Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The parathyroid hormone (PTH) family currently includes three peptides and three receptors. PTH regulates calcium homeostasis through bone and kidney PTH1 receptors. PTH-related peptide, probably also through PTH1 receptors, regulates skeletal, pancreatic, epidermal, and mammary gland differentiation and bladder and vascular smooth muscle relaxation and has a CNS role that is under investigation. Tuberoinfundibular peptide of 39 residues (TIP39) was recently purified from bovine hypothalamus based on selective PTH2 receptor activation. PTH2 receptor expression is greatest in the CNS, where it is concentrated in limbic, hypothalamic, and sensory areas, especially hypothalamic periventricular neurons, nerve terminals in the median eminence, superficial layers of the spinal cord dorsal horn, and the caudal part of the sensory trigeminal nucleus. It is also present in a number of endocrine cells. Thus TIP39 and PTH2 receptor-influenced functions may range from pituitary and pancreatic hormone release to pain perception. A third PTH-recognizing receptor has been found in zebrafish.
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PMID:New members of the parathyroid hormone/parathyroid hormone receptor family: the parathyroid hormone 2 receptor and tuberoinfundibular peptide of 39 residues. 1101 69

Deoxypyridinium (DPD) cross-links are a specific parameter for collagen type I degradation. We report the longitudinal tracking of DPD in relation to other bone markers and imaging techniques in a patient with osteomalacia and secondary hyperparathyroidism from reduced light exposure due to attire. This patient was first admitted for diffuse skeletal pain. X-rays showed general demineralization and Looser's transformation zones in the neck of the left femur. MRI examinations of the pelvis and the proximal femora demonstrated bilateral signs of acute sacroiliitis, as well as edema-like lesions in the femoral heads and necks bilaterally. The baseline parathyroid hormone level was 8 times higher than the normal upper limit, whereas 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were significantly reduced. A 7-fold increase in free urinary DPD and a 17-fold increase in bone-specific alkaline phosphatase (bone-AP) were also measured. Percutaneous transiliac bone biopsy revealed markedly increased osteoidosis. Osteomalacia was diagnosed due to chronically reduced sun exposure caused by restrictive attire, and cholecalciferol substitution therapy was begun. After a follow-up of 28 weeks, non-specific parameters of bone turnover (parathyroid hormone, total alkaline phosphatase, serum calcium and serum phosphate) had normalized, while DPD, as a specific bone degradation marker, and bone-AP, as a bone formation parameter, both remained elevated. This example underlines the validity of DPD and bone-AP as indicators of increased bone metabolism: not only were they the parameters with the highest baseline deviation, but they were also the last to normalize.
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PMID:Biomarkers and imaging in non-malignant and malignant osteomalacia. 1147 97

A 15-year-old boy with chronic renal failure secondary to Alport's syndrome underwent living-related renal transplantation from his 48-year-old father. His primary immunosuppressive regimen was composed of tacrolimus, mizolibine, and methylprednisolone. The postoperative course was satisfactory with one episode of mild acute rejection, treated successfully with methylprednisolone pulse therapy. Two months later, hypercalcemia (11.8-13.2 mg/dl) and hypophosphatemia (2.5-3.0 mg/dl) were noted without any bone symptoms. The serum intact-parathyroid hormone (PTH) and serum alkaline phosphatase levels were 240 pg/ml and 2483 IU/l, respectively. Ultrasound studies revealed enlargement of the two parathyroid glands. Under the diagnosis of tertiary hyperparathyroidism, he underwent percutaneous ethanol injection (PEIT) into the left parathyroid gland. Although levels of serum calcium and phosphorus returned to normal ranges and the intact PTH level decreased to 95 pg/ml with the three injections, another injection was needed to normalize recurrent hypercalcemia 2 months later. The patient experienced only transient mild dysphonia and local pain after PEIT. Although PEIT is believed less effective than parathyroidectomy, it has some advantages such as applicability to high-risk patients, repeatability of treatment, low incidence and severity of side effects.
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PMID:A case of post-transplant hyperparathyroidism treated with ethanol injection. 1195 72

