Novel technological applications for the management of endocrine diseases

Abstract 1: Introduction: Postsurgical hypoparathyroidism (hypoPT) increases fatigue and seems to affect the risk of mortality. Cardiovascular autonomic neuropathy (CAN) is an impairment of the cardiovascular autonomic system, a cause of increased mortality, and associated with increased fatigability. The aim of this study is to evaluate CAN in hypoPT and its relationship with hypocalcemia, PTH levels, and hyperphosphatemia. Methods: This is a cross-sectional study comparing 51 postsurgical hypoPT patients treated with calcium and calcitriol and 43 control subjects without any PTH/calcium/phosphate disorders who underwent thyroidectomy. CAN was assessed by heart rate (HR) response to deep breathing, HR response to the lying-to-standing test, HR response to the Valsalva maneuver, and blood pressure response to standing. Participants were considered to have "early CAN" if they had one abnormal result in the HR tests and "definite CAN" with two or more abnormal results. Results: The prevalence of CAN was 23% in the control group and 78% in the hypoPT group (OR 11.48; 95% CI, 4.48 to 32.17). Patients with hypoPT and serum calcium (sCa) 8.5 mg/dL had a prevalence of early CAN of 72.4% and the prevalence was 86.4% in those with sCa <8.5 mg/dL. Definite CAN was found in 2.3% of the control group, 24.1% of the hypoPT group without hypocalcemia, and 59.1% of the hypoPT group with hypocalcemia. In the hypoPT group, the OR for definite CAN in the patients with hypocalcemia compared to the patients with normocalcemia was 4.54 (95% CI, 1.36 to 15.11). The association between low sCa and definite CAN was confirmed after adjustment for confounders with OR 13.62 (95% CI, 2.12 to 149.84). No association was found between definite CAN and PTH levels or high phosphate levels. Conclusions: HypoPT is associated with CAN and hypocalcemia seems to affect its severity. Larger and prospective studies are needed to confirm our findings. Abstract2: Introduction: Hypoparathyroidism (hypoPT) results in an impairment of quality of life (QoL), an increase in fatigue and a higher risk of mortality. Cardiovascular autonomic neuropathy (CAN) is an impairment of the cardiovascular autonomic system and is associated with increased mortality and fatigability. Patients with hypoPT show an increased risk of CAN. However, no previous studies have investigated the association between CAN and QoL in hypoPT. To test whether CAN is associated with fatigue and impaired QOL in hypoPT patients. Methods: We enrolled 48 subjects with postsurgical hypoPT treated with calcium and calcitriol and 38 healthy subjects who underwent thyroidectomy. Subjects completed the RAND 36-Item Short Form (SF-36) Health Survey, evaluating physical (PCS) and mental (MCS) health, and fatigue score. CAN was assessed using cardiovascular autonomic reflex tests (CARTs). Participants were considered to have "early CAN" (EC) if they had one abnormal CART and "definite CAN" (DC) with two or more abnormal CARTs. Results: Compared with controls, hypoPT population had lower fatigue scores (44.5 IQR:9 vs 38.5 IQR:12.3, P = 0.031). In the hypoPT group, only participants with DC had a lower fatigue score than subjects without CAN (DC: beta: -9.55, P = 0.005) after adjusting for age, duration of disease, calcium concentration, TSH, calcitriol and calcium supplementation. No differences were found in the PCS and MCS scores in the hypoPT group. Conclusions: CAN may explain fatigue, a common complaint of postsurgical hypoPT patients. Further larger and prospective investigations are needed to confirm our findings. Abstract 3: Introduction: Primary hyperparathyroidism (PHPT) is associated with impaired bone quality and increased fracture risk. Reliable tools for the evaluation of bone quality parameters are not yet clinically available. Bone Strain Index (BSI) is a new metric for bone strength based on Finite Element Analysis from lumbar spine and femoral neck dual X-ray absorptiometry images. We aimed to investigate the lumbar spine (LS), femoral neck (FN), and total hip (TH) BSI in PHPT compared to controls. Methods: In this cross-sectional study we assessed the LS-BSI, FN-BSI and TH-BSI in 44 PHPT and 39 age- and sex-matched control subjects. Results: TH bone mineral density (BMD) and 1/3 distal radius BMD were lower in the PHPT group than in controls (TH 0.802 ± 0.13 vs 0.872 ± 0.09, P <0.05; radius 0.565 ± 0.07 vs 0.620 ± 0.06, P <0.001). There were no differences between groups in trabecular bone score (TBS) and T-score adjusted for TBS. BSI was significantly higher at LS (2.20 ± 0.58 vs 1.94 ± 0.48, p = 0.003), FN (1.66 ± 0.39 vs 1.40 ± 0.36, p = 0.003) and TH (1.46 ± 0.3 vs 1.24 ± 0.25, p = 0.001) in PHPT. LS-BSI showed moderate accuracy for detecting VFx [(area under the ROC curve 0.68 (CI:0.52-0.848)]. The best cut-off was set at 2.12 (sensibility 72%, specificity 64%, accuracy 67.4%). Conclusions: BSI, a DXA-derived bone quality index, is impaired in PHPT and may help to identify PHPT subjects at high risk of fractures. Abstract 4: Introduction: the impact of normocalcemic hyperparathyroidism (NHPT) on bone quality remains largely unexplored. We aimed to investigate the usefulness of trabecular bone score (TBS) assessment in NHPT and the accuracy of TBS in detecting vertebral fractures (VFs) in NHPT. Methods: In this multicentric cross-sectional study, we assessed the TBS in 47 subjects with NHPT, 41 with primary hyperparathyroidism (PHPT) and 39 age- and sex-matched control sub-jects. Results: TBS values did not differ among the three groups. The prevalence of low TBS (TBS <1.2) was 23.4% in NHPT, 26.8% in PHPT and 15.4% in controls, without statistically significant differences between groups. However, we found a lower Lumbar spine Z-score adjusted for TBS (LS Z-score*TBS) in PHPT participants when compared with controls (-0.48 ± 1.06 vs 0.07 ± 0.93, p: 0.017). In NHPT group, LS Z-score*TBS did not detect patients with overall VFs (Threshold -0.15, AUC 0.45 95%CI 0.253-0.648, accuracy 55.3%). Instead, it was useful for moderate-severe VFs (Threshold 0.55, AUC 0.81, 95%CI 0.62-0.996, accuracy 83%). In PHPT subjects also, TBS did not identify patients with VFs. Conclusions: In NHPT, TBS is not reduced. When adjusted for TBS, the LS Z-score does predict moderate to severe VFs.