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Karpov DS, Sosnovtseva AO, Pylina SV, Bastrich AN, Petrova DA, Kovalev MA, Shuvalova AI, Eremkina AK, Mokrysheva NG. Challenges of CRISPR/Cas-Based Cell Therapy for Type 1 Diabetes: How Not to Engineer a "Trojan Horse". Int J Mol Sci 2023; 24:17320. [PMID: 38139149 PMCID: PMC10743607 DOI: 10.3390/ijms242417320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Type 1 diabetes mellitus (T1D) is an autoimmune disease caused by the destruction of insulin-producing β-cells in the pancreas by cytotoxic T-cells. To date, there are no drugs that can prevent the development of T1D. Insulin replacement therapy is the standard care for patients with T1D. This treatment is life-saving, but is expensive, can lead to acute and long-term complications, and results in reduced overall life expectancy. This has stimulated the research and development of alternative treatments for T1D. In this review, we consider potential therapies for T1D using cellular regenerative medicine approaches with a focus on CRISPR/Cas-engineered cellular products. However, CRISPR/Cas as a genome editing tool has several drawbacks that should be considered for safe and efficient cell engineering. In addition, cellular engineering approaches themselves pose a hidden threat. The purpose of this review is to critically discuss novel strategies for the treatment of T1D using genome editing technology. A well-designed approach to β-cell derivation using CRISPR/Cas-based genome editing technology will significantly reduce the risk of incorrectly engineered cell products that could behave as a "Trojan horse".
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Affiliation(s)
- Dmitry S. Karpov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (D.S.K.); (A.O.S.); (M.A.K.); (A.I.S.)
| | - Anastasiia O. Sosnovtseva
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (D.S.K.); (A.O.S.); (M.A.K.); (A.I.S.)
| | - Svetlana V. Pylina
- Endocrinology Research Centre, 115478 Moscow, Russia; (S.V.P.); (A.N.B.); (D.A.P.); (A.K.E.)
| | - Asya N. Bastrich
- Endocrinology Research Centre, 115478 Moscow, Russia; (S.V.P.); (A.N.B.); (D.A.P.); (A.K.E.)
| | - Darya A. Petrova
- Endocrinology Research Centre, 115478 Moscow, Russia; (S.V.P.); (A.N.B.); (D.A.P.); (A.K.E.)
| | - Maxim A. Kovalev
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (D.S.K.); (A.O.S.); (M.A.K.); (A.I.S.)
| | - Anastasija I. Shuvalova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia; (D.S.K.); (A.O.S.); (M.A.K.); (A.I.S.)
| | - Anna K. Eremkina
- Endocrinology Research Centre, 115478 Moscow, Russia; (S.V.P.); (A.N.B.); (D.A.P.); (A.K.E.)
| | - Natalia G. Mokrysheva
- Endocrinology Research Centre, 115478 Moscow, Russia; (S.V.P.); (A.N.B.); (D.A.P.); (A.K.E.)
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Dobreva EA, Gorbacheva AM, Bibik EE, Eremkina AK, Elfimova AR, Salimkhanov RK, Kovaleva EV, Maganeva IS, Mokrysheva NG. Cardiovascular and metabolic status in patients with primary hyperparathyroidism: a single-center experience. Front Endocrinol (Lausanne) 2023; 14:1266728. [PMID: 37842310 PMCID: PMC10570793 DOI: 10.3389/fendo.2023.1266728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Cardiovascular diseases (CVD) and metabolic disorders (MD) have retained leading positions in the structure of morbidity and mortality for many years. Primary hyperparathyroidism (PHPT) is also associated with a greater incidence of CVD and MD. The aim of the present study was to describe the prevalence and structure of CVD and MD in hospitalized patients with PHPT and to search for possible associations between these pathologies. Methods 838 patients with a verified PHPT were included in the study. The studied cohort was divided into 2 groups according to their age at the time of admission: patients aged 18 to 49 years (group A, n = 150); patients aged 50 years and older (group B, n = 688). Results There were no significant differences between two groups in parameters of calcium-phosphorus metabolism. Obesity was diagnosed in 24.2% of patients in group A and in 35.9% in group B. Type 2 diabetes mellitus was more common in older patients (14.4% in group B vs. 2.6% in group A). Arterial hypertension, ischemic heart disease, chronic heart failure and brachiocephalic arteries atherosclerosis were more frequent in older patients, occurring in 79.1%, 10.8%, 8.4%, and 84% of cases respectively. The cutoff points that increased the risk of CVD detection turned out to be age above 56 years, eGFR below 92 ml/min/1.73m2, BMI above 28.3 kg/m2. Discussion The present study demonstrated a high incidence of some CVD, as well as disorders of lipid, carbohydrate and purine metabolism in patients with PHPT.
