Case report: Clinical characteristics and treatment of secondary osteoporosis induced by X-linked congenital adrenal dysplasia

OBJECTIVE

To summarize the clinical features and bone complications in a patient from a large family with X-linked congenital adrenocortical hypoplasia (AHC) and evaluate the efficacy of different treatment regimens on the prognosis of secondary osteoporosis caused by AHC at a 5-year follow-up.

METHODS

A large family with AHC was recruited, and the causative gene mutation was identified by Sanger sequencing in the proband. Clinical features as well as radiological examinations and laboratory indices of osteoporosis secondary to AHC were analyzed in this study. Meanwhile, the proband was treated with classical antiresorptive drugs (bisphosphonates) for 2 years and switched to a vitamin K₂ analogue for another 3 years, during which the efficacy of the drugs was evaluated.

RESULTS

The proband was identified as carrying a homozygous insertion mutation (p. Thr193GlyfsX13) in the NR0B1 (nuclear receptor subfamily 0, group B, member 1) gene, resulting in a premature stop codon due to a frameshift mutation. During treatment and follow-up, the proband did not respond well to bisphosphonate and developed atypical femoral fractures. Vitamin K₂ improved clinical symptoms. In terms of bone mineral density (BMD), there is no evidence of any effect of vitamin K₂ on the neck of femur, though some minor effects on spinal BMD cannot be excluded.

CONCLUSIONS

Secondary osteoporosis induced by AHC deserves clinical attention. Unlike in primary osteoporosis, the curative effect of bisphosphonates was unsatisfactory and was more likely to cause atypical femoral fractures in long-term treatment. It is suggested that bone anabolic drugs may be better alternatives.

Thyrotropin levels and severity of symptoms in migraine patients of tertiary headache center

BACKGROUND

The role of thyroid regulation in migraine is poorly understood, and data is contradictory.

OBJECTIVE

To study the possible association of clinical features of migraine with patients' thyroid function.

PATIENTS AND METHODS

One hundred and thirty migraine patients of a tertiary headache center took part in an open-label, cross-sectional comparative study. The Migraine Disability Assessment questionnaire, Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory, Vanderbilt's Questionnaire of Pain Management, Gothenburg Quality of Life Questionnaire and Migraine-Specific Quality of Life questionnaire were used. The effectiveness of the attacks' therapy was assessed according to the Migraine Assessment of Current Therapy questionnaire. Levels of thyrotropine (thyroid stimulating hormone), thyroxine, and triiodothyronine were studied by standard immune chemiluminescent method using the Immulite-2000 set.

RESULTS

An inverse correlation between levels of thyroid stimulating hormone in serum and duration of headache attacks was revealed. The effectiveness of abortive therapy for attacks showed a statistically significant positive correlation with thyroid stimulating hormone level. Quality of life measured by a general quality of life questionnaire, as well as the functional and social indices of a migraine-specific questionnaire, showed direct correlation with serum thyroid stimulating hormone.

CONCLUSION

These results show an association of a more severe clinical course of migraine with lower thyroid stimulating hormone levels.

[PET in gliomas. Overview of current studies]

Gliomas which represent 30% of intracranial tumours are morphologic lesions and therefore CT and MRI are the first line diagnostic procedures with MRI giving better soft tissue resolution and permitting additional functional information. These mainly morphologic imaging modalities yield only restricted information on grade of malignancy, on infiltration into and effects on surrounding brain tissue, on differentiation between necrotic and recurrent tumour, on prognosis and on efficacy of treatment. Information on these important issues for patient management can be obtained by PET-studies of glucose metabolism with FDG, of aminoacid-uptake and protein synthesis with 11C-methionin, 18F-fluorethyltyrosin and 18F-fluor-deoxyphenylalanin and of proliferation by 18F-deoxythymidin. With the increasing availability of 18F-tracers PET has obtained wider spread clinical application. In all these applications a coregistration with morphologic imaging should be obtained, and for that purpose hybrid installations (PET-MR) are already being used.

Effectiveness of ivermectin paste for removal of nematodes in the horse

Thirteen Standardbred horses, two to five years of age, were treated with ivermectin paste per os at 200 mug/kg of body weight and 13 were untreated. Two weeks after treatment, previously untreated horses were given the paste. Fecal samples were collected from all horses at the time of treatment and periodically thereafter up to 14 weeks and were examined for nematode eggs using the Cornell-McMaster dilution and the Cornell-Wisconsin double centrifugation procedures.All horses consumed the paste readily and had no signs of toxicosis. Strongyle eggs were found in the feces of all horses before treatment but not at two to three weeks after treatment. At five to six weeks after treatment only two horses had eggs in the feces. At eight, ten, 12 and 14 weeks after treatment 27, 69, 88 and 100% of the horses examined, respectively, had a few strongyle eggs but these were no greater than 18% of that of the pretreatment samples. Ivermectin oral paste, therefore, appeared to be highly effective against both adult and immature strongyles.