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This article discusses the clinical utility of untimed spot urine sampling in diagnosing primary hyperparathyroidism (PHPT) in patients with hypercalcemia. PHPT is a common endocrine disorder characterized by elevated parathyroid hormone (PTH) levels and hypercalcemia. The study found that untimed spot urine sampling can be a convenient and patient-friendly method for diagnosing PHPT, with a urine calcium/creatinine clearance ratio (CCCR) greater than 0.01 indicating PHPT. However, it is important to differentiate PHPT from familial hypocalciuric hypercalcemia (FHH), a benign autosomal dominant disorder, as FHH does not require surgical management. The article suggests a diagnostic algorithm that considers clinical factors, genetic testing, and historical serum calcium levels to prevent misdiagnosis. The prevalence of FHH in patients with PTH-dependent hypercalcemia was found to be 6%, and FHH should be considered in patients with persistently low urine CCCR, regardless of age. [Extracted from the article]

This document summarizes a study on the clinical outcomes of surgical management for primary aldosteronism (PA) when adrenal vein sampling (AVS) results are inconclusive. AVS is the preferred method for subtyping PA, but it can be challenging to successfully cannulate both adrenal veins. The study found that patients who had successful AVS and underwent unilateral adrenalectomy achieved clinical and biochemical remission. Patients with inconclusive AVS results were managed either surgically or with medical therapy, and the majority of those who underwent surgery achieved biochemical remission. The study suggests that inconclusive AVS results, along with imaging findings, can help guide surgical decision-making, but further research is needed to validate these findings. It also emphasizes that patients who are not candidates for surgery should not undergo AVS. [Extracted from the article]

This article discusses the diagnostic accuracy of morning serum cortisol concentration in confirming recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients on chronic glucocorticoid therapy (CGT). CGT is commonly used as an anti-inflammatory and immunosuppressive agent, but it can lead to glucocorticoid-induced adrenal insufficiency (AI). The study found that a morning serum cortisol concentration of >237 nmol/L (>8.6 μg/dL) had 100% specificity in confirming an intact HPA axis in patients on CGT. This finding suggests that this cutoff can be used as a screening test, potentially avoiding unnecessary synacthen stimulation tests (SSTs) in patients on tapering doses of CGT. The study also suggests that assessment of the HPA axis should be considered once a daily prednisolone dose of ≤3 mg is reached. Overall, this research provides a more rapid, convenient, and cost-effective method for assessing the HPA axis in patients on CGT. [Extracted from the article]

In those with successful AVS, 9/10 (90%) achieved AC > 3.5 or AV/IVC > 3.4 for the affected gland and 7/10 (70%) achieved A/C <= 0.63 or AV/IVC <= 0.37 for the suppressed gland. We avoid surgery on the unaffected adrenal gland by offering surgery to the contralateral side in selected cases with unilateral cannulation index of AV/IVC < 1. We read the article by Tomsic et al.[1] on the role of subtyping primary hyperaldosteronism (PA) with inconclusive adrenal vein sampling (AVS), with great interest. Of greater significance, among the patients with "inconclusive" AVS and only unilateral cannulation success, 3 out of 4 achieved AC > 3.5 or AV/IVC > 3.4 for the affected gland and the one patient with left-sided suppressed AV/IVC did not achieve the suppression index of A/C <= 0.63 or AV/IVC <= 0.37. [Extracted from the article]

ABSTRACT Objectives Methods Results Conclusions Anaemia is a key cause of morbidity in chronic kidney disease (CKD). Androgen deficiency (AD) in males can contribute to anaemia of all causes, including in CKD. We sought to examine the prevalence of AD in men with CKD, the extent to which it contributed to anaemia and whether it was independently associated with long‐term survival.This cross‐sectional observational study was conducted among males aged 18 years and over with CKD stages 4 and 5. The study analysed morning blood samples with regard to their full blood count, urea and electrolytes, albumin, lipids, testosterone (T) and sex hormone binding globulin, with calculation of free testosterone by mass action equation. Mortality data were obtained 15 years later for survival analysis.Among 322 patients with a mean age of 63 years, the overall prevalence of AD was 68.9%. There was a statistically significant negative correlation between erythropoiesis stimulating agent (ESA) dose and testosterone concentrations (Pearson correlation −0.193, p = 0.05). There was a positive correlation between haemoglobin (Hb) and free testosterone level among patients not on ESA therapy (Pearson correlation 0.331, p < 0.001). Kaplan‐Meier plots showed p < 0.001 on log‐rank analysis, indicating that AD was significantly associated with worse survival. However, in Cox regression analysis, free testosterone was not associated with survival (95% CI for free testosterone 0.997–1.000).AD is highly prevalent among this population, and increases further with older age and more severe CKD warranting haemodialysis. Association of lower Hb and higher ESA dose with lower T concentration might be causative, which has important pharmaco‐economic as well as clinical implications. Lower survival in men with low T, more likely reflects overall poor health rather than causation. A properly constituted randomised controlled study evaluating the effect of native T replacement is warranted in men with CKD and AD. [ABSTRACT FROM AUTHOR]