Patient: Female, 28Final Diagnosis: Primary hyperparathyroidismSymptoms: Clavate swelling of the tubular bones • deformation of ribs and pelvic bones • duck gait • gait disturbance • general weakness • joint restrictions • keeled thorax • lameness • muscle weakness • pain in the bones and joints • rachiocampsisMedication: —Clinical Procedure: C-section in the lower uterine segment by transverse incision • a thoracoscopic removal of ectopic formation of the parathyroid glandSpecialty: Obstetrics and GynecologyObjective:Rare co-existance of disease or pathologyBackground:Primary hyperparathyroidism is most common in women during the menopause and its occurrence in pregnant women is rare. However, because neonatal mortality is associated with maternal hyperparathyroidism, early diagnosis is essential. This report describes the case of a late diagnosis of primary hyperparathyroidism in a 28-year-old pregnant woman and describes the effects on the mother and neonate.Case Report:During her second pregnancy, a 28-year-old woman presented with symptoms of general weakness, bone and joint pain, multiple fractures with bone deformity, muscle weakness, and gait disturbance. Due to the high risk of perinatal pathology, a cesarean section was performed. Several weeks later, she underwent thoracoscopic removal of an ectopic parathyroid gland located at the aortic arch. Hypocalcemia in the newborn infant required treatment with calcium and magnesium supplements.Conclusions:This case demonstrates that primary hyperparathyroidism during pregnancy requires timely diagnosis and treatment to reduce potential maternal and fetal complications. Screening for primary hyperparathyroidism should be undertaken in pregnant women with any symptoms associated with hypercalcemia. Treatment should be individualized and includes conservative management, parathyroidectomy in the second trimester, or parathyroidectomy performed in the early postpartum period.

Nighttime salivary cortisol (NSC) has been suggested to be a useful diagnostic test for Cushings syndrome (CS). However, the reference range and cut-off value are assay-specific and discordant. The goal of this study was to assess the analytical performance of automated elecrochemiluminiscence immunoassay method (ECLIA) in CS. Ninety eight healthy volunteers and 123 obese patients including 45 proved to be CS provided salivary samples collected by them at 23:00 using Sallivette. Two hundred and five subjects collected salivary samples for two consecutive days and samples from 197 subjects were frozen to perform Enzyme-linked immunosorbent assay (ELISA). Obese patients underwent the 1-mg overnight dexamethasone suppression test (1-DST). CS was confirmed by the histologic diagnosis after surgical treatment or autopsy. The reference range for healthy volunteer has been set 0,5-9,4 nmol/l. Reproducibility was assessed in all subjects by a day-to-day variability and reflected by an intraclass correlation coefficient of 0,785. The cut-off value of 9,4 nmol/l has been suggested to differentiate CS among obese patients to achieve sensitivity of 84,4% (95%confidence interval 71,2-92,2%); specificity of 92,3% (95%CI 84,2-96,4%) and diagnostic odds ratio 65,1 (95% CI 20,4-207,6). Likelihood ratio positive was 11,0 (95% CI 5,0-23,9), with a likelihood ratio negative of 0,17 (95%CI 0,08-0,33). The comparison of the total areas under the ROC-curve for the measurement of NSC once, twice with mean level by ECLIA, the same samples by ELISA and 1-DST have not shown any statistically significant difference among the tests performance. Conclusion: Based on its remarkable reproducibility, easy noninvasive nature, automated assay and at least similar diagnostic performance, NSC measured by ECLIA on Cobas e601 is a preferable first-line screening test for CS.

This review paper was designed to discuss the accumulated worldwide experience with selective collection of blood from the inferior petrose sinuses for the purpose of differential diagnostics of ACTH-dependent hypercorticism. The history of the development of the method is described, principal indications and contraindications to its clinical application are considered with reference to the informative value of this diagnostic tool. Possible causes of false positive and false negative results as well as complications ever reported as associated with the diagnostic procedure are discussed. Much attention is given to the comparative analysis of advantages and disadvantages of alternative techniques for blood collection and to the use of pharmaceutical agents that may increase efficiency of the method under consideration.

Primary hyperparathyroidism (PHPT) is an endocrine disorder of parathyroid glands characterized by excessive secretion of parathyroid hormone (PTH) with an upper normal or elevated blood calcium level. Classical PHPT refers to a symptomatic, multi-system disorder, wich can lead to a significant decrease in the quality of life, disability of patients, and even an increased risk of premature death. Hypercalcemia and the catabolic effect of PTH on various cells are considered as the main pathogenetic mechanisms of the PHPT associated complications. In the last two decades, there has been an increase in the incidence of PHPT, mainly due to the mild forms of the disease, primarily due to the routine calcium screening in North America, Western Europe and, Asia. High prevalence of the disease, as well as the variety of clinical manifestations, cause the attention of different specialists - physicians, rheumatologists, urologists, nephrologists, cardiologists and other doctors. This review cover the main issues of Russian guidelines for the management of PHPT, approved in 2020, including laboratory and instrumental methods, differential diagnosis, surgical and conservative approach, short-term and long-term follow-up. This guidelines also include the recommendations for special groups of patients with hereditary forms of PHPT, parathyroid carcinoma, PHPT during pregnancy.