[Secondary hyperparathyroidism in hospitalized aged patients: apropos of 200 assays of intact parathyroid hormone]. / Hyperparathyroïdie secondaire chez le sujet âgé hospitalisé: à propos de 200 dosages de parathormone intacte.

Plasma intact parathyroid hormone (PTH) determinations were performed in 200 elderly patients admitted in a geriatric care unit. Abnormally high levels of PTH were observed in 40 subjects. There was a significant correlation between plasma ionized calcium determinations or creatinine clearance and PTH levels. Subjects with high PTH levels exhibited constantly reduced levels of 25 OH-D3. A calcium and vitamin D supplement, performed in 13 patients, was constantly followed by a decrease of the PTH level.

[Secondary hyperparathyroidism in the elderly. Apropos of 200 assays of intact parathormone]. / L'hyperparathyroïdie secondaire du sujet âgé. A propos de 200 dosages de parathormone intacte.

OBJECTIVES: To evaluate the frequency of high levels of intact parathormone in an elderly population of hospitalized patients and to determine whether there are any correlations with different factors involved in phosphocalcium metabolism, nutritional status and renal function. METHODS: Intact parathormone was assayed in all patients admitted to a geriatric ward (n = 200). Other laboratory tests included serum phosphorus, calcium, total albumin, prealbumin, ionized calcium, creatinine with calculation of the clearance and in 50 patients radioimmunoassay for 25 hydroxyvitamin D. RESULTS: Intact parathormone was abnormally high (> 65 pg/ml) in 40 patients. Mean levels increased significantly with age and reached 70.5 pg/ml in patients 90 years of age and over. No correlation was found between intact parathormone and total serum calcium, corrected serum calcium, albumin or prealbumin. Inversely there was a significant correlation with serum phosphorus and creatinine and creatinine clearance. Serum levels of 25 hydroxyvitamin D were abnormally low in 82% of the patients. There was a constant and significant decrease in intact parathormone level 15 days after calcium and calcifediol substitution therapy in 13 patients. CONCLUSION: The frequency of hyperparathyroidism increases with age to affect nearly 1 out of 2 subjects over 90. It would be useful to determine a threshold level for elderly subjects with a major risk of bone fracture.

[The eye and oral contraceptives]. / L'oeil et les contraceptifs oraux.

PIP: After a consideration of the history, general side effects, complications, and implications for the world's population of oral contraceptives, the ophthalmologic complications of the pill are summarized. Severe complications reported include ocular paralysis, papillary edema and thrombosis of the retinal vessels due to thrombosis of the cerebral vessels, particularly of the vertebro-basilar artery. The severe ocular complications fall into 2 categories, neuroophthalmologic and vascular. Neuroophthalmologic complications simulate cerebral tumors: in 4 cases there were 6th cranial nerve paralysis, parietal syndrome, hemianopsia, and papillary edema. Unilateral optic neuritis, usually with papillary edema or retrobulbar neuritis syndrome, occurs in several reports. The vascular complications may be associated with thrombosis of the cerebral vessels or limited to the retinal artery or vein. 150 such cases have been published since 1964. A few reports link thrombosis of other vessels with the pill, such as the central vein or central artery. Minor incidents, e.g., migraine, orbital phlebitis, exophthalmia, catatact, myopia, have been ascribed to the pill. The pill is probably responsible for ocular complications related to thrombosis, migraine, and neuritis, but retrospective studies of a few hundred subjects have not proven the association.^ieng