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Affiliation(s)
- Ekaterina A. Dobreva
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Anna M. Gorbacheva
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Ekaterina E. Bibik
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Anna K. Eremkina
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Alina R. Elfimova
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Rustam Kh. Salimkhanov
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Elena V. Kovaleva
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Irina S. Maganeva
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
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Mokrysheva NG, Eremkina AK, Elfimova AR, Kovaleva EV, Miliutina AP, Bibik EE, Gorbacheva AM, Dobreva EA, Maganeva IS, Krupinova JA, Salimkhanov RH, Aboishava LA, Karaseva EV, Melnichenko GA, Dedov II. The Russian registry of primary hyperparathyroidism, latest update. Front Endocrinol (Lausanne) 2023; 14:1203437. [PMID: 37465121 PMCID: PMC10352025 DOI: 10.3389/fendo.2023.1203437] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction Until recently no major epidemiological research of primary hyperparathyroidism (PHPT) has been conducted in the Russian Federation, this led to the creation of the Russian online registry. The objective of this study is to estimate the clinical and biochemical profile, classical and non-classical complications, surgical intervention and medical therapy of the patients with different forms of PHPT in the Russian Federation. Materials and methods The cross-sectional, observational, continuous study was conducted at the Endocrinology Research Centre (Moscow). The present study explored retrospective data from 6003 patients submitted to the Registry between 12.12.2016 and 25.10.2022 from 81 regions of the Russian Federation (http://pgpt.clin-reg.ru/). Results The median age was 59 [60; 66] years with a female:male ratio of 11.7:1. Symptomatic PHPT was observed in 74.3% while asymptomatic form - only in 25.7% of cases. Bone pathology was the predominant clinical manifestation in 62.5% of cases (n=2293), mostly in combination with visceral complications 45.7% (n=1676). The majority of patients (63.3%) had combined visceral disorders including kidney damage in 51.8% and gastroduodenal erosions/ulcers in 32.3% of patients. Symptomatic patients were older (60 [53; 67] vs. 54 [45; 62] years, p<0.001) and had more severe biochemical alterations of calcium-phosphorus metabolism. Cardiovascular disease (СVD) was recorded in 48% of patients, among them the most frequent was arterial hypertension (up to 93.9%). A genetic test was conducted in 183 cases (suspicious for hereditary PHPT) revealing the mutations in MEN1, CDC73, RET genes in 107, 6 and 2 cases, respectively. Surgery was performed in 53.4% of patients with remission achievement in 87%, the relapse/persistence were recorded in 13% of cases. Histological examination revealed carcinoma in 4%, atypical adenoma in 2%, adenoma in 84% and hyperplasia in 11% of cases. Drug therapy was prescribed in 54.0% of cases, most often cholecalciferol. Conclusion The detection rate of PHPT has increased in the Russian Federation in recent years. This increase is associated with the start of online registration. However, the majority of patients remain symptomatic with significant alterations of phosphorus-calcium metabolism that indicates delayed diagnosis and requires further modifications of medical care.
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Affiliation(s)
| | - Anna K. Eremkina
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Alina R. Elfimova
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Elena V. Kovaleva
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | | | - Ekaterina E. Bibik
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Anna M. Gorbacheva
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Ekaterina A. Dobreva
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Irina S. Maganeva
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Julia A. Krupinova
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Rustam H. Salimkhanov
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Lizaveta A. Aboishava
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | - Elena V. Karaseva
- Department of Parathyroid Glands Pathology, Endocrinology Research Centre, Moscow, Russia
| | | | - Ivan I. Dedov
- Directorate, Endocrinology Research Centre, Moscow, Russia
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Bibik EE, Dobreva EA, Elfimova AR, Miliutina AP, Eremkina AK, Gorbacheva AM, Krupinova JA, Koksharova EO, Sklyanik IA, Mayorov AY, Mokrysheva NG. Primary hyperparathyroidism in young patients is associated with metabolic disorders: a prospective comparative study. BMC Endocr Disord 2023; 23:57. [PMID: 36890506 PMCID: PMC9995253 DOI: 10.1186/s12902-023-01302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/14/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Components of metabolic syndrome can be observed in patients with primary hyperparathyroidism (PHPT). The link between these disorders remains unclear due to the lack of relevant experimental models and the heterogeneity of examined groups. The effect of surgery on metabolic abnormalities is also controversial. We conducted a comprehensive assessment of metabolic parameters in young patients with PHPT. METHODS One-center prospective comparative study was carried out. The participants underwent a complex biochemical and hormonal examination, a hyperinsulinemic euglycemic and hyperglycemic clamps, a bioelectrical impedance analysis of the body composition before and 13 months after parathyroidectomy compared to sex-, age- and body mass index matched healthy volunteers. RESULTS 45.8% of patients (n = 24) had excessive visceral fat. Insulin resistance was detected in 54.2% of cases. PHPT patients had higher serum triglycerides, lower M-value and higher C-peptide and insulin levels in both phases of insulin secretion compared to the control group (p < 0.05 for all parameters). There were tendencies to decreased fasting glucose (p = 0.031), uric acid (p = 0.044) and insulin levels of the second secretion phase (p = 0.039) after surgery, but no statistically significant changes of lipid profile and M-value as well as body composition were revealed. We obtained negative correlations between percent body fat and osteocalcin and magnesium levels in patients before surgery. CONCLUSION PHPT is associated with insulin resistance that is the main risk factor of serious metabolic disorders. Surgery may potentially improve carbohydrate and purine metabolism.
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Affiliation(s)
- Ekaterina E. Bibik
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Centre, Dm. Ulyanova St., 11, Moscow, 117036 Russia
| | - Ekaterina A. Dobreva
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Centre, Dm. Ulyanova St., 11, Moscow, 117036 Russia
| | - Alina R. Elfimova
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Centre, Dm. Ulyanova St., 11, Moscow, 117036 Russia
| | - Anastasiia P. Miliutina
- Department of Registers of Endocrinopathies, Endocrinology Research Centre, Dm. Ulyanova St., 11, Moscow, 117036 Russia
| | - Anna K. Eremkina
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Centre, Dm. Ulyanova St., 11, Moscow, 117036 Russia
| | - Anna M. Gorbacheva
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Centre, Dm. Ulyanova St., 11, Moscow, 117036 Russia
| | - Julia A. Krupinova
- Department of Parathyroid Pathology and Mineral Disorders, Endocrinology Research Centre, Dm. Ulyanova St., 11, Moscow, 117036 Russia
| | - Ekaterina O. Koksharova
- Laboratory of Clamp-Technology, Endocrinology Research Centre, Dm. Ulyanova St., 11, Moscow, 117036 Russia
| | - Igor A. Sklyanik
- Laboratory of Clamp-Technology, Endocrinology Research Centre, Dm. Ulyanova St., 11, Moscow, 117036 Russia
| | - Alexander Y. Mayorov
- Laboratory of Clamp-Technology, Endocrinology Research Centre, Dm. Ulyanova St., 11, Moscow, 117036 Russia
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Matyushkina AS, Gorbacheva AM, Tkachuk AV, Eremkina AK, Mokrysheva NG. [Case of clinically "aggressive" course of primary hyperparathyroidism, algorithm of differential diagnosis]. Probl Endokrinol (Mosk) 2022; 68:59-66. [PMID: 36689712 PMCID: PMC9939965 DOI: 10.14341/probl13159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/31/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023]
Abstract
Primary hyperparathyroidism (PHPT) is a significant endocrine disease caused by increased production of parathyroid hormone (PTH) by altered parathyroid glands and violation of the mechanisms of regulation of serum calcium concentrations. These changes can lead to nephrolithiasis, osteoporosis, erosive and ulcerative lesions of the gastrointestinal tract, a number of less specific symptoms (nausea, vomiting, weakness, fatigue, etc.). Etiologically, in more than 85% of cases, PHPT is a consequence of sporadic solitary adenoma or hyperplasia parathyroid glands, however, in 1-3% of cases, the cause is carcinoma of parathyroid glands , including as part of various genetic syndromes. The importance of timely examination for PHPT of patients with characteristic clinical manifestations of this disease and - with an aggressive course - alertness towards carcinomas of parathyroid glands was noted. At the same time, the severity of the clinical picture and even the presence of suspicious signs characteristic of hereditary forms of carcinomas of parathyroid glands are not always a consequence of the malignant process. We present a description of a young patient with a severe course of PHPT, multiple fractures and a voluminous tumor of the upper jaw, developed as a result of a typical adenoma of parathyroid glands. Additionally, the algorithm of pre- and postoperative differential diagnosis for such patients is highlighted.
