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Query: UMLS:C0011849 (diabetes)
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Calcium is unique in its distribution in living organisms with an extremely high hard and soft tissue and extra- intracellular concentration gradient. Calcium deficiency through stimulating parathyroid hormone secretion tends to blunt such a difference by paradoxically increasing the calcium concentration in the soft tissue and intracellular compartment. Since aging is associated with the progressive aggravation of calcium deficiency, such blunting also progresses with aging. The dysfunction, damage and death of cells occurring in all diseases is always associated with a blunting of the extra- and intracellular calcium components. Calcium supplement especially with highly biologically available active absorbable calcium, was associated with the suppression of parathyroid hormone secretion and the normalization of a such blunting of intercompartmental distribution of calcium examples in hypertension and diabetes mellitus with evident improvement of clinical manifestations and laboratory tests.
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PMID:Calcium, parathyroids and aging. 195 48

To investigate the parathyroid function in diabetes mellitus, we performed an oral phosphate load in 6 diabetic patients and 6 nondiabetic subjects without renal failure (serum creatinine less than 1.5 mg/dl). Each subject received a total of 2.0 g of phosphate daily per os on 5 consecutive days. Blood and urine samples were obtained daily before and 2 h after the administration of phosphate in the morning. All subjects responded with a similar increase in the serum phosphorus concentration and fall in the ionized calcium concentration. Intact parathyroid hormone levels rose by 2.6-fold in the control subjects but by less than 1.5-fold in the diabetic subjects. It was concluded that hyporesponsiveness of the parathyroid hormone to phosphate administration was found in the diabetic patients without renal failure.
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PMID:Parathyroid hormone secretion in diabetes mellitus. 195 50

In diabetic animals, there is a decrease in serum 1,25-dihydroxyvitamin D [1,25(OH)2D] and in renal production of 1,25(OH)2D. In nondiabetic animals, renal 1,25(OH)2D production is markedly stimulated by parathyroid hormone (PTH) and calcitonin (CT). There is evidence that diabetes impairs the responsiveness of the kidney to PTH. The effect of diabetes on responsiveness to CT is unknown. The studies reported here determined the effect of streptozotocin-induced diabetes on renal responsiveness to PTH and CT. Experiments were performed in 7- to 8-week-old rats that were fed a diet sufficient in calcium and vitamin D and were thyroparathyroidectomized (TPTX) 5 days before hormone treatment. PTH (0.33 U/g body weight at 24, 12, and 2 hours before death) significantly increased renal 1,25(OH)2D production by threefold in nondiabetic rats. This effect was markedly attenuated by diabetes. On the other hand, CT (20 U/100 g body weight at 12 and 2 hours before death) produced a maximal response in both groups of animals. In diabetic rats, CT stimulated renal 1,25(OH)2D production fivefold, whereas PTH stimulated production only 1.5-fold. Diabetes did not affect the capacity of PTH to increase serum calcium or decrease renal tubular reabsorption of phosphorus (TRP). These findings suggest that the decrease in renal 1,25(OH)2D production seen in experimental diabetes may be due to decreased renal responsiveness to PTH, but not to decreased responsiveness to CT.
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PMID:Calcitonin stimulates 1,25-dihydroxyvitamin D production in diabetic rat kidney. 198 64

Because insulin-dependent diabetes mellitus is associated with altered electrolyte metabolism and a derangement of the parathyroid hormone (PTH)-vitamin D endocrine system, we studied 23 children with diabetes (age 9.4 +/- 2.5 years) and found lower serum values for total and ionized calcium, magnesium, intact PTH, calcitriol, and osteocalcin than in age- and sex-matched control subjects. All patients were given magnesium orally (6 mg/kg daily of elemental magnesium) for up to 60 days. During treatment, serum magnesium, total and ionized calcium, intact PTH, calcitriol, and osteocalcin concentrations significantly increased, reaching control values. After a 3-day low-calcium diet, the patients had a significantly reduced delta-increment of PTH and calcitriol in comparison with values obtained during hypomagnesemia. After magnesium repletion, the delta-increments of both PTH and calcitriol, in response to the low-calcium diet, were not significantly different from control values. These data suggest that magnesium deficiency plays a pivotal role in altering mineral homeostasis in insulin-dependent diabetes mellitus.
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PMID:Hypomagnesemia and the parathyroid hormone-vitamin D endocrine system in children with insulin-dependent diabetes mellitus: effects of magnesium administration. 191 9