The effect of active absorbable algal calcium (AAA Ca) with collagen and other matrix components on aging-associated skin changes and backache and joint pain was tested in a case-controlled study of 40 test subjects and 40 age-matched control subjects (mean age, 65 years) complaining of backache and knee joint pain due to osteoarthritis, spondylosis deformans, and/or osteoporosis. Supplementation with 900 mg calcium (given as AAA Ca) and 3.5 g collagen and other matrix components, including glucosamine, daily for 4 months resulted in a marked alleviation of subjective pain, assessed by the face scale. A fall of skin impedance in response to exercise loads, such as standing up, walking, squatting, and climbing up and down stairs, reported as an objective manifestion of pain, was also alleviated. The basal skin impedance, which increases with age, was significantly reduced in response to the Ca-collagen-matrix supplementation, suggesting a change of skin properties similar to rejuvenation, along with subjective smoothening and moistening of the skin. Urinary excretion of N-terminal crosslinking telopeptide of type I collagen (NTx) was decreased in the Ca-collagen-matrix supplementation group, but not in the control group. In addition to calcium suppression of parathyroid hormone, preventing bone resorption, collagen, acting on the intestinal lymphatic system, may protect collagen from degradation through the inhibition of cytokine-induced release of metalloproteinases, including collagenase.
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PMID:The effect of active absorbable algal calcium (AAA Ca) with collagen and other matrix components on back and joint pain and skin impedance. 1220 36

Normocalcemic primary hyperparathyroidism is an uncommon condition usually found among patients with urinary stones. To the best of our knowledge, this is the first case of a patient with normocalcemic primary hyperparathyroidism presenting with bilateral femoral neck fracture. A 45-year-old man had pain both hip joints and limping in for several months. Vertical fractures of bilateral femoral necks were found by radiographs. Laboratory findings showed a normal value of total serum calcium but elevated serum ionized calcium. Serum parathyroid hormone and alkaline phosphatase levels were elevated. The patient was treated with subtrochanteric valgus osteotomy fixed with a dynamic hip screw and total parathyroidectomy. Histopathologic examination showed hyperplasia of the parathyroid glands. At 1-year follow-up, the patient was doing well clinically.
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PMID:Normocalcemic primary hyperparathyroidism with fractures. 1221 40

A 58-year-old man with a 4-month history of atypical chronic myeloid leukemia (aCML), treated with INF-alpha and hydroxyurea, presented with severe localized bone pain with involvement of upper limbs on July 17, 2000. Cytogenetic analysis of peripheral blood cells showed 46,XY,t(9;22)(p23;q11) and no BCR-ABL fusion gene was detected by fluorescence in situ hybridization (FISH). On October 30,2000, x-rays revealed extended destruction of the bilateral proximal upper limbs; pain in the femoral bones appeared in December, and the patient couldn't walk. Roentgenograms taken on January 4, 2001, showed diffuse lytic changes in bilateral femoral bones. On January 23, 2001, fixation of pending fractures in the bilateral femoral bones with an intramedullary rod had produced good results. The infiltration of immature myeloid cells was diagnosed by the histological findings of a bone specimen from the right femur. Because the serum levels of parathyroid hormone (PTH), PTH related protein, and calcitonin were normal, we considered that the bone destruction was caused by the invasion of immature myeloid cells. Four months later, the patient showed a marked increase in peripheral immature granulocytes. A bone marrow specimen showed blastic marrow, and he died of a brain hemorrhage. This report suggests that aCML might cause destructive bone lesions prior to the disease progression. To our knowledge, this is the first published case of aCML in which the chromosomal abnormality t(9;22)(p23;ql 1) was detected.
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PMID:Translocation t(9;22) (p23;q11) in atypical chronic myeloid leukemia (aCML) presenting osteolytic lesions. 1246 98

The human PTH2 receptor binds and is activated at high potency by PTH and by the recently discovered peptide tuberoinfundibular peptide of 39 residues (TIP39). Rat and zebrafish PTH2 receptors are more weakly activated by PTH, suggesting that TIP39 may be the natural ligand for the PTH2 receptor. Unlike the PTH1 receptor, the PTH2 receptor interacts extremely weakly with parathyroid hormone-related peptide (PTHrP). The PTH2 receptor is strongly coupled to stimulation of cAMP accumulation, and more weakly, in a cell-specific manner to increases in intracellular calcium concentration. A variety of evidence supports the general model of receptor amino terminal sequences binding ligand carboxyl terminal sequences with high affinity, and ligand amino terminal sequences activating the receptor through interaction with the "juxtamembrane" portion of the receptor. The receptor is present at greatest levels in the nervous system. It is expressed in scattered cells in the cerebral cortex and basal ganglia and at relatively high abundance in the septum, midline thalamic nuclei, several hypothalamic nuclei, and the dorsal horn of the spinal cord. Peripherally, expression in pancreatic islet somatostatin cells is most dramatic. Functional hypotheses based on the receptor's distribution are being tested. Recent data support involvement in hypothalamic releasing-factor secretion and pain.
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PMID:The parathyroid hormone 2 (PTH2) receptor. 1252 38

