Hypocalcemic tetany in the newborn as a manifestation of unrecognized maternal primary hyperparathyroidism.

Primary hyperparathyroidism (PHP) during pregnancy is a very rare event that increases maternal and perinatal morbidity and mortality. We present a case in which hypocalcemic tetany of the neonatal infant - caused by transient hypoparathyroidism in the child - finally revealed asymptomatic maternal PHP. An apparently healthy 30-year-old woman had an uneventful pregnancy and delivery. On the 15th postpartal day, the newborn developed hypocalcemic tetany. After receiving supplementation of calcium and vitamin D, the child developed without further pathological findings. Laboratory and radiological studies in the mother led to a diagnosis of maternal PHP. An adenoma of the right lower parathyroid gland was subsequently removed. The search for the cause of hypocalcemia in a newborn should not focus on the patient alone. Examining the apparently healthy mother and approaching the case in a multidisciplinary fashion may benefit both the child and the mother.

Proinflammatory parameters as CRP and IL-6 do not discriminate between post-PCI cardiac patients with and without exercise-induced ischemia as indicated by Tl-201 myocardial scintigraphy.

INTRODUCTION: Atherosclerosis is looked upon as an inflammatory disease. The production of proinflammatory markers may indicate activity in this inflammatory state. METHODS: We prospectively evaluated a range of proinflammatory serum parameters in 136 cardiac patients who had previously undergone percutaneous coronary intervention (PCI). RESULTS: By means of myocardial scintigraphy, an ischemia group (A; n=49) and a group with stable cardiovascular disease without exercise induced ischemia (B; n=87) were distinguished. Risk factors and lipoprotein profile of both groups were comparable. Serum levels of serum C-reactive protein (CRP), IL-6, sTNF-RI, IGF-I, neopterin, serotonin and prolactin did not present any significant difference between the two groups. CONCLUSIONS: We conclude that measurement of these (inflammatory) parameters does not help to delineate post-PCI cardiac patients with and without exercise-induced ischemia.

Is there a gender difference of somatostatin-receptor density in the human brain?

Animal experiments and observations in human brains have convincingly shown that sexual differentiation not only concerns the genitalia but also the brain. This has been investigated also in the light of a possible explanation of a presumed biological aetiology of transsexuality. The volume of the central subdivision of the bed nucleus of the stria terminalis, a brain area that is essential for sexual behaviour, has been reported to be larger in men than in women. Additionally, the number of somatostatin expressing neurons in this region was shown to be higher in men than in women. As neuronal production of somatostatin is involved the idea is striking whether somatostatin-receptor density in the cortex of cerebral hemispheres might be related to gender identity. We investigated in vivo the density of somatostatin-receptors in selected regions of the human brain in both sexes by means of receptor scintigraphy. Basal ganglia tracer uptake of 111-In-Pentreotide was equally low in both genders at 0,80% +/ 0,26 (related to tracer uptake of the whole brain layer). Temporal cortex accumulated at 2,9% +/ 1,1 in men and at 2,3% +/ 0,76 in women. Frontal brain region had an uptake of 3,0% +/ 1,4 in male and of 2,5% +/ 1,3 in female. This shows a tendency in males for relatively augmented uptake indicating higher somatostatin receptor density in temporal and frontal cerebral cortex.

Hyperthyroidism affects arterial stiffness, plasma NT-pro-B-type natriuretic peptide levels, and subendocardial perfusion in patients with Graves' disease.

BACKGROUND: Arterial stiffness is thought to play a critical role in the pathogenesis of cardiovascular events, and in hyperthyroidism increased cardiovascular event rates have been reported. AIM: To investigate markers of systemic arterial stiffness, volume homeostasis, and subendocardial perfusion and its interrelationship in patients with Graves' disease (GD) in hyperthyroidism and euthyroidism. METHOD: Aortic augmentation index (AIx@75) as a measure of systemic arterial stiffness and subendocardial viability ratio (SEVR) as a surrogate measure of subendocardial perfusion were assessed by applanation tonometry in 59 patients with GD in hyperthyroidism and euthyroidism, and measurements were compared to plasma levels of NT-pro-B-type natriuretic peptide (NT-ProBNP). RESULTS: AIx@75 and NT-ProBNP levels were significantly increased in hyperthyroidism compared to euthyroidism and were positively correlated with each other. SEVR was significantly decreased in hyperthyroidism compared to euthyroidism, mainly due to increased heart rates as shown by the heart rate-corrected SEVR75. CONCLUSIONS: In hyperthyroidism, patients with GD exhibited increased systemic arterial stiffness, paralleled by increased levels of NT-ProBNP, a marker of volume overload. The decreased subendocardial perfusion in hyperthyroidism seemed to be mainly due to increased heart rates. The observed unfavorable hemodynamic alterations in hyperthyroidism may serve to explain increased cardiovascular event rates in patients with GD.

