Screening for antibodies against gliadin in patients with osteoporosis.

Intestinal disease might contribute to osteopenia. Measurements of IgA antibodies to gliadin have been established as an accepted screening procedure for detection of coeliac disease. When we applied these measurements to 92 patients with verified osteoporosis, 11 subjects (12%) were found to have elevated levels. This is markedly higher than the incidence in healthy subjects (3%). However, the patients with raised levels of IgA antibodies displayed no clinical symptoms and no laboratory evidence of calcium malabsorption. Thus their values for serum calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase and osteocalcin, as well as the fasting urinary excretion of hydroxyproline and calcium, were similar to those found in other patients with osteoporosis. Intestinal biopsy verified coeliac disease in three patients and was normal in another three. This gives an incidence of verified coeliac disease in this patient group that is approximately tenfold higher than that in the healthy population. Subclinical coeliac disease appears to be unusually over-represented among patients with idiopathic osteoporosis, and screening for gliadin antibodies might therefore be a valuable addition to the routine assessment of the osteopenic patient. The mechanisms underlying the relationship are not clear, but calcium malabsorption is not evident.     

Serum levels of parathyroid hormone are related to the mortality and severity of illness in patients in the emergency department

Hypocalcaemia is a common finding in intensive care patients. In addition, raised levels of parathyroid hormone (PTH) have been described. The explanation and clinical importance of these findings are yet to be revealed. To investigate the occurrence of hypocalcaemia and elevated PTH levels and their relationship to morality and the severity of disease, serum levels of PTH, ionized calcium (Ca²⁺) and the cytokines interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) were measured on arrival in the emergency department in a broad spectrum of 140 acutely ill patients patients suffering from common diseases such as stroke, acute abdominal disorders, obstructive lung diseases, heart failure, acute myocardial infarction, angina pectoris, trauma and infectious diseases. A score (APACHE II) was calculated to assess the severity of disease. Elevated PTH levels (> 55 pg mL⁻¹) were seen in 16% of the patients, being most frequent in patients with myocardial infarction (28%) and congestive heart failure (42%). The levels were significantly correlated with the APACHE II score ( r  = 0.48, P  < 0.0001) and with the length of stay in hospital ( r  = 0.26, P  < 0.002). PTH was also significantly ( P  < 0.03) elevated in non-survivors compared with survivors and was found to be a stronger predictor of mortality ( P  < 0.01) than the APACHE II score ( P  < 0.02) in Cox's proportional hazard analysis. No close relationships were found between the cytokine levels and the indices of calcium metabolism. In conclusion, a rise in serum levels of PTH was common and related to the severity of disease and mortality in a mixed emergency department population.     

Serum lipoprotein and apolipoprotein concentrations and tissue lipoprotein-lipase activity in overt and subclinical hypothyroidism: the effect of substitution therapy

Abstract. Twenty-one patients with increased, thyroid-stimulating-hormone (TSH) concentrations in the serum while fasting were studied before and after substitution with l-thyroxine. Nine patients had TSH values < 40 mU/1 and an average serum-thyroxine value of 64 nmol/1. Twelve patients with TSH-values > 40 mU/1 had an average serum-thyroxine value of 23 nmol/1. On treatment TSH and thyroxine normalized (reference limits < 8 mU/1 and 65–160 nmol/1 respectively) as did also the response to a load with thyroid-releasing hormone (TRH). In the group with severe thyroid dysfunction (TSH > 40 mU/1) the lipoprotein-lipase activities in both adipose and skeletal-muscle tissue were subnormal before therapy and increased during substitution treatment. This was also reflected in a significant increase of the post-heparin, lipoprotein-lipase activity in the plasma and of the fractional removal rate of an i.v. injected fat emulsion. Ten out of twelve patients showed a decrease of the triglyceride concentration in whole serum, which reflected changes of the triglyceride concentrations in low-density lipoproteins (LDL) and high-density lipoproteins (HDL) more than changes in very-low-density lipoproteins, in which the triglyceride concentration was unchanged during treatment. In LDL, both the cholesterol and triglyceride concentrations were elevated before therapy and decreased by 22% and 32% of the pretreatment values, respectively, during treatment. Furthermore, the serum-apolipoprotein-B concentration decreased by 16%. The serum-apolipoprotein-A-I concentration was subnormal before treatment and the lipid composition of the HDL particle was changed towards an enrichment of triglycerides. During treatment, the HDL-triglyceride concentration decreased, whereas that of HDL cholesterol was unchanged. The fasting serum-insulin concentration increased significantly during the treatment period. In the group with mild hypothyroidism (TSH < 40 mU/1), there were no significant changes similar to those found in severe hypothyroidism.     

