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Title: CLINICAL-METABOLIC AND HORMONAL RELATIONSHIPS BETWEEN PARATHYROID DISEASE AND OTHER NON-CANCEROUS ENDOCRINE DISORDERS IN THE CHORNOBYL NPP ACCIDENT SURVIVORS.
Author: Kaminskyi OV, Kopylova OV, Afanasyev DE, Muraviova IM, Chikalova IG, Dombrovska NS.
Journal: Probl Radiac Med Radiobiol; 2021 Dec; 26():410-425. PubMed ID: 34965563.
Abstract:
OBJECTIVE: to investigate the clinical, hormonal-metabolic and structural features of parathyroid injuries in sur-vivors exposed to ionizing radiation after the Chornobyl NPP accident in adulthood and childhood, both with theirconnections to other non-cancerous endocrine disorders, and to establish the respective interhormonal and dys-metabolic relationships. MATERIALS AND METHODS: Clinical effects of ionizing radiation on the endocrine system in persons affected by theChornobyl NPP accident (n = 224) and their descendants (n = 146), compared with the general population sample(n = 70) were the study object. All patients underwent the ultrasound thyroid and parathyroid examination. Thegenerally recognized clinical, anthropometric (body weight, height, thigh volume, body mass index), instrumental(ultrasound examination of thyroid and parathyroid glands), laboratory (biochemical, hormonal), and statisticalmethods were applied. Parametric and nonparametric statistical methods were used in data processing. The value ofp < 0.05 was considered a statistically significant. RESULTS: No significant difference was found in the incidence of carbohydrate metabolic disorders in the ChornobylNPP (ChNPP) accident consequences clean-up workers (ACCUW), evacuees from the NPP 30-km exclusion zone, res-idents of radiologically contaminated areas and in the control group in whom the parathyroid hyperplasia wasdetected. There was a significant increase in the incidence of arterial hypertension among ACCUW who had parathy-roid hyperplasia (76.9%) vs. the control group (51.2%). In cases of parathyoid hyperplasia the vitamin D levels weresignificantly lower than without it. Vitamin D insufficiency/deficiency was found in 94% of the surveyed subjects.The average level of parathyroid hormone in blood serum was significantly higher in the ACCUW of «iodine» period withdiagnosed parathyroid hyperplasia than in the control group: (57.2 ± 2.87) pg / ml against (32.74 ± 3.58) pg / ml,p < 0.05. Results of multivariative analysis indicated a strong association of vitamin 25(OH)D insufficiency/defi-ciency with development of thyroid disease, carbohydrate metabolic disorders, cardiovascular disease, osteo-penia/osteoporosis. parathyroid ultrasound scan was at that an effective diagnostic method for primary screeningfor parathyroid hyperplasia and regular monitoring of the treatment efficiency. When examining children bornto parents irradiated after the ChNPPA the parathyroid hyperplasia (58%) and low serum content of vitamin D(11.6 ± 3.5) nmol / l were most often found in children living on radiologically contaminated territories (RCT).A strong correlation was established between the HOMA insulin resistance index and serum content of vitamin D(r = 0.65), parathyroid hormone (r = 0.60), and free thyroxine (r = 0.68) in the group of children born to parents irra-diated after the ChNPPA, having got chronic autoimmune thyroiditis, which indicated a relationship between thy-roid function, impaired carbohydrate and fat metabolism and the state of parathyroids. CONCLUSIONS: No difference in the incidence of carbohydrate metabolic disorders was found in the ChNPP ACCUW,evacuees from the 30-km exclusion zone, and residents of radiologically contaminated territories in whom parathy-roid hyperplasia was detected vs. the control group. Patients with parathyroid hyperplasia were found to be defi-cient in vitamin D in 94% of cases, and level of latter was significantly lower than under the normal parathyroid size.There was a significant increase in the incidence of diagnosed arterial hypertension among ACCUW who had parathy-roid hyperplasia vs. the control group: (76.9 ± 3.5)% vs. (51.2 ± 3.7)%. According to multivariate analysis a strongassociation between the vitamin 25(OH)D insufficiency/deficiency and development of thyroid disease, carbohydratemetabolic disorders, cardiovascular disease, and osteopenia/osteoporosis was established. The average level of pa-rathyroid hormone in the blood serum of the ChNPP ACCUW of the «iodine» period with diagnosed parathyroid hyper-plasia was significantly higher (57.2 ± 2.87) pg / ml against (32.74 ± 3.58) pg / ml; p <0,05) in the control group. Meta: doslidyty klinichni, gormonal'no-metabolichni ta strukturni osoblyvosti urazhennia pryshchytopodibnykh zalozpostrazhdalykh osib, oprominenykh vnaslidok avariï na ChAES u doroslomu i dytiachomu vitsi, ïkh sporidnenist' z inshy-my nezloiakisnymy endokrynnymy porushenniamy, vstanovyty mizhgormonal'ni ta dysmetabolichni vzaiemozv’iazky.Materialy ta metody. Ob’iekt doslidzhennia: klinichni naslidky diï ionizuiuchogo vyprominiuvannia na endokrynnusystemu u 224 osib, postrazhdalykh vnaslidok avariï na ChAES ta 146 ïkhnikh nashchadkiv, u porivnianni z zagal'noiu po-puliatsiieiu naselennia (70 osib). Vsim patsiientam bulo provedeno ul'trazvukove doslidzhennia shchytopodibnoï ta pry-shchytopodibnykh zaloz (PShchPZ). Vykorystani zagal'novyznani klinichni, antropometrychni (masa tila, zrist, obsiagstegna, indeks masy tila), instrumental'ni (ul'trazvukove doslidzhennia shchytopodibnoï ta PShchPZ), laboratorni(biokhimichni, gormonal'ni), statystychni. Vykorystovuvaly parametrychni i neparametrychni metody doslidzhennia.Pry rozrakhunku statystychnoï znachushchosti ïï riven' r < 0,05 vvazhaly statystychno dostovirnym. Rezul'taty. Ne znaĭdeno virogidnoï riznytsi v chastoti porushen' vuglevodnogo obminu v uchasnykiv likvidatsiïnaslidkiv avariï (ULNA) na ChAES, evakuĭovanykh iz 30-km zony vidchuzhennia, meshkantsiv radiatsiĭno zabrudnenykh te-rytoriĭ ta v grupi kontroliu, v iakykh bula vyiavlena giperplaziia PShchPZ. Vstanovleno znachne pidvyshchennia chastotyarterial'noï gipertenziï sered ULNA, iaki maly giperplaziiu PShchPZ (76,9 %), porivniano z grupoiu kontroliu (51,2 %).U patsiientiv z giperplaziieiu PShchPZ pokaznyky zabezpechenosti organizmu vitaminom D buly virogidno nyzhchi, nizh bezneï. Nestachu/defitsyt vitaminu D vyiavleno u 94 % obstezhenykh. Vyznacheno, shcho v ULNA na ChAES ĭodnogo periodu,v iakykh vyiavlena giperplaziia PShchPZ, seredniĭ riven' paratgormonu u syrovattsi krovi virogidno buv vyshchym, nizh ugrupi kontroliu: (57,2 ± 2,87) pg/ml proty (32,74 ± 3,58) pg/ml, p < 0,05. Bagatofaktornyĭ analiz pokazavvirogidnyĭ zv’iazok nestachi/defitsytu vitaminu 25(ON)D z rozvytkom tyreoïdnoï patologiï, porushenniam vuglevod-nogo obminu, sertsevo-sudynnymy zakhvoriuvanniamy, osteopeniieiu/osteoporozom, a UZD PShchPZ ie diievym diagnos-tychnym metodom pervynnogo skryningu giperplaziï PShchPZ i postupovogo monitoryngu klinichnoï efektyvnostilikuvannia. Pry obstezhenni diteĭ, iaki narodylysia vid bat'kiv, oprominenykh vnaslidok avariï na ChAES, giperplaziiaPShchPZ (58 %) i nyz'kyĭ riven' vitaminu D v syrovattsi krovi – (11,6 ± 3,5) nmol'/l naĭchastishe vyiavlialy u diteĭ,meshkantsiv radiatsiĭno-zabrudnenykh terytoriĭ (RZT). Vstanovleno virogidnyĭ koreliatsiĭnyĭ zv’iazok mizh indeksominsulinorezystentnosti NOMA i vitaminom D (r = 0,65), paratgormonom (r = 0,60), vil'nym tyroksynom (r = 0,68)u grupi diteĭ, narodzhenykh vid bat'kiv, oprominenykh vnaslidok avariï na ChAES, z khronichnym autoimunnym tyreoïdy-tom, shcho svidchyt' pro naiavnist' vzaiemozv’iazku mizh funktsiieiu shchytopodibnoï zalozy, porushenniam vuglevodnogo izhyrovogo obminu ta stanom PShchPZ. Vysnovky. Takym chynom, v ULNA na ChAES, evakuĭovanykh iz 30-km zony vidchuzhennia, meshkantsiv radiatsiĭno zabrud-nenykh terytoriĭ ta v grupi kontroliu ne vyiavleno virogidnoï riznytsi v chastoti porushen' vuglevodnogo obminu vobstezhenykh osib, v iakykh bula vyiavlena giperplaziia PShchPZ. U patsiientiv z giperplaziieiu PShchPZ vyiavlena nesta-cha/defitsyt vitaminu D u 94 %, a ĭogo riven' buv virogidno nyzhchym, nizh pry normal'nykh rozmirakh tsykh zaloz. Vsta-novleno znachne pidvyshchennia chastoty diagnostovanoï arterial'noï gipertenziï sered ULNA, iaki maly giperplaziiuPShchPZ, porivniano z grupoiu kontroliu: (76,9 ± 3,5) % proty (51,2 ± 3,7) %. Bagatofaktornyĭ analiz pokazavvirogidnyĭ zv’iazok nestachi/defitsytu vitaminu 25(ON)D z rozvytkom tyreoïdnoï patologiï, porushenniamy vuglevod-nogo obminu, sertsevo-sudynnymy zakhvoriuvannia, osteopeniieiu/osteoporozom. Vyznacheno, shcho v ULNA na ChAES ĭodnogo periodu, v iakykh vyiavlena giperplaziia PShchPZ, seredniĭ riven' paratgormonu u syrovattsi krovi virogidnobuv vyshchym (57,2 ± 2,87) pg/ml proty ((32,74 ± 3,58) pg/ml; p < 0,05) nizh u grupi kontroliu.

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