Joanna Rutkowska

Primary hyperparathyroidism in pregnancy — a diagnostic and therapeutic challenge

Hypercalcaemia during pregnancy is uncommon, and mostly associated with primary hyperparathyroidism (pHPT). If unrecognised, it poses a significant risk for the mother and the foetus. Maternal symptoms include: hyperemesis, muscle weakness, pancreatitis, nephrolithiasis, bone disease, mental status changes, and hypercalcaemic crisis. Untreated disease complicates foetal development and foetal death is a significant risk. Our case illustrates the difficulty in detecting pHPT during pregnancy, serious complications connected with severe hypercalcaemia, and difficulties in preparing the patient for surgical treatment. Our review of the medical literature did not identify any previous case of a pregnant woman with hypercalcaemic crisis (total calcium 17 mg/dL, parathyroid hormone 2302 pg/mL), acute pancreatitis caused by pHPT, and with hyperthyroidism, who had undergone a successful surgical treatment.

Assessment of real-world usage of lanreotide AUTOGEL 120 in Polish acromegalic patients – results from the prospective 12-month phase of Lanro-Study

Aim of the study To assess resource utilization and costs of treatment with lanreotide AUTOGEL 120 mg (ATG120) administered as part of routine acromegaly care in Poland. Material and methods A multicentre, non-interventional, observational study on resource utilization in Polish acromegalic patients treated with ATG120 at 4 weeks or extended (> 4 weeks) dosing interval. The study recruited adult acromegalic patients treated medically for ≥ 1 year including at least 3 injections of ATG120. Data on dosing interval, aspects of administration, and resource utilization were collected prospectively during 12 months. Costs were calculated in PLN from the public health-care payer perspective for the year 2013. Results 139 patients were included in the analysis. Changes in dosing regimen were reported in 14 (9.4%) patients. Combined treatment was used in 11 (8%) patients. Seventy patients (50%) received ATG120 at an extended dosing interval; the mean number of days between injections was 35.56 (SD 8.4). ATG120 was predominantly administered in an out-patient setting (77%), by health-care professionals (94%). Mean time needed for preparation and administration was 4.33 and 1.58 min, respectively, mean product wastage – 0.13 mg. Patients were predominantly treated in an out-patient setting with 7.06 physician visits/patient/year. The most common control examinations were magnetic resonance imaging of brain and brain stem (1.36/patient/year), ultrasound of the neck (1.35/patient/year), GH (1.69/patient/year), glycaemia (1.12/patient/year), IGF-1 (0.84/patient/year), pituitary-thyroid axis hormone levels assessment (TSH-0.58/patient/year, T4-0.78/patient/year). There were 0.43 hospitalizations/patient/year. For direct medical costs estimated at PLN 50 692/patient/year the main item was the costs of ATG120 (PLN 4103.87/patient/month; 97%). The mean medical cost, excluding pharmacotherapy, was PLN 1445/patient/year (out-patient care – 49%, hospitalization – 23%, diagnostics/laboratory tests – 28%). Conclusions These results represent the current use of ATG120 in the population of Polish acromegalic patients in a realistic clinical setting. Findings that 50% of patients could be treated with dose intervals of longer than 28 days support the potential of ATG120 to reduce the treatment burden.

Vitamin D deficiency in women with gestational diabetes mellitus

Background . The relationships between vitamin D[25(OH)D] deficiency and gestational diabetes mellitus(GDM) are under investigation. We wanted to assessthe relationships between maternal 25(OH)D concentrationand metabolic indicators, and blood pressurein women with GDM. Methods . Prospective study was conducted in northernPoland between September 2012 and February2013. GDM was diagnosed by 75 g OGTT between 20––29 weeks of pregnancy. Pre-gestational BMI werecalculated, weight gain during pregnancy and bloodpressure were collected. Fasting glucose, insulin, lipids,25(OH)D were assessed. HOMA-IR was used to estimateinsulin resistance, defined as > 2.5. The women were dividedinto group A with 25(OH)D deficiency (≤ 20 ng/mL)and group B with 25(OH)D > 20 ng/mL. Statisticalanalysis was performed. Results . We analyzed 56 pregnant women with GDM,mean age 30.3 ± 5.1. 25(OH)D deficiency was found in25 women (44.6%) with its concentration 13.8 ± 3.9ng/mL. In the group B, the mean 25(OH)D concentrationwas 30.6 ± 9.3 ng/mL. 25(OH)D deficiency wasassociated with higher systolic blood pressure (p == 0.03), insulin resistance (p = 0.38) and with thethird and subsequent pregnancies (p = 0.047). 25(OH)D concentration was 22.8 ± 2.0 ng/mL in the first andsecond pregnancies, comparing to 14.3 ± 3.9 ng/mL inthe third and subsequent pregnancies. There was nocorrelation between 25(OH)D and other parameters. Conclusions . 1. Low 25(OH)D concentration in theanalyzed group of women with GDM was significantlycorrelated with increased insulin resistance and systolicblood pressure. 2. In multipara the incidence of 25(OH)Ddeficiency was higher. 3. The results imply necessity offocusing on guidelines implementation for 25(OH)Dsupplementation for women in childbearing age.