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Eremkina AK, Gorbacheva AM, Enenko VA, Litvinova EE, Mokrysheva NG. [Experience in using teriparatide for the treatment of postoperative hypoparathyroidism in hemodialysis patients]. Probl Endokrinol (Mosk) 2022; 68:30-39. [PMID: 36104963 DOI: 10.14341/probl13075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 01/01/2023]
Abstract
The frequency of chronic postoperative hypoparathyroidism after total parathyroidectomy for secondary and tertiary hyperparathyroidism in patients with end-stage renal failure, according to various authors, can reach 20% or more. Prescribing active metabolites of vitamin D and calcium it is not always sufficient for achievement of target goals. This dictates the need for replacement therapy with recombinant parathyroid hormone. Teriparatide is the only drug of this series approved by the American Food and Drug Administration (FDA) and registered in the Russian Federation. However, it is registered as an anabolic anti-osteoporotic drug and is not indicated for the treatment of chronic hypoparathyroidism. The use of teriparatide in postoperative hypoparathyroidism in patients receiving renal replacement therapy with programmed hemodialysis in the Russian Federation has not been previously studied. Data on this issue is also limited in foreign literature. However, it is a potential treatment option for hemodialysis patients with chronic hypoparathyroidism and severe bone disorders. In this article, we present 2 clinical cases of substitution and anabolic therapy with teriparatide in this cohort of patients.
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Kovaleva EV, Eremkina AK, Elfimova AR, Krupinova JA, Bibik EE, Maganeva IS, Gorbacheva AM, Dobreva EA, Melnichenko GA, Mokrysheva NG. The Russian Registry of Chronic Hypoparathyroidism. Front Endocrinol (Lausanne) 2022; 13:800119. [PMID: 35250859 PMCID: PMC8889095 DOI: 10.3389/fendo.2022.800119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/13/2022] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Chronic hypoparathyroidism is a relatively rare disease associated with multicomponent medical therapy and various complications. The analysis of large databases of patients with chronic hypoparathyroidism is a necessary tool to enhance quality of medical care, as well as to determine the optimal clinical and therapeutic approaches, and prognostic markers of the disease. THE AIM of this study is to estimate the clinical and biochemical profile, long-term complications, medical therapy and disease control of the patients with chronic postsurgical and non-surgical hypoparathyroidism. MATERIALS AND METHODS the cross-sectional, observational, continuous study was based on the Russian Registry of patients with hypoparathyroidism. 544 patients from 63 regions of the Russian Federation were included in this study. RESULTS The majority of cases had postsurgical etiology (88.4%). Postsurgical hypoparathyroidism prevailed in females (р<0.001). About a half of patients had blood calcium and phosphorus targets, 56 and 52% respectively. Nephrolithiasis was confirmed in 32.5%, nephrocalcinosis - in 12.3% of cases. The risk of nephrocalcinosis/nephrolithiasis increased by 1.85 times with disease duration more than 4.5 years. The cataract was found in 9.4%. The cut-off point for the development of cataracts was 9.5 years, with a 6.96-fold increased risk. The longer duration of hypoparathyroidism of any etiology was associated with more frequent cataract (p=0.0018).We found brain calcification in 4%, arrhythmias in 7.2% and neuropsychiatric symptoms in 5.15% of cases. Generally, the BMD in the studied group corresponded to age values, and there was no evidence for the phenomenon of high bone density. TBS was consistent with normal bone microarchitectonics. In our study, the majority of patients (83.5%) was treated with standard therapy of calcium and vitamin D supplements. 5 patients with severe disease course were treated with rhPTH (1-34). CONCLUSIONS Analysis of the presented database indicates insufficient diagnosis of the complications associated with chronic hypoparathyroidism. Overall, hypoparathyroidism is associated with higher risks of renal stone formation, decreased GFR, cataract especially in patients with longer duration of disease.
