[Chronic progressive bone pain in an 82-year-old male patient]. / Chronisch progrediente Knochenschmerzen bei einem 82-jährigen Patienten.

The case of an 82-year-old man who suffered from bone pain is reported. This was due to osteomalacia with hypophosphatemia. The cause was renal phosphate wasting mediated by fibroblast growth factor 23 (FGF-23) with oncogenic osteomalacia. The mesenchymal tumor could be detected at the elbow by positron emission tomography-computed tomography (PET/CT) scanning with 68 Ga-DOTATATE. After resection of this hemangiopericytoma (phosphaturic mesenchymal tumor, PMT) the phosphate level quickly returned to normal.

Comparative Characteristics of Patients with Type 2 Diabetes Mellitus Treated by Bariatric Surgery Versus Medical Treatment: a Multicentre Analysis of 277,862 Patients from the German/Austrian DPV Database.

INTRODUCTION: Bariatric surgery is a well-established treatment option for serious obesity and concomitant type 2 diabetes mellitus (T2DM). In this analysis, we investigated predictors for bariatric surgery in everyday clinical practice. MATERIALS AND METHODS: In the DPV-registry, patients with T2DM from Germany and Austria treated by bariatric surgery were compared to non-surgery controls by descriptive statistics and regression analysis. RESULTS: Among 277,862 patients with T2DM, 0.07% underwent bariatric surgery. Surgery patients were predominantly female [61.20%], younger [median age (Q1;Q3) 54.74(47.40;61.61) vs. 70.04 (60.36;77.58) years] and had a longer diabetes duration [11.21 (7.15;17.93) vs. 8.36 (2.94;14.91) years]. They had a higher BMI [40.02 vs. 30.61 kg/m2, adjusted p < 0.0001] and a slightly lower HbA1c [7.25 vs. 7.56%, adjusted p < 0.05]. There was a trend using more often insulin therapy (52.79 vs.50.08%, n.s.) with no difference in insulin dose/kg × day [0.56 vs. 0.58, n.s.]. Sleeve gastrectomy was performed most frequently, followed by Roux-en-Y gastric bypass, gastric banding, gastric balloon and others. A 2-year follow-up data in 29 patients demonstrated significant reductions in BMI [45.23 to 38.00 kg/m2, p < 0.005] and HbA1c [7.98 to 6.98%, p < 0.005], and a trend for reduced insulin requirements [62.07 vs. 44.83%, n.s.]. CONCLUSION: Despite favourable 2-year outcomes, bariatric surgery is still used rarely in patients with T2DM and obesity. BMI rather than metabolic control seems to represent the major selector for or against bariatric surgery in T2DM.

[Replacement and supplementation of DHEA--is it a wellness hormone?]. / "Zeitloses Altern" mit DHEA. Lange gesund leben und Sex bis ins hohe Alter?

DHEA is an adrenal steroid hormone, the physiological role of which is largely unknown. Since the DHEA/DHEAS levels decrease appreciably with age in most people, DHEA is often considered to have a role to play in the aging process, and its use as an anti-aging or wellness hormone to diminish age-related complaints is often propagated. Studies on this are, however, meager. Currently, there is no definitive indication for DHEA supplementation in persons with low DHEA levels. In adrenal cortex insufficiency in contrast, there is an absolute DHEA deficiency. In women suffering from Addisons's disease or pituitary insufficiency with high-grade DHEA and androgen deficiency, however, substitution makes good pathophysiological sense, and treatment can be useful.