PITUITARY EVALUATION IN PATIENTS WITH LOW PROSTATE-SPECIFIC ANTIGEN.

OBJECTIVE: To evaluate pituitary function in men with a low screening prostate-specific antigen (PSA) of ≤0.1 ng/mL and test the hypothesis that low PSA is associated with hypogonadism alone or other hormone deficiency. METHODS: This was a case-control study evaluating the rates of hypogonadism and low insulin-like growth factor (IGF)-1 in a cohort of men with low or normal screening PSA level. Sixty-four men >40 years old without known prostate disease were divided into a low-PSA group (PSA ≤0.1 ng/mL) and normal-PSA group (PSA 1 to 4 ng/mL). Hormonal evaluation included total testosterone, prolactin, luteinizing hormone, follicle-stimulating hormone, IGF-1, growth hormone, thyroid-stimulating hormone, free thyroxine, morning cortisol, and adrenocorticotropic hormone. The difference between each patient's observed IGF-1 and the IGF-1 age-specific lower limit was calculated. The odds ratios (ORs) for having hypogonadism and associated 95% confidence intervals (CIs) were calculated using the Cochran-Mantel-Haenszel test. RESULTS: The rate of hypogonadism was significantly higher in the low-PSA group (n = 44) compared with the normal-PSA control group (n = 20) (45.5% vs. 15.0%; OR, 4.7; 95% CI, 1.2 to 18.4; P = .027). The total testosterone in the low-PSA group was significantly lower compared with the control group (181.7 ng/dL vs. 263.7 ng/dL; P = .008). IGF-1 values were below their lower bound in 18.6% of subjects in the low-PSA group, compared with 0% in the control group. CONCLUSION: Men with low PSA have significantly higher rates of hypogonadism and low IGF-1 compared with those with normal PSA. In such men, we recommend hormonal evaluation to exclude associated pituitary dysfunction. ABBREVIATIONS: BMI = body mass index; GH = growth hormone; IGF-1 = insulin-like growth factor 1; MRI = magnetic resonance imaging; PSA = prostate-specific antigen; T2DM = type 2 diabetes mellitus; VA-NWIHCS = VA-Nebraska Western Iowa Health Care System.

Management of inpatient hyperglycemia: assessing knowledge and barriers to better care among residents.

To identify areas that should be targeted for improvement, we surveyed residents for their knowledge and barriers regarding management of inpatient hyperglycemia. One hundred thirty-five residents from 4 teaching hospitals completed a questionnaire to assess their knowledge about the different types of insulin, the perceived barriers toward managing inpatient hyperglycemia, and the problems they face when dealing with this commonly encountered problem. The majority of participants thought that managing inpatient hyperglycemia was very important in the critically ill and perioperative patients, whereas only 65% thought that it was very important for noncritically ill patients. Most residents reported that they will target blood glucose levels that are inconsistent with the current recommendations. Half of them reported that they were very comfortable with managing inpatient hyperglycemia and hypoglycemia. Of the participants, 46% said they will use a stand-alone insulin sliding scale for patients with difficult to control blood glucose and 43% thought that physicians still use it because of their unfamiliarity with ordering prandial and basal insulin. Unpredictable changes in patient diet and mealtimes, along with the risk of causing patient hypoglycemia, were the most frequently chosen as barriers to better management of inpatient hyperglycemia. Most participants lack important inpatient hyperglycemia knowledge, specifically about insulin types and pharmacokinetics. This study demonstrated the gap in knowledge about management of inpatient hyperglycemia among residents and illustrated the need to develop certain policies and to implement educational programs directed toward residents that reflect the current guidelines.

Calcium absorption response to cholecalciferol supplementation in hemodialysis.

BACKGROUND AND OBJECTIVES: Recent understanding of extrarenal production of calcitriol has led to the use of more vitamin D supplementation in CKD populations. This paper reports the effect of cholecalciferol supplementation on calcium absorption. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Paired calcium absorption tests were done before and after 12-13 weeks of 20,000 IU weekly cholecalciferol supplementation in 30 participants with stage 5 CKD on hemodialysis. The study was conducted from April to December of 2011. Calcium absorption was tested with a standardized meal containing 300 mg calcium carbonate intrinsically labeled with (45)Ca; 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were measured. RESULTS: 25-Hydroxyvitamin D rose from 14.2 ng/ml (11.5-18.5) at baseline to 49.3 ng/ml (42.3-58.1) at the end of the study (P<0.001). 1,25-Dihydroxyvitamin D rose from 15.1 (10.5-18.8) pg/ml at baseline to 20.5 (17.0-24.7) pg/ml at the end of the study (P<0.001). The median baseline calcium absorption was 12% (7%-17%) and 12% (7%-16%) at the end of study. CONCLUSIONS: Patients with stage 5 CKD on hemodialysis had very low calcium absorption values at baseline, and cholecalciferol supplementation that raised 25(OH)D levels to 50 ng/ml had no effect on calcium absorption.