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  • Author: J R Tucci x
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J R Tucci

Objective

To determine whether vitamin D repletion of patients with primary hyperparathyroidism (PHPT) and vitamin D deficiency or insufficiency (hypovitaminosis D) has deleterious clinical and/or biochemical effects.

Design

Prospective audit of the effect of vitamin D repletion on biochemical data in 56 patients with PHPT. Patients were treated with 50 000 units of vitamin D2 weekly for 8 weeks with biochemical measurements at 5 and 10 weeks, and subsequently after 12 weeks on 800 units of vitamin D3 daily, and in those with hypovitaminosis D after 12 weeks of up to 100 000 units of vitamin D2 monthly.

Methods

Serum calcium, albumin, phosphorus, 25-OHD, intact parathyroid hormone (PTH) and urine calcium/creatinine (Ca/Cr) ratios were measured before and during vitamin D therapy.

Results

Patients treated with 50 000 units of vitamin D2 weekly for 8 weeks resulted in a significant increase in serum 25-OHD levels from 36.4 to 89.4 nmol/l at 5 weeks (P<0.0001) and 88.6 nmol/l at 10 weeks (P<0.0001). There were no significant changes in serum calcium. At 10 weeks, there was a non-significant decrease in serum PTH and in urine Ca/Cr ratios. None of the patients developed any calcium-related adverse events. Subsequently, patients with subnormal 25-OHD levels on 800 units of vitamin D daily were treated for the next 12 weeks with up to 100 000 units of vitamin D2 monthly with normalization of serum 25-OHD in all but 4 patients.

Conclusion

These data fail to demonstrate any adverse effects of vitamin D repletion in PHPT.

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S. Khoury and J. R. Tucci

Abstract. Studies were performed in 60 patients with proven primary hyperparathyroidism pre-operatively and in 54 of these patients post-operatively, 22 patients with permanent hypoparathyroidism and 34 normal subjects. Urinary and nephrogenous cyclic AMP excretion were increased in the hyperparathyroid patients with an overlap of values with the normal group of 10 and 9%, respectively. Values fell in all patients post-operatively, and were decreased in those with permanent hypoparathyroidism. TmPO4/GFR was decreased in the preoperative hyperparathyroid patients and rose postoperatively while it was increased in the hypoparathyroid patients with an overlap of values with the normal group of 9%. Post-operative hypocalcaemia due to bone hunger was associated with continuing normo- or hypophosphataemia and urinary cyclic AMP that exceeded 4.5 nm/dl GF while those who developed permanent hypoparathyroidism had hyperphosphataemia, increased TmPO4/GFR and urinary cyclic AMP that was less than 3.5 nM/dl G.F. Urinary and nephrogenous cyclic AMP were equally effective in characterizing patients with primary hyperparathyroidism and less effective in distinguishing patients with hypoparathyroidism from normal while TmPO4/GFR estimates were more effective in delineating the hypoparathyroid state.

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L. W. Raymond, J. Sode and J. R. Tucci

ABSTRACT

Treadmill walking produced a prompt reduction in serum cortisol in 10 of 12 healthy military men. In contrast, two subjects, with pre-exercise tachycardia and apprehension, showed an increase in serum cortisol with treadmill exercise. In each group, the changes produced by exercise were still evident 30 and 60 minutes after the 30-minute treadmill walk. Urine collected before and after exercise contained similar amounts of 11-hydroxy- and 17-hydroxycorticosteroid material. These results may be explained by an increase in cortisol utilization during exercise and/or by a change in its distribution. The data indicate that in the absence of psychic factors, non-exhaustive exercise is not associated with pituitary adrenocortical activation.