Hyperparathyroid bone disease is a common complication of end stage renal failure, particularly in patients on maintenance haemodialysis. Several studies have, however, shown a near absence of hyperparathyroid bone disease in diabetic patients who have been receiving haemodialysis for periods of up to 4 years. We have studied biochemical indices of mineral metabolism in 54 consecutive pre-dialysis patients with moderate to severe renal impairment. Deteriorating renal function was associated with developing hypocalcaemia and hyperphosphataemia. Hypocalcaemia was strongly related to increased severe alkaline phosphatase activity (p less than 0.001), suggesting the development of hyperparathyroidism. Five patients with hypocalcaemia and increased alkaline phosphatase were studied in detail. All had elevated serum concentrations of parathyroid hormone and histological signs of hyperparathyroidism on bone biopsy. Three of the patients had low serum 25 hydroxyvitamin D levels with associated osteomalacia, the other 2 patients were notable for their long duration of renal failure. In the long-term (greater than 4 years) we also observed the development of hyperparathyroidism in a small group of diabetic patients maintained on haemodialysis. We conclude that diabetic patients are not uniquely protected against renal osteodystrophy. Although the prevalence of hyperparathyroidism may be lower in diabetic patients than in those with other types of renal disease, the same factors which predispose to bone disease in non-diabetic patients (long duration of renal failure, low serum 25 hydroxyvitamin D and long periods on haemodialysis) also operate in the diabetic population.
Diabetes Res 1990 Aug
PMID:Hyperparathyroid bone disease in diabetic renal failure. 213 93

Magnesium (Mg) makes up 0.5-1% of bone ash and is therefore not a trace element in the skeleton. Mg influences both mineral and matrix metabolism in bone by a combination of effects on hormones and other factors that regulate skeletal and mineral metabolism, and by direct effects on bone itself. The skeletal content of Mg is very variable both between and within species, and reported values range between 150 and 440 mmol/kg ash weight (AW). Dietary Mg has a direct influence and age an inverse influence on skeletal Mg content. It is unclear whether skeletal Mg content varies from region to region. In humans, reported values cluster around the 200 mmol/kg AW level, 30-40% lower than most rat data. Human iliac crest cortical bone has 10-20% less Mg per unit weight than iliac crest trabecular bone. Mg depletion adversely affects all phases of skeletal metabolism. In the rat, cessation of bone growth is noted with a decrease in both osteoblast and osteoblast activity, decreased bone formation, osteopenia, increased fragility and development of a form of 'aplastic bone disease'. The epiphyseal growth plate is thinned and the percent ash weight of the growth plate is increased, possibly due to enhanced crystallization of bone salt under conditions of Mg depletion. In contrast, in chicks and in rats with severe Mg deficiency, these 'antianabolic' effects are not observed but instead, predominant inhibition of bone resorption occurs with increased cortical thickness rather than osteopenia, and the occasional development of subperiosteal hyperplasia or of fibrous tumors of the periosteum. It is probable that this unusual response under conditions of severe Mg deficiency is in part an indirect effect secondary to a defect in secretion and/or skeletal responsiveness to parathyroid hormone (PTH) and vitamin D metabolites. Mg excess also has adverse biologic effects on bone. Crystallization of bone salt is severely impaired and an osteomalacia-like picture may be produced with decreased osteoblastic activity, widened growth plates, excessive osteoid seams and short, thickened bones. In some studies, especially in mice, Mg excess stimulates bone resorption, independently of PTH. The role of Mg deficiency and excess in human skeletal conditions requires more extensive investigation. Bone Mg is uniformly increased in renal insufficiency and may play a role in renal osteodystrophy since improvement has been noted in the osteomalacic component by normalizing the serum Mg. Decreased bone Mg has been reported in alcoholic patients, diabetes and in osteoporosis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Effects of magnesium on skeletal metabolism. 218 30