Minimally invasive radio-guided surgery (MIRS) of parathyroid adenomas has been favoured by three main factors. One is the significant improvements achieved in preoperative localizing imaging, particularly with sestamibi scintigraphy. Another is the availability of intra-operative quick parathyroid hormone measurement, and finally the increase in availability of the intra-operative gamma probes in many surgical centres especially those performing sentinel node biopsy. In contrast with the traditional wide bilateral neck exploration (BNE), MIRS requires strict inclusion criteria: 1) high probability of a solitary parathyroid adenoma, 2) a significant sestamibi uptake in the parathyroid adenoma, 3) absence of a concomitant thyroid nodular disease, 4) no family history of familial hyperparathyroidism (HPT) of multiple endocrine neoplasia, 5) no previous neck irradiation. Following these criteria about 60-70% of all primary HPT patients are suitable for a MIRS. Two main protocols for MIRS have been proposed. The single day, imaging and surgery, protocol is based on the injection of a 740 MBq dose of 99mTc sestamibi with the purpose of obtaining scintigraphic imaging and then MIRS within 3 hours from radio-tracer injection. An alternative is for imaging to be performed a few days before surgery, with a further small administered activity of 37MBq of 99mTc sestamibi injected intravenously in the operating theatre a few minutes before commencing the intervention for the purpose of MIRS only. The latter protocol allows both better planning of operating theatre scheduling and reduction of the radiation exposure to the surgical staff. The main advantages of MIRS in respect to the traditional BNE include less surgical trauma, a shorter duration of anaesthesia and surgery, a shorter hospital stay with the possibility of same-day discharge, less post-surgical pain with improved cosmetic results and lower costs. Moreover, MIRS has proven to be a safe technique with a low morbidity rate and a cure rate higher than 95% in patients with primary HPT.
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PMID:Optimization of peroperative procedures. 1254 37

Painful pathological fractures of the femoral neck and the subtrochanteric region of the femur are reported in two women originating from India. After exclusion of renal or intestinal causes, laboratory data on bone metabolism, scintigraphic and radiographic examinations were characteristic for the presence of secondary hyperparathyroidism. Based on vitamin deficiency and low calcium absorption, disturbed mineralization of bone and increased osteoclastic resorption have apparently led to osteomalacia and subsequent fracturing. Fracture localization necessitated surgical fixation in one patient; conservative treatment including protected weightbearing was effective in the other women. After supplementation of calcium and vitamin D3, levels of parathyroid hormone and scintigraphic alterations returned to normal in both patients. In these two cases, pathological fractures of the hip could be attributed to the presence of secondary hyperparathyroidism based on decreased cutaneous vitamin D synthesis.
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PMID:Decreased cutaneous vitamin D-synthesis in heavily melanized individuals: a rare cause for pathologic fractures of the hip. 1274 Oct 80

In Japan, there are many dialysis patients because of the successful development and wide application of dialysis techniques. Almost all patients require long-term hemodialysis treatment because kidney transplantation is performed rarely. Renal hyperparathyroidism is one of the serious complications for hemodialysis patients. According to the overview of regular dialysis treatment reported by the Japanese Society for Dialysis Therapy, parathyroidectomy is required in 9.2%of patients who remain on hemodialysis more than 10 years and in 33.5%of those who so remain for more than 25 years. In this paper, we will describe the diagnosis, surgical indications, and operative strategy of renal hyperparathyroidism. The symptoms and biochemical variables were high serum parathyroid hormone (PTH) level, hyperphosphatemia, bone and joints pain, itching, irritability, muscle weakness, severe skeletal deformity, progression of ectopic calcification, and anemia. The clinical indications for performing parathyroidectomy to treat renal hyperparathyroidism in our institute are based on the indications reported by Tominaga et al. These are 1) high serum PTH level, 2) detection of enlarged parathyroid glands, 3) detection of osteitis fibrosa cystica on radiography or detection of high bone turnover by bone metabolic markers or bone scintigram, 4) resistance of symptoms to medical treatment. The routine operative procedure for renal hyperparathyroidism is total parathyroidectomy with forearm autograft. For autotransplantation, 30 pieces sliced 1x1x3 mm of diffuse hyperplasia are implanted into 30 pockets in the forearm without arteriorvenous (A-V) fistula for hemodialysis. In any surgical procedure for renal hyperparathyroidism, it is crucial to identify all parathyroid glands, including supernumerary glands and ectopic glands. At the initial operation for renal hyperparathyroidism, the surgeon must remove all parathyroid glands to avoid persistent and recurrent hyperparathyroidism and choose proper and adequate parathyroid tissue for autograft.
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PMID:[Endocrine surgery: the tenth report. Diagnosis, surgical indications and operative strategy of renal hyperparathyroidism]. 1292 32


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