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Differential diagnosis between secondary hyperparathyroidism and aluminum intoxication in uremic patients: Usefulness of /sup 99m/Tc-pyrophosphate bone scintigraphy

Journal Article · · World J. Surg.; (United States)
DOI:https://doi.org/10.1007/BF01658405· OSTI ID:5877426
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Forty-one patients in chronic end-stage renal failure and 4 patients with a functioning kidney transplant presented with spontaneous hypercalcemia or intolerance to vitamin D3 sterols and/or oral calcium supplements. Bone iliac crest biopsy with aluminum staining and Tc-pyrophosphate bone scintigraphy with determination of Fogelman score were performed in all cases. Two patients had aluminum-induced osteomalacia (AL O). Thirty-eight biopsies showed renal osteodystrophy (secondary hyperparathyroidism or various combinations of osteitis fibrosa and osteomalacia): 19 with positive staining for aluminum (RO + AL) and 19 without aluminum deposits (RO). The series also comprised 2 cases of pure osteomalacia (OM), 2 cases of osteoporosis (OP), and 1 case of osteoporosis with aluminum accumulation (OP + AL). Mean Fogelman score in RO patients (9.1 +/- 0.3) was significantly higher than in all other categories (5.9 +/- 0.5 for RO + AL, and scores ranging from 0 to 8 in the last 7 patients, p less than 0.01). Patients with massive aluminum accumulation in bone (greater than 75% of the total trabecular surface) showed no or very low uptake of the isotope by the skeleton. Fogelman scores of 9 or higher were always associated with histological secondary hyperparathyroidism. /sup 99m/Tc-pyrophosphate bone scintigraphy is helpful to distinguish aluminum intoxication from secondary hyperparathyroidism in uremic patients.

OSTI ID:
5877426
Journal Information:
World J. Surg.; (United States), Journal Name: World J. Surg.; (United States) Vol. 13:2; ISSN WJSUD
Country of Publication:
United States
Language:
English

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Related Subjects

550601* -- Medicine-- Unsealed Radionuclides in Diagnostics
560300 -- Chemicals Metabolism & Toxicology
62 RADIOLOGY AND NUCLEAR MEDICINE
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.
ALUMINIUM
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BODY
COUNTING TECHNIQUES
DIAGNOSIS
DIAGNOSTIC TECHNIQUES
DISEASES
ELEMENTS
ENDOCRINE DISEASES
HOURS LIVING RADIOISOTOPES
HYPERPARATHYROIDISM
INTERMEDIATE MASS NUCLEI
ISOMERIC NUCLEI
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
KIDNEYS
METALS
NUCLEI
ODD-EVEN NUCLEI
ORGANS
OXYGEN COMPOUNDS
PATIENTS
PHOSPHORUS COMPOUNDS
PYROPHOSPHATES
RADIOISOTOPE SCANNING
RADIOISOTOPES
SCINTISCANNING
SKELETON
TECHNETIUM 99
TECHNETIUM ISOTOPES
TOXICITY
UROGENITAL SYSTEM DISEASES
YEARS LIVING RADIOISOTOPES