Background. Secondary hyperparathyroidism (sHPT) is one of the serious complications in chronic kidney disease and is associated with progressive bone disease and vascular calcification.The objective of the study was to determine the impact of Mimpara (Cinacalcet HCl) on mineral disorder, bone turnover and bone mineral density (BMD) versus parathyroidectomy (PTx) in haemodialysis patients’ refractory to alfacalcidol. Materials and methods. 62 haemodialysis patients with sHPT were enrolled in this 6=months prospective study. All of them had surgical indications for PTx. Surgical indications was established according to clinical or biological assessment. 40 patients underwent Mimpara treatment. Dose of Mimpara was titrated every 4 weeks. Sequential doses included 30–180 (mean 59.1 ± 34.2) mg/day. 22 patients underwent PTx. The surgical technique was depended on quantity of hyperplastic parathyroid glands.Results. In 6 months mean iPTH, Ca, Са×Р, CTx and OC levels significantly decreased by 55.7%, 13.8%,34.3%, 21.4 and 1.4% in the Mimpara group vs. 90.7%, 14%, 55.5%, 58.7% and 26.9% in the PTx group. Median serum iPTH level decreased by 30% after initiation of Mimpara in 94.3% patients, from them by 50%in 74.3%. Achieved the KDOQI treatment targets for PTH in 28.6% patients.In 6 months after PTx median serum iPTH level was 100 pg/ml in 50% patients, achieved the KDOQI treatment targets in 27.3%, 300 pg/ml in 18.2%. Median serum 25(ОН)D after PTx significantly increase by 127.3% vs 6.72% in the Mimpara group. In 6 months active restoration of BMD was found in the PTx patients, and patients treated with Cinacalcet showed stabilization of BMD.Mimpara therapy led to a reduction in glandular volume during the course of the study: in both glands with a baseline volume 500 mm3 and with a baseline volume ≥500 mm3. Conclusions. PTx and Cinacalcet therapy improves phosphorus=calcium homeostasis, bone turnover, but bone resorption and formation markers decreased better in the PTx group compared to Cinacalcet group. The effectiveness and safety of Mimpara for secondary hyperparathyroidism were evaluated in dialysis patients’ refractory to alfacalcidol, which reduced the need for parathyroidectomy in patient without severe osteodystrophy.

In this article we describe a clinical case of primary hyperparathyroidism, gout tophus and diabetes mellitus type 2. The relationship between hyperuricemia and hypercalcemia linked to primary hyperparathyroidism is discussed.

Three groups of premenopausal women with diffuse toxic goiter (DTG) of different duration and different activity of thyrotoxicosis were examined for assessing calcium-phosphorus metabolism, osseous metabolism, and mineral compactness of bone tissue by ultrasonic (US) densitometry and bienergetic x-ray absorptiometry. Manifest hypercalciuria and hyperphosphaturia with normal levels of Ca2+ and inorganic phosphorus in the blood were revealed in patients with newly detected and recurrent DTG. In patients with hyperthyrosis the blood alkaline phosphatase activity and hydroxyproline excretion with the urine on an empty stomach were increased, these changes being most of all expressed in the group with newly detected thyrotoxicosis; however, these shifts were liable to normalize when stable drug-induced euthyrosis was attained. A reliable correlation between free T4 in the blood serum and osseous metabolism was revealed, which may indicate a direct effect of TH excess on bone tissue metabolism. The osteopenic syndrome was detected primarily in the proximal portions of the femoral bone, the severity of osteopenia reliably correlating with the disease duration. The authors come to a conclusion about the informative value of US densitometry and bienergy x-ray absorptiometry for the diagnosis of early stages of the osteopenic syndrome in DTG.

