension did not demonstrate reduction of muscle strength in the health survey hypercalcemic patients. Follow-up of the HPT patients 1 year after parathyroid surgery revealed a marked improvement in mental health (HSCL score 73.2 +/- 13.7, p less than 0.001). In the health survey hypercalcemic patients, neither the psychiatric symptomatology nor the muscle strength were influenced by 6 months of oral vitamin D therapy (alphacalcidol). The results demonstrate that psychiatric symptoms are experienced frequently by patients with HPT and minimum to moderate increases in the serum calcium level and that these disturbances are reversed by parathyroid surgery.

Bony pathology in the cancer patient.

Bony pathology in the cancer patient represents a significant source of morbidity and mortality. Complications include insufficiency and pathological fractures resulting from either medical treatments or bony metastases that can cause significant functional limitations. Additional complications include spinal cord compression, hypercalcemia, and bone marrow failure. Rehabilitation management of such conditions is reviewed, with an emphasis on diagnostic and therapeutic management. Bracing and focused rehabilitation programs facilitate maximal participation and functional outcomes, which can result in an enhanced quality of life. Specific rehabilitation goals and strategies are discussed, with an emphasis on tailoring these according to the functional staging of the patient.

Mood disorder and chronic hypercalcemia.

Fifty-five patients with chronic hypercalcemia were compared with test norms, and two comparison groups of orthopedic patients and hypertensive patients on objective and subjective tests of mood. Sixteen percent of the hypercalcemic patients were found to score over the cut-off point for anxiety on the anxiety subsection of the Hospital Anxiety and Depression Scale, and 16% were diagnosed as suffering from depression on the Paykel Clinical Interview for Depression. There were, however, no significant differences between the comparison groups and those with hypercalcemia on the scales used. There has been debate about the management of individuals with hypercalcemia. This study supports a conservative rather than a surgical approach as far as psychological symptoms are concerned.

[Cognitive and neuropsychological profiles in malformation syndromes: a comparison between Down's syndrome and Williams' syndrome within a follow-up]. / Studio dei profili cognitivi e neuropsicologici nelle sindromi malformative: confronto tra sindrome di Down e sindrome di Williams all'interno di un follow-up.

The present work compares the neuropsychological and cognitive profiles of 4 children with the Williams and Down syndrome. The Authors stress the importance of an accurate analysis of each child's developmental story. They monitor children with physical malformations associated to Mental Retardation or other psychopathological problems in order to have a better understanding of their cognitive strategies and true potential and of their social and emotional implications. This procedure allows immediate action to be taken as soon as physical, emotional or cognitive problems arise. It also enables parents to be fully aware of their children's problems and to be able to meet their different developmental needs.

[Supportive therapy of urogenital tumors: diagnostic and therapy of common complications]. / Supportivtherapie bei Urogenitaltumoren : Diagnostik und Therapie häufiger Komplikationen.

Within the framework of systemic therapy with cytostatic agents and advanced stages of tumor diseases, therapy-induced and disease-related complications can severely impair the quality of life. This article gives a brief synopsis of the current literature on the diagnosis and therapy concerning anemia thrombotic events and tumor-related hypercalcemia as well as recommendations on treating therapy-associated neutropenia.