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Krupinova JA, Elfimova AR, Rebrova OY, Voronkova IA, Eremkina AK, Kovaleva EV, Maganeva IS, Gorbacheva AM, Bibik EE, Deviatkin AA, Melnichenko GA, Mokrysheva NG. Mathematical model for preoperative differential diagnosis for the parathyroid neoplasms. J Pathol Inform 2022; 13:100134. [PMID: 36268079 PMCID: PMC9577121 DOI: 10.1016/j.jpi.2022.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background and objective Methods Results Conclusions
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Affiliation(s)
- Julia A. Krupinova
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
| | - Alina R. Elfimova
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
| | - Olga Yu. Rebrova
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
- Pirogov Russian National Research Medical University, 117997, Ostrovityanova str., 1, Moscow, Russian Federation
| | - Iya A. Voronkova
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
| | - Anna K. Eremkina
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
| | - Elena V. Kovaleva
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
| | - Irina S. Maganeva
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
| | - Anna M. Gorbacheva
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
- Corresponding author.
| | - Ekaterina E. Bibik
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
| | - Andrey A. Deviatkin
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
| | - Galina A. Melnichenko
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
| | - Natalia G. Mokrysheva
- Endocrinology Research Centre, 117292, Dm. Ulyanova str., 11, Moscow, Russian Federation
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Mokrysheva NG, Eremkina AK, Kovaleva EV, Krupinova JA, Vikulova OK. Modern problems of hyper- and hypoparathyroidism. TERAPEVT ARKH 2021; 93:1149-1154. [DOI: 10.26442/00403660.2021.10.201109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
The parathyroid glands are the most important regulators of mineral metabolism. The parathyroid glands were first discovered only in 1880 and their function went the long way unrecognized. Even the term "parathyroid gland" itself speaks of the initial misconception of it as an underdeveloped part of the thyroid. To date, there is a large amount of data regarding the role of this endocrine gland in the human body and the significant changes associated with their dysfunction, including such widespread diseases such primary, secondary and tertiary hyperparathyroidism, hypoparathyroidism. This review covers the problem of the main disturbances in calcium-phosphorus metabolism, presents the results of databases of patients with primary hyperparathyroidism and hypoparathyroidism, as well as current epidemiological trends in Russia and in the world.
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Larina II, Severina AS, Maganeva IS, Ainetdinova AR, Eremkina AK, Gavrilova AO, Shamhalova MS, Dmitriev IV, Pinchuk AV, Shestakova MV. Advanced glycation end products and oxidative stress as a basis for metabolic abnormalities in patients with type 1 diabetes after successful simultaneous pancreas-kidney transplantation. TERAPEVT ARKH 2021; 93:1155-1163. [DOI: 10.26442/00403660.2021.10.201100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
Aim. To compare advanced glycation end-products (AGE, RAGE) and 3-nitrotyrosine (3-HT) in patients with DM 1 after successful simultaneous pancreas-kidney transplantation (SPK) and kidney transplantation alone (KTA). To assess relationship between levels of AGE, RAGE, 3-HT and renal transplant (RT) function, carbohydrate and mineral metabolism.
Materials and methods. The study included 58 patients who received kidney transplantation in end-stage renal disease (ESRD). 36 patients received SPK. There were performed routine laboratory, examination of AGE, RAGE, 3-NT, parathyroid hormone (PTH), 25(OH)vitamin D, calcium, phosphorus, FGF23, osteoprotegerin (OPG), and fetuin-A levels.
Results. All patients after SPK reached normoglycemia (HbA1c 5.7 [5.3; 6.1] %; C-peptide 3.24 [2.29; 4.40] ng/ml) with the achievement of significant difference vs patients after KTA. Arterial hypertension (AH) was more frequent in recipients of SPK before transplantation than after (p=0.008). AH also persisted in greater number of cases in patients after KTA than after SPK. Patients after SPK had higher AGE (р=0.0003) and lower RAGE (р=0.000003) levels. OPG in patients after SPK was significantly higher (р=0.04). The correlation analysis revealed significant positive correlation between 3-HT and OPG (p0.05; r=0.30), RAGE and eGFR (r=-0.52), HbA1c (r=0.48), duration of AH (r=0.34), AGE with HbA1c (r=0.51).
Conclusion. The results of the "metabolic memory" markers analysis may indicate their contribution to the persistence of the metabolic consequences of CKD and DM 1 after achievement of normoglycemia and renal function restoration and their possible participation in development of recurrent nephropathy, vascular calcification, and bone disorders.
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Mokrysheva NG, Kovaleva EV, Eremkina AK. [Registries of parathyroid glands diseases in the Russian Federation]. ACTA ACUST UNITED AC 2021; 67:4-7. [PMID: 34533008 DOI: 10.14341/probl12803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/06/2022]
Abstract
The most important and effective way to organize nationwide the healthcare, as well as monitoring and routing for patients with endocrine diseases, is the creation of an unified medical record (Endocard). The Endocard is also aimed at maximizing the opportunity for professionals and researchers on various scientific issues. Registries are the potential informational and analytical platform to achieve this goal. They include the basic information on the epidemiological and clinical features of the most severe diseases such as diabetes mellitus. Given the lack of large-scale epidemiological data on the parathyroid glands pathology - primary hyperparathyroidism and hypoparathyroidism - the registers of these diseases that collects a common dataset and clinician and patient reported outcomes are of particular interest.
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Kovaleva EV, Eremkina AK, Krupinova JA, Mirnaya SS, Kim IV, Kuznetzov NS, Andreeva EN, Karonova TL, Kryukova IV, Mudunov AM, Sleptcov IV, Melnichenko GA, Mokrysheva NG, Dedov II. [Review of clinical practice guidelines for hypoparathyroidism]. ACTA ACUST UNITED AC 2021; 67:68-83. [PMID: 34533015 DOI: 10.14341/probl12800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/06/2022]
Abstract
Hypoparathyroidism is a rare disorder characterized by the absent or inappropriately decreased serum parathyroid hormone in the parathyroid glands, which is accompanied by impaired calcium-phosphorus metabolism.The main etiology of hypoparathyroidism remains damage or removal of the parathyroid glands during neck surgery. In view of the incidence of thyroid cancer, primary hyperparathyroidism and other pathologies of the neck organs, which radical treatment can lead to the parathyroid gland impairment, an increased number of patients with hypoparathyroidism is expected. Autoimmune hypoparathyroidism is the second most common form of the disease, usually occurring as part of type 1 autoimmune polyglandular syndrome. Autoimmune hypoparathyroidism usually occurs in childhood and is characterized by a severe course of the disease, especially in the case of concomitant malabsorption syndrome.Chronic hypoparathyroidism of any etiology requires lifelong multicomponent therapy, as well as careful monitoring and an individual approach to choose the optimal treatment strategy. In the absence of adequate follow-up, the risks of long-term complications significantly increase, particularly in the renal, cardiovascular systems; in the soft tissues and in the brain, it could lead to visual disturbances; pathology of the musculoskeletal system with a decreased bone remodeling and a potential risk of fractures, as well as to the neurocognitive disorders and an impaired health-related quality of life.Timely diagnosis, rational medical therapy and management strategy may reduce the risks of short-term and long-term complications, frequency of hospitalizations and disability of patients, as well as improve the prognosis.This review covers the main issues of Russian guidelines for the management of chronic hypoparathyroidism, approved in 2021, including laboratory and instrumental evaluation, treatment approaches and follow-up. This guidelines also include the recommendations for special groups of patients: with acute hypocalcemia, hypoparathyroidism during pregnancy.