Circulating reticulin autoantibodies of IgA class in dermatitis herpetiformis

Circulating reticulin autoantibodies of IgA class and anti-nuclear antigen antibodies were found in a high frequency in dermatitis herpetiformis patients as compared with age- and sex-matched controls.     

Hyperoxaluria or hypercalciuria in nephrolithiasis: the importance of renal tubular functions

The role of the kidney in states of hyperoxaluria and hypercalciuria was investigated in seven patients with hyperoxaluria after jejunoileal bypass (JIB) and six patients with idiopathic hypercalciuria (IHC). Eight apparently healthy persons formed a control group. Besides hyperoxaluria, the patients with JIB displayed an elevated plasma concentration of oxalate and the oxalate clearance was increased and higher than creatinine clearance, indicating a net tubular secretion of oxalate. The JIB patients had lower 24-h urinary excretions of calcium, phosphate, magnesium and citrate and higher serum parathyroid hormone (PTH) than controls, indicating increased secretion of PTH to compensate for calcium malabsorption. IHC patients exhibited increased fasting urinary calcium even though their serum values were similar to those in the controls. These results indicate a reduced tubular calcium reabsorption, which was most pronounced in patients with highest PTH values. We conclude that hyperoxaluria in JIB patients is associated both with intestinal hyperabsorption and with enhanced tubular secretion of oxalate, and that in some patients with IHC hypercalciuria is due to reduced tubular reabsorption of calcium.     

The prevalence of the use of androgenic anabolic steroids by adolescents in a county of Sweden

Background: The prevalence of the use of androgenic anabolicsteroids has been poorly studied in Europe. This study was undertakento examine the prevalence of the misuse - the non-medical use- of androgenic anabolic steroids among adolescents in a countyof Sweden. Methods: The total population of 16 and 17 year oldmale and female adolescents in a county on the south-west coastof Sweden was studied. The investigation was done by an anonymousmultiple-choice questionnaire. The questionnaire was completedby 5,827 pupils and statistically analysed. The participationrate was 95%. Results: Among male adolescents 16 and 17 yearsold, 3.6% and 2.8% had misused androgenic anabolic steroids,respectively. These male adolescents had also misused alcohol,growth hormones and narcotic drugs more than the steroid hormonenon-users. Among female adolescents there was no recorded misuseof these drugs (0.0%). Conclusions: The misuse of androgenicanabolic steroids Is a reality in both small and large municipalitiesin Sweden. The prevalence figures are higher among 16 year oldcompared to 17 year old male adolescents. There is an associationbetween this drug misuse and other substance misuse such asnarcotic drugs. Female adolescents do not misuse steroid hormones.The findings indicate the need for preventive work among maleadolescents in order to induce adolescents not to start misusingandrogenic anabolic steroids.     

IMPAIRED SECRETION OF PARATHYROID HORMONE IN PATIENTS WITH RHEUMATOID ARTHRITIS: RELATIONSHIP TO INFLAMMATORY ACTIVITY

Hypocalcaemic tests, employing infusion of EDTA over 1 h, were performed in 22 patients with rheumatoid arthritis (RA) and 14 healthy controls. The basal levels of calcium and parathyroid hormone (PTH) were not significantly different in the two groups. The RA patients displayed a markedly impaired PTH response during infusion of EDTA compared with the controls although the reduction of plasma ionized calcium was similar. The PTH response was furthermore significantly, inversely, related to the inflammatory activity measured as sedimentation rate (r = 0.65; P less than 0.01), i.e. the more pronounced the inflammation, the less the capacity to secrete PTH. Since secretion of PTH is related to the intracellular calcium concentration of the parathyroid cells, these findings are in line with previous observations of a higher intracellular calcium content in inflammatory disease. They also support the earlier indications of reduced bone turnover in inflammatory arthritides. An insufficient parathyroid function could be one factor contributing to bone disease in these conditions.     

