Wojciech Matuszewski

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.

Diagnosis and treatment of diabetic retinopathy — historical overview

Before the discovery of insulin, diabetes had been a fatal disease. Insulin extended lifespan of diabetic patients, yet it also gave rise to a number of chronic vascular complications, including diabetic retinopathy. Ophthalmic lesions were first observed in 1798 by John Rollo. Precise assessment of the eye fundus became possible following the construction of ophthalmoscope, which later made it possible to propose a classification of diabetic eye disease. The history of diabetic retinopathy encompasses not only the discovery of diagnostic methods such as fluorescein angiography, ultrasound examination or optical coherence tomography, but also the history of its treatment. Both initially as well as at present, clinical nutrition constitutes the most important aspect of treatment. DCCT and UKPDS have shown that good metabolic balance plays a significant role in preventing and treating DR. Further studies proved that pharmacological treatment based on fibrates and angiotensin-convertingenzyme inhibitors. A turning point in the history of DR treatment appeared when laser photocoagulation was introduced in 1959. The discovery of epidermal growth factor in 1982 led to the use of anti-VEGF medications in treating maculopathy. Surgical treatment of DR primarily consisted of vitrectomy whose procedures are continually improved.

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.