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Affiliation(s)
| | | | | | | | - I V Kim
- Endocrinology Research Center
| | | | | | - T L Karonova
- National Medical Research Center. V. A. Almazova
| | - I V Kryukova
- Moscow Regional Research Clinical Institute. M.F. Vladimirskogo
| | - A M Mudunov
- National Medical Research Center of Oncology named after V.I. N.N. Blokhin
| | - I V Sleptcov
- Clinic of high medical technologies. N.I. Pirogov St. Petersburg State University
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Kovaleva EV, Eremkina AK, Ajnetdinova AR, Miliutina AP, Mokrysheva NG. [The Russian registry of chronic hypoparathyroidism and clinical decision support system integration]. ACTA ACUST UNITED AC 2021; 67:8-12. [PMID: 34533009 DOI: 10.14341/probl12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Abstract
According to available research, chronic hypoparathyroidism is a relatively rare disease characterized by low serum calcium levels and the absence or deficiency of parathyroid hormone. The chronic course of the disease is associated with the multicomponent medical therapy, careful dynamic monitoring to reduce the risks of various complications in different organs and systems as well as disability and mortality.The Russian registry of patients with chronic postsurgical and nonsurgical hypoparathyroidism has started its work in 2020, based on data of the Endocrinology Research Centre. The main goals of the Registry are the assessment of the actual prevalence, incidence of hypoparathyroidism, the key epidemiological characteristics, the analysis of the clinical features and medical therapy of chronic hypoparathyroidism in Russian Federation.This article covers all objectives of this project, the methodology for maintaining the registry of chronic postsurgical and nonsurgical hypoparathyroidism, the analytical possibilities of its use, including the integration of a decision support system designed to help specialists in real clinical practice follow the algorithms for diagnosis and treatment of the disease, approved by clinical guidelines.The registry of chronic postsurgical and nonsurgical hypoparathyroidism is located on a single platform for the registers of endocrinopathies, regulated by the Endocrinology Research Centre (http://gipopt.clin-reg.ru/).
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Zheleznyakova AV, Volodicheva VL, Vikulova OK, Serkov AA, Eremkina AK, Shestakova MV, Mokrysheva NG. Evaluation of calcium level in patients with diabetes mellitus according to the examination in the mobile medical center (Diamodule). CM 2021. [DOI: 10.26442/20751753.2021.4.200834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background. Diabetes mellitus (DM) is characterized by multiple risk factors for the combined development of disorders of phosphorus-calcium metabolism, due to more frequent overweight, decreased renal filtration function and vitamin D deficiency in this category of patients. Aim. To assess the level of calcium in blood serum and its correlations with parameters of carbohydrate metabolism, body mass index (BMI) and renal function in patients with type 1 and type 2 diabetes. Materials and methods. The object of the study: adult patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) ≥18 years old who underwent examination in Diamodule (n=294) in 2019 in the Voronezh region, who were additionally tested for serum calcium. The examination at the mobile medical center includes: assessment of anthropometric data (height, weight, BMI), biochemical data of blood lipids and creatinine levels with calculation of glomerular filtration rate (GFR-EPI), albuminuria and the albumin/creatinine in a single portion of urine, measurement of glycated hemoglobin (HbA1c), blood pressure, electrocardiogram, consultation with a cardiologist, ophthalmologist, specialist of the Diabetic Foot office, diabetologist. All biochemical parameters was carried out using commercial kits on a biochemical express analyzer Spotchem EZ ArkraySP-4430. Determination of HbA1c, albuminuria, albumin/creatinine was performed by immunochemical method on a DCA Vantage analyzer. Data analysis was carried out using the Statistica v.13.3 software package (TIBCO Software Inc., USA). The results are presented as medians and quartiles [25; 75], the level of reliability is taken as p<0.05. Results. Hypocalcemia (serum calcium level less 2.15 mmol/L) was detected in 88.3% of patients with T1DM and 73.6% of patients with T2DM. The level of serum calcium in T1DM was 1.96 [1.83; 2.07], in T2DM – 2.04 [1.97; 2.16] (p<0.001) with significant differences in GFR: in T1DM 69.6 [57.8; 82.5], with T2DM 50.5 [44.1; 59.9] (p<0.001). We observed correlation between GFR and calcium level r=-0.3 (p<0.05,). GFR<60 ml/min/1.73 m² was observed in 30.5% of T1DM patients, in 75.0% of T2DM. The HbA1c in T1DM was 8.7% [7.7; 9.8], in T2DM – 8.3% [6.8; 9.4] (p=0.01). Obesity was revealed in T1DM in 12.3%, in T2DM in 71.4%; the median BMI in T1DM was 25.5 kg/m2 [21.9; 28.4], in T2DM – 33.2 kg/m2 [29.7; 37.9]. There was correlation between BMI and calcium level r=0.26 (p<0.05). Conclusion. The results of the study revealed a high prevalence of hypocalcemia among patients with diabetes, the most pronounced in type 1 diabetes. In the presence of a correlation between calcium and GFR, there was a high incidence of hypocalcemia in patients with T1DM, even in the absence of a significant decrease in GFR, which may indicate to additional risk factors. Since the assessment of the level of calcium is not included in the list of standard clinical examination, it is recommended to include this parameter and conduct regular screening in risk groups, which include patients with diabetes. More extensive research is needed to analyze the factors.
