RESUMEN
Most patients with primary hyperparathyroidism in the 1980s do not have evidence of bone disease when they are evaluated by conventional radiography. We sought to determine whether skeletal involvement can be appreciated when more sensitive techniques, such as bone densitometry and bone biopsy, are utilized. We investigated 52 patients with primary hyperparathyroidism. They had mild hypercalcemia, 2.8 +/- 0.03 mmol/liter (11.1 +/- 0.1 mg/dl), low normal phosphorus, 0.9 +/- 0.03 mmol/liter (2.8 +/- 0.1 mg/dl), and no symptoms or specific radiological signs of skeletal involvement. The greatest reduction in bone mineral density was found at the site of predominantly cortical bone, the radius (0.54 +/- 0.1 g/cm; 79 +/- 2% of expected), whereas the site of predominantly cancellous bone, the lumbar spine (1.07 +/- 0.03 g/cm2), was normal (95 +/- 3% of expected). The site of mixed composition, the femoral neck (0.78 +/- 0.14 g/cm2), gave an intermediate value (89 +/- 2% of expected). Preferential involvement of cortical bone with apparent preservation of cancellous bone in primary hyperparathyroidism was confirmed by percutaneous bone biopsy. Over 80% of patients had a mean cortical width below the expected mean, whereas cancellous bone volume in over 80% of patients was above the expected mean. The results indicate that the majority of patients with asymptomatic primary hyperparathyroidism have evidence by bone densitometry and bone biopsy for cortical bone disease. The results also indicate that the mild hyperparathyroid state may be protective of cancellous bone. The therapeutic implications of these observations await further longitudinal experience with this study population.
Asunto(s)
Enfermedades Óseas/etiología , Hipertiroidismo/complicaciones , Biopsia , Enfermedades Óseas/patología , Densitometría , Femenino , Humanos , Hipercalcemia/etiología , Hipertiroidismo/diagnóstico por imagen , Masculino , Microscopía Electrónica de Rastreo , Persona de Mediana Edad , Minerales/análisis , Hormona Paratiroidea/sangre , Fósforo/sangre , Radiografía , RadioinmunoensayoRESUMEN
Sharp increases in the concentration of chromium in plasma were found in five subjects with normal glucose utilization after administration of glucose by mouth. This rise was not observed in two diabetics when glucose tolerance was impaired; however, it appeared when glucose tolerance was improved and when trace amounts of trivalent chromium were given as a dietary supple-ment. The source of chromium which became elevated was most likely an internal pool. Possibly there is a relation between chromium and insulin function.