The emerging role of denosumab in the long-term management of parathyroid carcinoma-related refractory hypercalcemia.

Objective: The main cause of death in patients with parathyroid carcinoma is parathyroid hormone (PTH)-induced hypercalcemia. To date, the management of hypercalcemia has been based on the use of bisphosphonates and calcimimetic agents. In recent reports, the use of denosumab has shown encouraging results in cases of refractory hypercalcemia of malignancy.

Insulin resistance: an adaptive mechanism becomes maladaptive in the current environment - an evolutionary perspective.

Human survival has relied upon the ability to withstand starvation through energy storage, the capacity to fight off infection by a proinflammatory immune response, and the ability to cope with physical stressors by an adaptive stress response. Energy storage, mainly as glycogen in liver and triglycerides in adipose tissue, is regulated by the anabolic actions of insulin. On the other hand, mobilization of stored energy during infection, trauma or stress is served by the temporary inhibition of insulin action (insulin resistance) in target tissues by proinflammatory cytokines and stress hormones.

Hypokalemic paralysis following administration of intravenous methylprednisolone in a patient with Graves' thyrotoxicosis and ophthalmopathy.

Glucocorticoids are commonly used in the treatment of patients with thyroid disorders, in particular Graves' ophthalmopathy. Thyrotoxic hypokalemic periodic paralysis (TPP) is an infrequent but potentially serious condition characterised by recurrent episodes of weakness associated with hypokalemia. We describe the development of acute hypokalemic paralysis in a middle-aged Caucasian man with recently diagnosed thyrotoxicosis and severe, active Graves' opthalmopathy who developed progressive flaccid paralysis 12 hours following intravenous administration of methylprednisolone.

PROP-1 gene mutations in a 63-year-old woman presenting with osteoporosis and hyperlipidaemia.

PROP-1 gene mutations have been reported as a cause of combined pituitary hormone deficiency. Physical and hormonal phenotypes of affected individuals are variable. We report a 63-year-old female who presented with osteoporosis.

The effects of micronutrient supplementation on vasomotor symptoms in postmenopausal women.

Objective: Estrogen is the most effective treatment for vasomotor symptoms. Given its potential risks, herbal preparations and nutritional supplements have been developed as alternative remedies. The main aim of this double-blind, randomized, placebo-controlled trial was to assess any impact of a nutritional supplement containing 12 vitamins and nine minerals on the frequency and severity of hot flushes in postmenopausal women over a 3-month period.

Active Paget's disease of bone with normal biomarkers of bone metabolism: a case report and review of the literature.

Paget's disease of bone is a focal skeletal disorder characterized by the formation of structurally abnormal bone, skeletal deformities, and other complications leading to bone pain and significant disability. It can involve one or more areas in a single bone (monostotic) or multiple bones (polyostotic). Most of the time the disease is asymptomatic and the diagnosis is made incidentally by increased levels of bone metabolism markers, especially alkaline phosphatase and is confirmed by specific findings in radiographs and radionuclide bone scan.

Congenital hypopituitarism: monitoring after coronary artery bypass grafting.

Cardiovascular disease in patients with congenital hypopituitarism is not rare; however, there is a lack of reports referring to cardiac interventions in such patients. We present a 76-year-old man with complete pituitary hormone deficiency, who presented with recurrent events of unstable angina. He had a significant stenosis of the left anterior descending artery and he underwent off-pump coronary artery bypass.

Menopausal hot flush: is it only a nuisance or also a marker of cardiovascular disease risk?

Hot flush is one of the most commonly reported symptoms during menopause; however, it is not experienced by all menopausal women, for reasons that remain unclear. In this review, we present current evidence that link hot flushes with cardiovascular disease, suggesting that the persistence of hot flushes many years after the menopause may represent a marker of an underlying disorder that increases the risk for cardiovascular disease.

Serum levels of soluble fas in patients with multinodular goiter.