Treatment with One-alpha-hydroxycholecalciferol in Middle-aged Men with Impaired Glucose Tolerance—A Prospective Randomized Double-blind Study

ABSTRACT Experimental evidence suggests a specific role for the active metabolite of vitamin D (1,25(OH)₂D₃) in insulin secretion. In order to evaluate the possible clinical significance, 65 middle-aged men with impaired glucose tolerance, and normal serum levels of vitamin D metabolites, were enrolled in a three-month study where they were given either 0.75 μg alpha-calcidol (1α(OH)D₃) daily or placebo. Indices of glucose and lipid metabolism were evaluated before and after treatment. There were no significant changes during the trial neither for fasting blood glucose, hemoglobin A_1C or for the intravenous glucose tolerance between the treatment and the placebo groups, nor were there any consistent changes in insulin values during the glucose tolerance test. Subjects treated with alpha-calcidol displayed a significant reduction in body weight with an average of 1.1. kg, while those receiving placebo lost no weight. Treatment did not affect the serum lipoprotein values. Thus, a modest dose of active vitamin D, which did not cause elevation of serum calcium, did not provide general improvement of glucose tolerance or of insulin secretion when given to patients with impaired glucose tolerance, but without vitamin D deficiency, over a three-month period.     

Regional and systemic effects of short-term intense muscular work on plasma concentration and content of total and ionized calcium

Isokinetic work with one leg was carried out with maximal force for 2 min by five healthy subjects. The concentrations of plasma total calcium and of ionized calcium in the effluent from the leg increased by a mean of 13.6 +/- 1.8% (SD) and 16.2 +/- 2.0%, respectively. The corresponding rises in the resting arm were 7.7 +/- 4.3% and 8.1 +/- 3.0%. There was a close correlation (r = 0.86; P less than 0.001) between the degree of exercise-induced acidosis and the rise in plasma ionized calcium. However, the calcium values normalized both in the leg and in the arm within 5 min after the exercise and were similar at the two measuring sites despite a lower pH in the leg sample. During work there was a reduction of the plasma volume of 11.2 +/- 6.0% in the regional (femoral) and 12.4 +/- 4.2% in the systemic (antecubital) sample (P less than 0.001 compared to baseline values for both measurements). When adjustments were made for the reduction in plasma volume as well as for acidosis it was evident that, despite the apparent increases in the calcium concentrations, there was a net reduction of the plasma ionized calcium content (the total amount of plasma ionized calcium). This decrease was significantly (P less than 0.05) more pronounced in the exercising leg than in the systemic circulation but the difference could largely be explained by higher calcium-lactate complex formation in the leg.     

Enzymatic determination of urinary chondroitin sulphate: applications in renal stone disease and acromegaly

A method was developed for the determination of urinary chondroitin sulphate (CS), including dermatan sulphate and chondroitin 4 and 6-sulphates, using an enzymatic degradation with chondroitinase-ABC followed by precipitation with Alcian blue, whereby CS was determined as the difference between undigested and chondroitinase digested material. The method was linear in the range 0-100 mg l-1 with a detection limit of 1 mg l-1 and allowed determinations on small urine volumes without pretreatment of the urine. It could be demonstrated that males excreted more CS than females, and growing children had the highest urinary content of CS. Renal calcium stone formers did not differ from healthy controls in urinary CS. Patients with acromegaly had a higher excretion of CS compared with controls. There was also, in these patients, a positive correlation between the serum growth hormone levels and the urinary CS, indicating that CS-excretion may be an estimate of the activity of the pituitary disorder.