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Abstract
The parathyroid glands (PTGs) are a key regulator of calcium and phosphorus metabolism in the human body. In terms of their, morphological and immunophenotypic characteristics, PTGs are neuroendocrine organs, and their neoplasms are neuroendocrine tumors. These neoplasms include adenoma and cancer; in addition, glandular hyperplasia may develop, which is most characteristic of multiple endocrine neoplasia (MEN1, MEN2a, and MEN4) syndromes. The morphological characteristics of pathologically altered PTGs in MEN syndromes are variable. The analysis and generalization of knowledge about the features and expression of various immunohistochemical markers in PTG tissue in health and in diseases are useful in the practical work of not only pathologists, but also clinicians of various specialties.
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Affiliation(s)
- I A Voronkova
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia.,M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - A K Eremkina
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia
| | - Yu A Krupinova
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia
| | - L E Gurevich
- M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - N G Mokrysheva
- National Medical Research Center of Endocrinology of the Ministry of Health of Russia, Moscow, Russia
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Dobreva EA, Bibik EE, Eremkina AK, Ajnetdinova AR, Nikankina LV, Malysheva NM, Mokrysheva NG. [Dynamic changes of renin-angiotensin-aldosterone system parameters after surgery of primary hyperparathyroidism]. TERAPEVT ARKH 2020; 92:63-69. [PMID: 33346481 DOI: 10.26442/00403660.2020.10.000725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
AIM To study an activity of the Renin-Angiotensin-Aldosterone System (RAAS) components in patients with primary hyperparathyroidism (PHPT) before and after parathyroidectomy (PTE). MATERIALS AND METHODS A comparative study of patients with PHPT and control group. The first stage of the study included 56 patients with PHPT (group 1) before and on the third day after PTE. The second stage was carried out in 27 patients with remission of PHPT (group 2). All patients and healthy volunteers were tested for the main parameters of phosphorus-calcium metabolism and the RAAS parameters (plasma renin activity PRA, serum aldosterone, angiotensin II AT II). RESULTS Patients with active PHPT demonstrated changes in RAAS activity (lower PRA, higher AT II level) comparing to control group, that have statistical significance in group 1 (p0.001 for both parameters). There were no significant differences in aldosterone levels (p1=0.090;p2=0.140). On the third day after PTE (group 1), a decrease in aldosterone level (p=0.009) and a tendency to decrease in PRA (p=0.030) were detected. However, an increase in PRA (p=0.018), a decrease in AT II concentration (p=0.032) comparing to the initial values and their normalization were observed 12 months after surgery when permanent normal serum calcium and PTH levels had been achieved. There were controversial correlations between the parameters of phosphorus-calcium metabolism and RAAS. The influence of angiotensin-converting-enzyme inhibitors and AT II receptor blockers on phosphorus-calcium metabolism in patients with PHPT was not observed. CONCLUSION In patients with PHPT, there were no сlear correlations of phosphorus-calcium metabolism parameters with RAAS, however an increase of AT II concentration was noted, that can take part in a development of hypertension for this endocrinopathy. PTE can have a positive effect on AT II level.
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Krupinova JA, Almaskhanova AA, Eremkina AK, Bibik EE, Vasilyev EV, Mokrysheva NG. [A series of clinical cases of familial hypocalciuric hypercalcemia syndrome]. ACTA ACUST UNITED AC 2020; 66:61-69. [PMID: 33369373 DOI: 10.14341/probl12537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 12/19/2022]
Abstract
Familial hypocalciuric hypercalcemia (FHH) - rare disease with predominantly autosomal dominant inheritance. FHH typically develops due to a heterozygous inactivating mutation in the calcium-sensitive receptor gene (CASR), less commonly due to heterozygous mutations in GNA11 and AP2S1. CASR mutations lead to an increase in the threshold for calcium sensitivity, which requires a higher concentration in serum to reduce the release of PTH. These changes are accompanied by an increase of calcium and magnesium reabsorption in the proximal tubules, which leads to hypercalcemia and hypocalciuria. Basically, FHH may be asymptomatic or accompanied by mild hypercalcemia. FHH doesn't require surgical treatment, unlike primary hyperparathyroidism (PHPT), therefore, differential diagnosis of these two conditions is extremely important. In addition, immediate relatives of a proband with FHH also require the exclusion of disease inheritance. We analyzed a series of clinical cases with a genetically confirmed diagnosis of FHH. Our clinical cases indicate a variety of clinical manifestations and the difficulties of differential diagnosis with PHPT.
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Kovaleva EV, Ajnetdinova AR, Eremkina AK, Mokrysheva NG. [Evaluation of chronic hypoparathyroidism course according to the Database of Endocrinology Research Centre]. ACTA ACUST UNITED AC 2020; 66:7-14. [PMID: 33369368 DOI: 10.14341/probl12675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 12/26/2022]
Abstract
BACKGRAUND Currently high frequency of thyroid or parathyroid surgery is associated with significant increased incidence of hypoparathyroidism. Evaluation of the epidemiological and clinical features of chronic hypoparathyroidism is necessary to predict social-significant complications and to improve the quality of medical care. AIMS To estimate clinical and demographic features, different regimens and efficacy of conventional therapy in patients with chronic postsurgical and nonsurgical hypoparathyroidism. MATERIALS AND METHODS The cross-sectional, observational, continuous study was carried out based on Database of patients with chronic postsurgical and nonsurgical hypoparathyroidism of Endocrinology Research Centre, Moscow. 293 patients from 61 regions of the Russian Federation were included in this study. Statistical analysis was done on June 2020. The descriptive statistics are presented by medians (Ме) and the first and third quartiles (Q1; Q3) and by absolute and relative frequencies. RESULTS Hypoparathyroidism was most often recorded in women (85%) at the age of 43 [32; 52] years, after thyroid surgery. Less than a half of the study group had target indicators of serum calcium and phosphate levels (31% and 47%, respectively) despite ongoing treatment. A complex instrumental examination for the disease complications was performed in 58% of cases (n = 169). Among them, kidney disorders were detected in 38%, visual disturbance in 14%, brain calcification in 10%, arrhythmias in 4% and neuropsychiatric symptoms in 6%. Conventional therapy with calcium supplements and activated vitamin D analogues was noted in 75% of patients. CONCLUSIONS The analysis of large databases of patients with chronic hypoparathyroidism is a necessary tool for determining of optimal clinical and therapeutic approaches, as well as prognostic markers of disease complications.
