Sebastian Szewczyk

Treatment of active, moderate-to-severe Graves’ orbitopathy (GO) is the administration of intravenous methylprednisolone (IVMP). IVMP may be followed by additional therapy with oral prednisone. The aim of this study was to analyze the impact of IVMP on adrenal function by evaluation of serum, salivary cortisol and serum dehydroepiandrosterone sulfate (DHEA-S). Fourteen patients received IVMP treatment (cumulative dose of 4.5 g in 12 weekly infusions) followed by oral prednisone (for three months). All patients showed normal adrenal function before the 12th IVMP pulse and one patient was diagnosed with secondary adrenal insufficiency (AI) after prednisone treatment. DHEA-S was significantly lower before the 12th IVMP pulse and after oral prednisone (p = 0.015 and p = 0.00002, respectively) in comparison to evaluation before therapy. DHEA-S levels were below the reference range in one and three patients before the 12th IVMP pulse and after prednisone therapy, respectively. We observed decreased serum (p = 0.05) and salivary (p = 0.011) cortisol levels after oral prednisone therapy in comparison to evaluation before therapy. Treatment with IVMP in a cumulative dose of 4.5 g affects adrenal function, causing more severe impairment of DHEA-S secretion than that of cortisol but does not cause secondary AI. Additional therapy with oral glucocorticoids after IVMP can cause secondary AI.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

ABSTRACT
 Background: Intravenous glucocorticoids pulses administration is the main therapeutic option in the treatment of Graves’ orbitopathy. Such therapy could relate to the multiple adverse effects. The aim of the study is evaluation the influence of intravenous methylprednisolone (IVMP) pulse therapy on the heart rhythm (HR) changes in patients with active, moderate-to-severe Graves’ Orbitopathy (GO).
 Methods: We studied 20 patients with moderate-to-severe GO. All patients received 12 IVMP pulses (6x500 mg plus 6x250mg) at equal time intervals in a weekly schedule. We performed Holter ECG monitoring for 3 consecutive days (the day before, the day of IVMP and day after IVMP) to monitor HR and arrhythmias. We compared changes in HR between these 3 days and set time interval when the alteration was significant. This evaluation was performed during the 1st, 6th and 12th IVMP pulse.
 Results: Increased HR, in comparison with the day before, was registered on the day of IVMP administration. The most significant increase in HR started 5 hours (h) after a pulse administration and lasted 12 h. There were no significant differences in HR between the day before and the day after IVMP. We did not notice any major adverse cardiac events including severe arrhythmias.
 Conclusions: IVMP therapy is associated with increased HR, that occurs a few hours after infusion, lasts several hours and is transient. 
 Keywords: Graves’ ophthalmopathy; Graves’ disease; glucocorticoids; heart rate

Introduction: Primary hyperparathyroidism is characterized by chronic parathyroid hormone excess, leading to hypercalcemia, increased bone turnover, and skeletal complications. Although osteoporosis is a common manifestation of these, the biochemical determinants of bone loss remain insufficiently defined. The roles of active vitamin D and renal phosphate handling require further clarification. This study aimed to identify biochemical determinants of osteoporosis in patients with primary hyperparathyroidism, with a particular focus on the contribution of calcitriol levels and renal phosphate handling. We further sought to evaluate their predictive performance in discriminating osteoporotic from non-osteoporotic individuals. Materials and methods: We retrospectively analyzed 74 adults with primary hyperparathyroidism ineligible for surgery, assessing serum calcium, phosphate, vitamin D metabolites, parathormone, and 24 h urinary calcium. Renal phosphate handling was estimated by TMP/GFR. Logistic regression and ROC analyses identified independent predictors and optimal cutoff values for osteoporosis. Results: Osteoporosis was present in 33.8% of patients. Individuals with osteoporosis demonstrated significantly higher calcitriol levels and lower renal phosphate reabsorption, also in multivariate analysis, while serum calcium, phosphate, and 25-hydroxyvitamin D did not differ between groups. Receiver operating characteristic curve analysis identified clinically meaningful cutoff values for both parameters. Conclusion: Increased levels of the active form of vitamin D and impaired renal conservation of phosphate are independently associated with osteoporosis in primary hyperparathyroidism, outperforming traditional biochemical markers. Incorporating these measures into routine clinical assessment may improve identification of patients at high skeletal risk and enhance decision-making in the management of bone disease in primary hyperparathyroidism.

INTRODUCTION: Nephrolithiasis is a common complication of primary hyperparathyroidism (PHPT), but the mechanisms underlying stone formation remain incompletely understood. Calcium-sensing receptor (CaSR) activity, indirectly assessed by serum calcitriol levels and urinary excretion of calcium and magnesium, may influence the risk of nephrolithiasis. Current diagnostic methods are cumbersome, prompting the need for more practical biomarkers. This study aimed to evaluate a novel parameter - calcium and magnesium fractional excretion (CAMFE) - as a predictor of nephrolithiasis risk in patients with PHPT. MATERIAL AND METHODS: A retrospective analysis was conducted on 109 patients with PHPT. CAMFE was calculated from 24-hour urine collection under a standard diet. Associations with nephrolithiasis were analyzed using logistic regression and receiver operating characteristic (ROC) curve analysis. RESULTS: Nephrolithiasis was present in 40% of patients. The CAMFE index was correlated significantly with kidney stone formation. Calcitriol levels were higher in stone formers, supporting its role in enhanced intestinal calcium absorption. CAMFE showed good predictive power with an optimal cut-off value of 6.18, offering a simpler alternative to dual urine collection protocols. CONCLUSIONS: Low CAMFE (< 6.18) may be connected with a higher risk of nephrolithiasis, potentially serving as a useful marker for assessing the risk of renal complications in patients with PHPT.