Treatment of hormone-active pituitary adenomas should be aimed at correcting metabolic disorders without the subsequent development of pituitary hormone deficiency. As a rule, selective adenomectomy is adequate to such requirements. However, intraoperative examination of the pituitary gland is not always successful, even with the use of an operating microscope. Therefore, preoperative detection of the location of pituitary adenoma should be absolutely accurate, which can significantly improve the results of surgical treatment. Prior to 1990, X-ray methods for examining the sella turcica were used only with a small degree of probability to suggest the presence of pituitary microadenomas. The appearance in the 70s of computed tomography (CT) made it possible to significantly improve the topical diagnosis of microadenomas and raise the percentage of their detection to 60-70. The next significant step forward in this direction was the use of magnetic resonance imaging (MRI) since the early 1980s, with the percentage of detection of microadenomas reaching 87. However, in 10-15% of patients with clinical and laboratory manifestations of endocrinopathies, microadenomas cannot be detected. This makes us look for more advanced methods of diagnosis, which include bilateral catheterization of cavernous sinuses (BCCS), with subsequent measurement of the level of hormones in the blood flowing from the pituitary gland.

Bone system was examined in 112 liquidators; in 71 of these osseous tissue density was studied by osseous densitometer using bienergetic x-ray absorptiometry and in 45 x-ray examinations, analyses of biochemical and hormonal parameters were carried out. Spinal painful syndrome was detected in 61 to 82% of the examinees. For analysis of densitometric and x-ray parameters the liquidators were divided into 2 groups: group 1 included those who worked at the power plant in 1986 (55%) and group 2 were those who worked there in 1987-1989. Radiation doses in group 1 reliably surpassed those in group 2 (p < 0.001). Bone mineral density in the lumbar vertebrae was significantly lower in group 1 as against group 2 and lower in both groups vs. controls. More than 5% osseous mineral loss was revealed in 73% of group 1 liquidators and in 43% of group 2 ones. Analysis of spinal roentgenograms in 45 liquidators showed a high incidence of negligible and moderately expressed osteoporosis without compression fractures of vertebral bodies: osteopenia signs were found in 87% of group 1 examinees complaining of pain in the spine and in 73% of group 2 examinees; signs of osteochondrosis and spondylosis were detected in 40% of group 1 and in 47% of group 2 subjects. Hence, a higher incidence of osteopenia in liquidators, more manifest condition and its higher detection rate in subjects exposed to higher radiation doses indicate a certain contribution of radiation factor to the development of the osteopenia syndrome in liquidators.

The informative value of diagnosis of osteoporosis in 53 patients with Itsenko-Cushing disease was assessed by visual estimation of radiograms of the axial skeleton, standard x-ray densitometry of the phalanges of the thumbs and single-photon absorptiometry of the distal parts of antebrachial bones. Diagnosis of osteoporosis and its evaluation over time were shown to be accurate in combination of visual assessment of radiograms of the axial skeleton with standard x-ray densitometry of the peripheral parts of the skeleton. Single-photon absorptiometry revealed no decrease in the level of the osseous mineral in the forearm of patients with endogenous hypercorticoidism. In the majority of female patients this indicator even exceeded the normal age value. Possible causes of this phenomenon are under discussion.

The authors presented the results of a study of the indices of phosphorocalcium homeostasis, metabolism of osseous tissue and calcium regulating hormones in 44 patients with Icenko-Cushing's syndrome with regard to severity of disease and expression of osteoporosis. It was shown that disturbances of phosphorocalcium homeostasis and an increase in the level of the parathyroid hormone were characteristic for the active stage of Icenko-Cushing's disease and were most noticeable in a severe course of disease accompanied by sharply marked osteoporosis. Hypocalcemia, hypophosphatemia, hypercalciuria, a decrease in phosphate maximum resorption and an increase in AP activity in the blood serum were revealed in this form of disease. Patients with the average gravity of disease and weakly pronounced osteoporosis were characterized by hypercalcemia and an increase in calcium intestinal absorption. Patients with the active stage of hypercorticism were characterized by hypermagnesemia. Secondary hyperparathyrosis was found in 25% of patients with the active stage of Icenko-Cushing's disease.