[Osteomalacia following intravenous iron suppletion]. / Osteomalacie na intraveneuze ijzersuppletie.

BACKGROUND: Ferric carboxymaltose (FCM) is highly effective in supplementing iron-deficiency anemia and frequently used. However, it can severely interfere with the phosphate metabolism. CASE DESCRIPTION: A 63 year old man with iron-deficiency anemia due to hereditary hemorrhagic telangiectasia was treated with intravenous FCM. After initiation of the FCM he developed generalized bone and muscle pain as well as insufficiency fractures. Treatment with colecalciferol was started. However, the bone pain increased and further investigation showed a hypophosphatemicosteomalacia with high urine phosphate loss suggesting renal phosphate wasting. Serum FGF23 level was increased confirming the diagnosis of FGF23 mediated hypophosphatemicosteomalacia induced by intravenous iron suppletion. CONCLUSION: FCM injections may cause FGF23 mediated hypophosphatemia already 4 weeks after suppletion. Therefore it is recommended that serum phosphate levels should be checked frequently. In patients developing hypophosphatemia, a non-maltose form of iron suppletion must be started as well as active vitamin D.

Glucose-dependent leucocyte activation in familial hypercholesterolemia.

BACKGROUND: Leucocyte activation is an obligatory factor in the development of atherosclerosis. The postprandial situation has been associated to increased leucocyte activation in several disorders, such as type 2 diabetes mellitus and familial combined hyperlipidaemia. Our study aim was to evaluate the effect of post-OGTT hyperglycaemia on leucocyte activation in patients with familial hypercholesterolemia (FH). MATERIALS AND METHODS: Patients who met the diagnostic criteria for heterozygous FH and healthy volunteers were asked to undergo an oral glucose tolerance test. Leucocyte activation markers CD11b and CD66b were determined by flow cytometry. Post-OGTT changes were calculated as area under the curve (AUC) and the incremental area under the curve corrected for baseline values (dAUC). The impact of being an FH patient and using statins on the time-dependent profile of the leucocyte activation markers was studied with repeated measurements analysis. RESULTS: Thirteen FH patients using statins, nine FH patients without statins and 14 healthy volunteers were included. FH subjects on statins had a slightly higher HbA1c than those not using these drugs or controls. Post-OGTT glucose levels were significantly higher in patients with FH when compared to healthy controls (P = 0·001). These effects were independent from the use of statins. CONCLUSIONS: Surprisingly, our study shows impaired post-OGTT glucose excursions in patients with FH compared to healthy volunteers. Post-OGTT hyperglycaemia may be related to persistent post-OGTT activation of monocytes in FH patients compared to healthy controls, and therefore, it may contribute to the development of cardiovascular disease in patients with FH.

Maternal C-Reactive Protein Concentration in Early Pregnancy and Child Autistic Traits in the General Population.

BACKGROUND: Exposure to elevated levels of inflammatory markers during pregnancy has been suggested as possible aetiologic factor in the occurrence of autism spectrum disorder (ASD). In this study, we investigated the prospective relation between maternal C-reactive protein (CRP) during early pregnancy and children's autistic traits in the general population. METHODS: In a large population-based cohort in the Netherlands, we measured maternal CRP levels before 18 weeks of gestation (N = 4165). Parents reported on their children's autistic traits at age 6 years using the Social Responsiveness Scale, and the Pervasive Developmental Problem scale. Regression models were used to examine the relation between maternal CRP levels and autistic traits in children. RESULTS: Compared with the reference group (CRP < 2.3 mg/L), elevated levels of CRP (>7.8 mg/L) in pregnant women were associated with higher Social Responsiveness Scale scores in children [ß = 0.055, 95% confidence interval (CI) 0.033, 0.078]; however, the effect was strongly attenuated after adjustment for several socioeconomic factors and in particular by maternal health-related factors including body mass index (fully adjusted model ß = 0.018, 95% CI -0.005, 0.042). We found no relation between maternal CRP levels and pervasive developmental problem. CONCLUSIONS: Our results suggest that the association between elevated levels of maternal CRP in pregnancy and autistic traits in children is confounded by maternal health-related and socioeconomic factors. Further studies are needed to explore whether other maternal inflammatory markers during pregnancy, as a response to maternal inflammation, are associated with the development of autistic traits in the offspring.