Objective: Fibroblast growth factor 23 (FGF23), a phosphatonin, inhibits renal phosphate reabsorption and suppresses 1-α hydroxylase activity. Calcitriol stimulates FGF23 synthesis in bone. We aimed to determine the effect of vitamin D replacement therapy on serum FGF23 concentrations in vitamin D-deficient women and to compare the FGF23 concentrations of vitamin D-deficient patients with healthy subjects and patients with genetically determined hypophosphatemic rachitis.Design and methods: The study group was composed of vitamin D-deficient females (n=18, mean age 29.1±9.9 years), vitamin D-sufficient healthy females (control group;n=19, mean age 28.5±5.2 years), and patients with genetically determined hypophosphatemic rachitis (n=13, mean age 26.5±15.1 years). The groups were compared for serum FGF23, 1,25-dihydroxyvitamin D3 (1,25(OH)2D), calcium, phosphate, bone turnover markers, intact parathyroid hormone (PTH), and urinary excretion of calcium and phosphate. The vitamin D-deficient group was re-evaluated after a standard treatment regimen.Results: Serum FGF23 concentrations were significantly lower in vitamin D-deficient patients than in vitamin D-sufficient women and hypophosphatemic rachitis group. Serum FGF23 and phosphate concentrations further decreased significantly during replacement of vitamin D (P<0.05). A significant negative correlation was evident between FGF23 and PTH before vitamin D replacement in the patients (r=−0.469,P<0.05).Conclusion: Decreased FGF23 concentrations, which further decline during vitamin D replacement therapy, may have favorable action on bone mineralization by counterregulatory effect on phosphate homeostasis. Lower 1,25(OH)2D concentrations at baseline and hypophosphatemia during treatment may have dominating effects on FGF23 concentrations in vitamin D deficiency, leading to decreased FGF23 concentrations at baseline and during replacement therapy.

Introduction: This study aims to assess ⁶⁸Ga-Trivehexin PET/CT for detecting hyperfunctioning parathyroid tissue in comparison to [^99mTc]Tc-MIBI scintigraphy-SPECT/CT (MIBI scan) in patients with primary hyperparathyroidism (PHPT). Methods: The cohort comprised 13 patients diagnosed with PHPT based on biochemical analyses, including serum calcium, phosphorus, and parathyroid hormone (PTH) levels. Each participant underwent cervical ultrasonography, MIBI scan, and ⁶⁸Ga-Trivehexin PET/CT imaging. Complementary 4D-CT and [¹⁸F]fluorocholine PET/CT were conducted in 7 patients. Ten lesions of 7 patients underwent PTH wash-out (WO) procedure. ⁶⁸Ga-Trivehexin PET/CT findings were compared with other modalities and PTH-WO results. Results: Ten patients had sporadic PHPT, while 3 were diagnosed with MEN-1 syndrome-associated PHPT. One patient did not have any identifiable parathyroid lesion across the imaging modalities. On a patient-based analysis, MIBI scan and ⁶⁸Ga-Trivehexin PET/CT identified parathyroid lesions in 10 and 11 patients, respectively. However, ⁶⁸Ga-Trivehexin PET/CT detected 7 additional parathyroid lesions that were negative on the MIBI scan. Consequently, 17 lesions were identified and confirmed as hyperfunctioning parathyroid tissue through imaging, PTH-WO, or a combination of both modalities. In lesion-based evaluation, ⁶⁸Ga-Trivehexin identified 16 lesions compared to 10 by MIBI scan, resulting in a detection rate of 94.1% and 58.8%, respectively. Notably, in three patients who underwent [¹⁸F]fluorocholine PET/CT, no lesions were detected; yet ⁶⁸Ga-Trivehexin PET/CT successfully identified parathyroid lesions in two of these patients. Conclusion: Our study provides the first evidence that ⁶⁸Ga-Trivehexin PET/CT can effectively identify hyperfunctioning parathyroid tissue with a high detection rate warranting further investigations to comprehensively explore its potential in PHPT management.

Gestational diabetes mellitus (GDM) is a prevalent condition requiring accurate patient education, yet the reliability and readability of large language models (LLMs) in this context remain uncertain. This study evaluated the performance of four LLMs—ChatGPT-4o, Gemini 2.5 Pro, Grok 3.0, and DeepSeek R-1—using 25 patient-oriented questions derived from clinical scenarios. Seven endocrinologists independently rated the responses with the modified DISCERN (mDISCERN) instrument and the Global Quality Score (GQS). Readability was analyzed using the Flesch Reading Ease (FRES), Flesch–Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman–Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG), while lexical diversity was assessed through type–token ratio (TTR). Grok and Gemini obtained the highest mDISCERN and GQS scores, whereas ChatGPT performed significantly lower (p < 0.05). DeepSeek generated the most readable outputs, while Grok provided the longest and most complex responses. All models scored below the FRES threshold of 60 recommended for lay audiences. Response length showed strong positive correlations with mDISCERN and GQS, while TTR was inversely related to quality but positively associated with readability. These findings highlight variability among LLMs in GDM education and emphasize the need for model-specific improvements to ensure reliable patient-facing health information.