Objective: Fas is a cell-surface receptor responsible for induction of apoptosis in human thyrocytes upon interaction with Fas Ligand. Fas protein expression on thyroid cells and Fas-mediated apoptosis is decreased in multinodular goiter (MNG) resulting in thyroid cell proliferation. The soluble form of Fas (sFas) produced by alternative mRNA splicing may inhibit Fas-Fas Ligand binding and apoptosis.

Menopausal hot flushes revisited.

Vasomotor symptoms are generally recognized as one of the most common symptoms, or signs, of the menopause, together with menstrual cycle changes. The etiology of hot flushes is unknown, although several mechanisms have been implicated. The reduction in hot flushes with estrogen replacement therapy suggests a hormonal etiology.

The contribution of ApoB and ApoA1 measurements to cardiovascular risk assessment.

LDL has been widely recognized as the major atherogenic lipoprotein and designated as the primary target for prevention of coronary heart disease (CHD); however, there is growing evidence that other triglyceride-rich lipoproteins, such as very low-density lipoprotein (VLDL) and intermediate density lipoprotein (IDL) carry atherogenic potential as well. This led to the designation of non-HDL cholesterol (HDL-C) (LDL + IDL + VLDL) as a secondary target of treatment for hyperlipidaemia. As each one of LDL, IDL and VLDL particles carries only one apolipoprotein B-100 (ApoB-100) molecule, the total ApoB value represents the total number of potentially atherogenic lipoproteins, whereas non-HDL-C provides the cholesterol content of these same lipoproteins.

Hypolipidaemia is not always indicating liver dysfunction. A review of primary and secondary high density lipoprotein and low density lipoprotein deficiencies.

Hypolipidaemias can be either primary due to several genetic defects altering the serum concentration of lipoproteins, or secondary resulting from various disorders such as liver disease, malabsorption, malnutrition, malignancy, hyperthyroidism and immunoglobulin disorders. We present a review of the current knowledge regarding the various causes of hypolipidaemias. Our aim is to emphasize on the different mechanisms, apart from deranged liver synthetic function, that are responsible for unusually low levels of cholesterol and on the disorders that need to be considered during the investigation of hypolipidaemia.

Fine needle aspiration biopsy-RT-PCR molecular analysis of thyroid nodules: a useful preoperative diagnostic tool.

Fine needle aspiration biopsy (FNAB)-based cytology is an accurate preoperative diagnostic method for the evaluation of thyroid nodules. Despite its high specificity and sensitivity, the results are non-diagnostic in a significant number of cases, commonly due to inadequacy of the samples or the presence of undetermined cellular morphology. Overlap-ping cytologic features among follicular-derived lesions are the most common causes of cyto-histopathologic discordances.

Fas and Bcl-2 protein expression in thyrocytes of patients with nodular goiter.

Objective: The relative expression of the apoptotic protein Fas and the anti-apoptotic protein Bcl-2 were investigated in thyrocytes from patients with non-toxic nodular goiter (NTG, n=20) and Hashimoto's thyroiditis (HT, n=5), who underwent fine-needle aspiration biopsy for diagnostic reasons. On the basis of the clinical and cytological findings, the patients with NTG were sub-classified into the group of those with colloid nodules (n=9), degenerative nodules (n=6) and adenomatous nodules (n=5).

Methods: Fine-needle biopsy aspirates were examined by immunocytochemistry for Fas and Bcl-2 expression, using specific monoclonal antibodies.

The role of Fas-mediated apoptosis in thyroid disease.

Recent evidence has emphasized the importance of apoptosis in the maintenance of tissue homeostasis and the pathogenesis of malignant and immune diseases. Autoimmune thyroid diseases such as Hashimoto's thyroiditis and Graves' disease, as well as other autoimmune endocrine diseases, have been associated with dysregulation of apoptotic signaling pathways. In particular, dysfunction of the Fas apoptotic pathway or production of soluble factors including soluble Fas and soluble Fas ligand may be involved in the pathogenesis of these disorders.