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Gorbacheva AM, Eremkina AK, Mokrysheva NG. [Hereditary syndromal and nonsyndromal forms of primary hyperparathyroidism]. ACTA ACUST UNITED AC 2020; 66:23-34. [PMID: 33351310 DOI: 10.14341/probl10357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/21/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
Primary hyperparathyroidism is a common disorder of mineral homeostasis, characterized by overproduction of parathyroid hormone and upper normal or elevated calcium levels due to hyperplasia or a tumor of parathyroid gland. 90−95% of cases of primary hyperparathyroidism are sporadic, while hereditary genetic forms occur in 5–10% of all cases. Primary hyperparathyroidism as the component of hereditary syndromes can present in various clinical forms (asymptomatic, symptomatic), can be associated with other endocrine or non-endocrine diseases, and require special approaches to treatment. Given that primary hyperparathyroidism is one of the most common components of these syndromes, it can be used as an important diagnostic tool in identifying affected families. This review is devoted to modern ideas about the clinical course and genetic characteristics of hereditary variants of primary hyperparathyroidism and the diagnostic and treatment algorithms recommended today. The review considers primary hyperparathyroidism as a component of hereditary syndromes including multiple endocrine neoplasias types 1, 2A and 4 and syndrome of hyperparathyroidism with a jaw tumor. Also non-syndromic hereditary forms are descripted, such as familial isolated hyperparathyroidism, familial hypocalciuric hypercalcemia, and severe neonatal primary hyperparathyroidism.
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20
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Mokrysheva NG, Galstyan GR, Kirzhakov MA, Eremkina AK, Pigarova EA, Melnichenko GA. COVID-19 pandemic and endocrinopathies. ACTA ACUST UNITED AC 2020; 66:7-13. [DOI: 10.14341/probl12376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/11/2020] [Indexed: 12/13/2022]
Abstract
Many endocrinopathies have chronic course; patients with endocrinopathies (above all diabetes mellitus and thyroid diseases) who receive outpatient care on a regular basis amount up to 80% of patients with chronic diseases. Endocrinologists most likely play the role of general practitioners for these patients; therefore, they should quickly and efficiently explain the patients with diabetes, thyroid, hypophysis and adrenal diseases how to behave in new setting of COVID19 pandemic (coronavirus infection). The most severe course of the infection can be observed in patients older than 65 years with chronic diseases, especially endocrinopathies. This review sums up the currently available data on the disease pathogenesis and progression. It also provides information about patient responsibility to prevent infection, special aspects of communication between the patient and the physician in the setting of self-isolation and quarantine, additional care needed in case of COVID19 in patients with most severe endocrinopathies.
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21
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Abstract
A high prevalence of vitamin D deficiency and its negative consequences for health is identified as area of primary concern for scientists and clinicians worldwide. Vitamin D deficiency affects not only bone health but many socially significant acute and chronic diseases. Observational studies support that pregnant and lactating women, children and teenagers represent the high risk groups for developing vitamin D deficiency. Current evidence highlights a crucial role of vitamin D in providing the fetal life-support system and fetus development, including implantation, placental formation, intra- and postpartum periods. Hypovitaminosis D during pregnancy is associated with a higher incidence of placental insufficiency, spontaneous abortions and preterm birth, preeclampsia, gestational diabetes, impaired fetal and childhood growth, increased risk of autoimmune diseases for offsprings. Potential mechanisms for the observed associations contain metabolic, immunomodulatory and antiinflammatory effects of vitamin D. Epigenetic modifications in vitamin D-associated genes and fetal programming are of particular interest. The concept of preventing vitamin D deficiency is actively discussed, including supplementation in different ethnic groups, required doses, time of initiation and therapy duration, influence on gestation and childbirth. An adequate supply of vitamin D during pregnancy improves the maternal and fetal outcomes, short and long term health of the offspring. Still current data on relationship between maternal vitamin D status and pregnancy outcomes remains controversial. The large observational and interventional randomized control trials are required to create evidence-based guidelines for the supplementation of vitamin D in pregnant and lactating women.
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Affiliation(s)
- A K Eremkina
- National Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - N G Mokrysheva
- National Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - E A Pigarova
- National Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - S S Mirnaya
- National Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
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22
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Mokrysheva NG, Eremkina AK, Mirnaya SS, Rozhinskaya LY, Kuznetsov NS, Yesayan RM, Kan NE, Dudinskaya EN. A Case of Pregnancy Complicated by Primary Hyperparathyroidism Due to a Parathyroid Adenoma. Am J Case Rep 2019; 20:53-59. [PMID: 30636767 PMCID: PMC6340266 DOI: 10.12659/ajcr.912436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Primary hyperparathyroidism is most common in women during the menopause and its occurrence in pregnant women is rare. However, because neonatal mortality is associated with maternal hyperparathyroidism, early diagnosis is essential. This report describes the case of a late diagnosis of primary hyperparathyroidism in a 28-year-old pregnant woman and describes the effects on the mother and neonate. CASE REPORT During her second pregnancy, a 28-year-old woman presented with symptoms of general weakness, bone and joint pain, multiple fractures with bone deformity, muscle weakness, and gait disturbance. Due to the high risk of perinatal pathology, a cesarean section was performed. Several weeks later, she underwent thoracoscopic removal of an ectopic parathyroid gland located at the aortic arch. Hypocalcemia in the newborn infant required treatment with calcium and magnesium supplements. CONCLUSIONS This case demonstrates that primary hyperparathyroidism during pregnancy requires timely diagnosis and treatment to reduce potential maternal and fetal complications. Screening for primary hyperparathyroidism should be undertaken in pregnant women with any symptoms associated with hypercalcemia. Treatment should be individualized and includes conservative management, parathyroidectomy in the second trimester, or parathyroidectomy performed in the early postpartum period.