[Subacute thyroiditis with cell destruction and temporary hyperthyroidism in Graves'disease--case report]. / Subakute Thyreoiditis mit Zellzerfall und passagerer Hyperthyreose in einer Basedow-Struma--Fallbericht.

We present the case of a 60-year old woman with painful swelling of the thyroid gland and temporary thyrotoxicosis. 30 years ago she had experienced a period of hyperthyroidism because of Graves' disease. This time thyrotropin-receptor-antibodies were negative, Tc-99 m scan revealed decreased uptake in both lobes (this pattern normalised later on) and fine needle aspiration presented leucocyte infiltration of the thyroid. Three months later hypothyroidism was observed requiring treatment with levothyroxine. The development of subacute thyroiditis and Graves' disease in the same person is rare, autoimmune factors and a possible relationship are discussed.

Bone scintigraphy using Tc-99m DPD and F18-FDG in a patient with SAPHO syndrome.

Synovitis (inflammatory arthritis), acne (pustulosa), palmoplantar pustulosis, hyperostosis and osteitis (bland osteomyelitis) are symptoms forming the acronym SAPHO. We present the case of a 48-year old man with sterno-costo-clavicular hyperostosis and typical pustulosis palmaris. We performed Tc-99m DPD serial bone scanning to monitor the course of disease and to assess therapeutic efficiency. Control bone scans in 2001 showed minor compromises of the ribs and diminished disease activity on collarbones and the sternum after medication with non-steroidal anti-inflammatory drugs (NSAIDs) and bisphosphonates. F-18 FDG PET presented synovial inflammation in the left sterno-clavicular joint but no relevant tracer uptake on clavicles or breastbones. In case of diagnostic doubts F-18 FDG PET could be recommended in order to discriminate bland osteomyelitis from bacterial osteomyelitis or from bone malignancy when SAPHO-syndrome is assumed.

Pro-inflammatory role of serotonin and interleukin-6 in arthritis and spondyloarthropathies--measurement of disease activity by bone scan and effect of steroids.

OBJECTIVE: As serotonin is a mediator of inflammatory joint disease, serum levels were investigated in human patients with arthritis for a possible corresponding role as a disease marker. DESIGN: 48 patients were evaluated by bone scan for disease activity. 5-HT and CRP were measured in the whole group, and IL-6 in those not yet receiving corticosteroids. The pro-inflammatory parameters were compared to each other and to scintigraphic features. RESULTS: The serum levels of serotonin did not correspond to disease activity measured by CRP, IL-6 or activity on joints in skeletal scintigraphy. No difference was seen in comparison to the values of a control group, but when glucocorticoid treatment was included, low 5-HT serum values were observed. A significant correlation between CRP and IL-6 as indicators of inflammation and bone scan results versus CRP could be shown. CONCLUSION: The measurement of serum serotonin provides no relevant information about disease activity in synovial inflammation. For monitoring osteoarthritis and synovial inflammation, bone scan and laboratory determination of CRP and IL-6 together appear to present useful information about infestation in the disease process.

[Diagnosis and therapy of Graves' ophthalmopathy--consensus guidelines]. / Diagnostik und Therapie der endokrinen Orbitopathie--Konsensusrichtlinien.

On 22-09-2001 the VIth Grazer Hormonsymposion took place. Diagnosis and therapy of Graves' Ophthalmopathy was discussed in an interdisciplinary way by endocrinologists, surgeons and ophthalmologists. The results of the round-table discussion and the consensus talk are presented.