ABSTRACT
We investigated (1) the prevalence of aluminium overload among 96 patients with symptomatic bone disease haemodialysed from 1987 to 1989 in the Sao Paulo area, Brazil; (2) the effect of 6 months desferrioxamine (DFO) treatment (1-2g/week). All patients underwent a first bone biopsy. Aluminium overload (extent of stainable bone aluminium more than 20% trabecular surface) was observed in 74 of 96 patients. Forty overloaded patients were divided into patients with high bone formation rate (BFR) (group 1; n = 17) and patients with low BFR (group 2; n = 23), and had a second biopsy after DFO therapy. In both groups aluminium surface was reduced after treatment (P < 0.001), osteoblast surface (P < 0.02-P < 0.01) and plasma parathyroid hormone (iPTH) (P < 0.01) increased. In group 1 BFR remained high. In group 2 BFR remained low in 16 patients (2a) and increased in seven (P < 0.02) (2b). In group 2a plasma phosphorus was below that in group 2b patients, before (P < 0.03) and after (P < 0.01) DFO. The histological features of group 2a patients resembled hypophosphataemic osteomalacia, those of group 2b patients aluminium osteodystrophy. These data show a high prevalence of aluminium overload in Brazilian patients. Low-dose DFO therapy was safe, decreased bone pain, prevented fractures, and reduced stainable bone aluminium. Bone lesions only partially improved, suggesting that low phosphorus intake and/or plasma calcitriol concentrations may have prevented improvement of bone formation and mineralization.
Subject(s)
Aluminum/analysis , Bone Remodeling/drug effects , Chronic Kidney Disease-Mineral and Bone Disorder/etiology , Deferoxamine/therapeutic use , Ilium/pathology , Phosphorus/metabolism , Adolescent , Adult , Alkaline Phosphatase/blood , Aluminum/blood , Calcium/blood , Chronic Kidney Disease-Mineral and Bone Disorder/blood , Chronic Kidney Disease-Mineral and Bone Disorder/drug therapy , Female , Humans , Ilium/chemistry , Male , Middle Aged , Parathyroid Hormone/blood , Phosphorus/blood , Renal Dialysis/adverse effectsSubject(s)
Calcitonin/blood , Carcinoma/metabolism , Thyroid Neoplasms/metabolism , Adolescent , Adult , Aged , Bone Neoplasms , Calcitonin/therapeutic use , Female , Humans , Hypercalcemia/drug therapy , Male , Methods , Middle Aged , Neoplasm Metastasis , Phosphorus/bloodABSTRACT
Seven patients with medullary carcinoma of the thyroid were investigated, and the thyrocalcitonin activity of the primary tumours, metastatic deposits, and the serum was estimated.Medullary carcinomas of the thyroid with amyloid stroma contain 100 to 600 times more thyrocalcitonin than normal thyroid tissue, and lymph nodes with metastatic deposits are equally rich in the hormone. High values of thyrocalcitonin are also found in the blood of these patients. Medullary carcinoma of the thyroid with amyloid stroma is the first disease to be recognized in which there is hypersecretion of thyrocalcitonin.