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Affiliation(s)
- Natalia G Mokrysheva
- Department of Parathyroid Gland Pathology, Endocrinology Research Center, The Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Anna K Eremkina
- Department of Parathyroid Gland Pathology, Endocrinology Research Center, The Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Svetlana S Mirnaya
- Department of Parathyroid Gland Pathology, Endocrinology Research Center, The Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Lyudmila Y Rozhinskaya
- Department of Neuroendocrinology and Bone Disease, Endocrinology Research Center, The Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Nikolay S Kuznetsov
- Department of Surgery, Endocrinology Research Center, The Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Rosa M Yesayan
- Department of Therapy, The National Medical Research Center for Obstetrics, Gynecology and Perinatology (named after V.I. Kulakov), Moscow, Russian Federation
| | - Natalia E Kan
- Department of Obstetrics, The National Medical Research Center for Obstetrics, Gynecology and Perinatology (named after V.I. Kulakov), Moscow, Russian Federation
| | - Ekaterina N Dudinskaya
- Laboratory of Age-Related Metabolic and Endocrine Disorders, The Russian Gerontology Clinical Research Center, Moscow, Russian Federation
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23
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Abstract
Non-functioning pituitary adenomas (NFPAs) account for about 30% of all pituitary tumors. NFPAs are characterized by the lack of secretory potential or its weak expression insufficient for determination of the blood level of adenohypophyseal tropic hormones and for development of a specific clinical picture. Morphologically, NFPAs are a heterogeneous group of tumors, the classification of which was previously based only on immunoreactivity for pituitary tropic hormones. The WHO revised its Classification of Tumors of Endocrine Organs (4th edition) in 2017. The main changes relate to adenohypophysial-cell lineage for the designation of adenomas into subtypes. The introduction of transcription factor antibodies has become a fundamentally new approach to the classification of NFPAs, which is necessary to recognize less differentiated tumor types. This paper provides information on the new histopathological classification of pituitary adenomas, on the theories of silent adenomas, and on the proliferative and prognostic markers of NFPAs.
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Affiliation(s)
- A K Eremkina
- National Medical Research Center for Endocrinology, Ministry of Health of Russia, Moscow, Russia
| | - L K Dzeranova
- National Medical Research Center for Endocrinology, Ministry of Health of Russia, Moscow, Russia
| | - E K Pigarova
- National Medical Research Center for Endocrinology, Ministry of Health of Russia, Moscow, Russia
| | - N G Mokrysheva
- National Medical Research Center for Endocrinology, Ministry of Health of Russia, Moscow, Russia
| | - I I Dedov
- National Medical Research Center for Endocrinology, Ministry of Health of Russia, Moscow, Russia
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24
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Abstract
A high prevalence of vitamin D deficiency and its negative consequences for health is identified as area of primary concern for scientists and clinicians worldwide. Vitamin D deficiency affects not only bone health but many socially significant acute and chronic diseases. Observational studies support that pregnant and lactating women, children and teenagers represent the high risk groups for developing vitamin D deficiency. Current evidence highlights a crucial role of vitamin D in providing the fetal life-support system and fetus development, including implantation, placental formation, intra - and postpartum periods. Hypovitaminosis D during pregnancy is associated with a higher incidence of placental insufficiency, spontaneous abortions and preterm birth, preeclampsia, gestational diabetes, impaired fetal and childhood growth, increased risk of autoimmune diseases for offsprings. Potential mechanisms for the observed associations contain metabolic, immunomodulatory and antiinflammatory effects of vitamin D. Epigenetic modifications in vitamin D-associated genes and fetal programming are of particular interest. The concept of preventing vitamin D deficiency is actively discussed, including supplementation in different ethnic groups, required doses, time of initiation and therapy duration, influence on gestation and childbirth. An adequate supply of vitamin D during pregnancy improves the maternal and fetal outcomes, short and long term health of the offspring. Still current data on relationship between maternal vitamin D status and pregnancy outcomes remains controversial. The large observational and interventional randomized control trials are required to create evidence-based guidelines for the supplementation of vitamin D in pregnant and lactating women.
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25
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Abstract
Hypoparathyroidism is an endocrine disease that results from deficiency or complete absence of parathyroid hormone (PTH), a biologically active 84-amino acid polypeptide. Standard therapy for chronic hypoparathyroidism includes oral calcium salts and active vitamin D metabolites and is aimed at maintaining a balance between optimal near-normal serum calcium concentration and normocalcuria. Traditional treatment regimens not always lead to the compensation for calcium and phosphorus metabolism. Until recently, hypoparathyroidism is the only endocrine disorder that has not been treated with the recombinant hormone. To date, two recombinant PTH forms have been synthesized, which can be used as pathogenetic therapy for hypoparathyroidism. This review is dedicated to replacement therapy for hypoparathyroidism, by using both the full-length PTH molecule (1-84) and its shorter, but fully active, PTH form (1-34). This review considers stages in the developmental of hormone replacement therapy for hypoparathyroidism, discusses the most rational dosing regimens, and compares their efficacy and safety, as well as prospects for the development of this area.
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Affiliation(s)
- A K Eremkina
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - N G Mokrysheva
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - E V Kovaleva
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - Yu A Krupinova
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
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