Bone Mineral Density and Vitamin D Status in Patients with Autoimmune Polyglandular Syndromes: A Single Tertiary Care Center Experience

Diverse clinical manifestations and management strategies in autoimmune polyglandular syndrome: a review of cases

Autoimmune polyglandular syndrome (APS) is a rare autoimmune disease that affects multiple endocrine glands. It can lead to various clinical manifestations. The primary objective of this review was to provide a comprehensive analysis of the clinical features and management strategies used in managing APS, based on a review of case reports. We emphasize disease pattern recognition and detection of atypical clinical signs, as well as the outcomes of various treatment modalities. Case reports from credible journals were searched in PubMed, resulting in a systematic literature review adopting the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Of the 1173 records identified, 474 remained after duplicates were removed, and 49 full-text articles were reviewed. After further screening based on criteria such as associated disorders, patient age, follow-up, and treatment details, 12 articles were selected for the final analysis. The findings revealed that common endocrine dysfunctions in APS include Addison's disease and hypothyroidism, while non-endocrine manifestations, such as autoimmune encephalitis and pernicious anemia, can also occur. The most frequently adopted strategies were immunosuppressive and hormone therapies. The heterogeneity of APS indicates early diagnosis and individualized treatment strategies. Ultimately, this analysis identifies existing insufficiencies and provides recommendations for formulating standard operating procedures for the treatment of APS.

Drug-induced osteoporosis and mechanisms of bone tissue regeneration through trace elements

Osteoporosis is associated with an imbalance in bone formation, with certain drugs used in disease treatment being implicated in its development. Supplementation with trace elements may contribute to bone regeneration, offering an alternative approach by enhancing bone mineral density (BMD) and thereby thwarting the onset of osteoporosis. This review aims to assess the mechanisms through which trace elements such as copper (Cu), iron (Fe), selenium (Se), manganese (Mn), and zinc (Zn) are linked to increased bone mass, thus mitigating the effects of pharmaceuticals. Our findings underscore that the use of drugs such as aromatase inhibitors (AIs), proton pump inhibitors (PPIs), antiretrovirals, glucocorticoids, opioids, or anticonvulsants can result in decreased BMD, a primary contributor to osteoporosis. Research indicates that essential elements like Cu, Fe, Se, Mn, and Zn, through various mechanisms, can bolster BMD and forestall the onset of the disease, owing to their protective effects. Consequently, our study recommends a minimum daily intake of these essential minerals for patients undergoing treatment with the aforementioned drugs, as the diverse mechanisms governing the effects of trace elements Cu, Fe, Mn, Se, and Zn facilitate bone remodeling.