The face of many endocrine diseases is rapidly changing as early detection and intervention is achieved. Nevertheless, certain musculoskeletal symptoms can suggest a possible endocrinopathy. The clinician can expect the appearance of particular rheumatic problems during the course of a chronic endocrine disorder. This is especially germaine for diabetes and acromegaly, in which the disorder is controlled but not cured. Clearly hormones play a critical role in the development and expression of immunologic disease. Sex hormones and calcitriol have a direct effect on basic immunobiology (3). The rheumatoid synovium responds to parathyroid hormone and calcitriol in concert with local signals such as prostaglandins, interleukins, and interferon (2,77). Finally, the immune system plays a central role in the pathogenesis of several endocrine diseases. The thyroid diseases, Graves' disease and Hashimoto's disease are best studied. The mechanisms of Ia expression leading to immune destruction and lymphocytic infiltration of the gland will be applied to other endocrine disorders.
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PMID:The endocrine system and connective tissue disorders. 226 59

Changes in parathyroid hormone (PTH) and osteocalcin over 3 years were studied in hemodialyzed patients with diabetic nephropathy (HD/DM) and hemodialyzed patients without diabetes (HD/non-DM). In HD/DM patients, concentrations of the carboxyl terminal regions of PTH and osteocalcin in the serum did not change significantly, but in HD/non-DM patients, both concentrations increased significantly. In patients in both groups, the mean concentration of the mid-region of PTH increased significantly. Secondary hyperparathyroidism in HD/DM develops slower than in HD/non-DM.
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PMID:Changes in parathyroid hormone in diabetic patients on long-term hemodialysis. 232 97

We recently observed a patient in whom basal ganglia calcification (BGC) was demonstrated on sequential CT scans only 9 days after the anoxic episode. A 58-year-old woman had a history of diabetes mellitus for 23 years for which she was treated with insulin. She had a operation for retinal detachment under local anesthesia. Two days after the operation, she developed dyspnea, and was referred to our department. She was intubated, and respiratory support was begun. On neurological examination, she was semicomatose, and intermittent spontaneous movements involved in all extremities. The pupils were 3 mm in diameter, equal and responsive. Full doll's eye responses were obtained both horizontally and vertically. Deep tendon reflexes were hyperactive bilaterally without ankle jerks and extensor plantar responses. Arterial blood gas levels revealed a PaO2 of 49 mmHg, PaCO2 38 mmHg: pH 7.16. Serum Ca, P, Mg, Al-p and parathyroid hormone levels were normal. The EEG was isoelectric. Although the initial CT scan was normal, the subsequent CT scan 9 days later showed extensive high density change of the striatum, which was assumed to be BGC due to anoxia was briefly discussed.
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PMID:[CT evidence of high density area in bilateral striatum secondary to anoxia]. 259 29

Blood serum levels of calcitonin, parathyroid hormone, calcium, magnesium and inorganic phosphate have been measured in basal condition and following intravenous administration of calcium in 31 patients with diabetes of type I, in 31 patients with diabetes of type II and in 29 healthy subjects. The level of 25-hydroxy cholecalciferol was measured in all these patients in basal condition only. It was found that the basal calcitonin level was significantly higher in patients with both types of diabetes than in healthy subjects. The administration of calcium caused a significantly higher increase in the blood calcitonin level in patients with type I diabetes than in those with type II diabetes. It was found in addition that in women with type II diabetes blood serum level of parathyroid hormone was significantly higher than that in men suffering from diabetes of the same type, suggesting the participation of some sex-related factor in the pathogenesis of the abnormal parathyroid level in these patients.
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PMID:[Serum levels of calcitonin, parathyroid hormone and 25-hydroxycholecalciferol in patients with diabetes mellitus]. 264 13


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