Summary
The aim of this study was to detect linear arterial calcification (Mönckeberg’s sclerosis) localized in feet, ankles, legs, knees and hands in an attempt to correlate the extent of calcification with the presence and severity of autonomic neuropathy as well as with microangiopathy (proliferative retinopathy, proteinuria >200 mg/die) and peripheral neuropathy. Typical linear calcification were observed in 37 out of 41 (90.2%) patients with autonomic neuropathy and in none of those without autonomic neuropathy (p<0.001). These 37 patients were divided into two subgroups by cluster analysis: Subgroup A, including 18 subjects with calcification length ranging from 8 to 26 cm and moderate autonomic neuropathy, and Subgroup B, including 19 subjects with calcification length between 58 and 126 cm and severe autonomic neuropathy (p<0.0001 by Spearman’s test). No difference in the length of arterial calcification was detected between patients with proteinuria >200 mg/24h and/or proliferative retinopathy and patients without these complications. A possible relationship between arterial calcification and peripheral neuropathy is difficult to evaluate; in fact, the majority of subjects having autonomic neuropathy had peripheral neuropathy, too. Vice versa, around 10% of patients without peripheral neuropathy but with autonomic neuropathy did not have Mönckeberg’s sclerosis. Autonomic neuropathy is the principal factor responsible for calcification of the arterial media, and in addition the severity of the neuropathy, rather than the patient’s age or the known disease duration seems to determine the extent of calcification.
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References
Amos R. S., Wright V.: Mönckeberg’s arteriosclerosis and metabolic bone diseases — Lancetii, 248–249, 1980.
Armely M. F.: Denervation of ciliary muscle and iris sphincter following resection of the ciliary ganglion — Trans. Amer. Ophthalmol. Soc.66, 475–501, 1968.
Bellavere F., Bosello G., Fedele D., Cardone C., Ferri M.: Diagnosis and management of diabetic autonomic neuropathy — Brit. med. J.287, 61, 1983.
Bevan R. D., Tsuru H.: Long term denervation of vascular smooth muscle causes not only functional but structural change — Blood Vessels16, 109–112, 1979.
Boulton A. M. G., Scarpello J. H. B., Ward J. D.: Venous oxygenation in the diabetic neuropathic foot: evidence of arteriovenous shunting? — Diabetologia22, 6–8, 1982.
Bowen B. D., Koenig E. C., Viele A.: A study of the lower extremities in diabetes as compared with non-diabetic subjects from the standpoint of X-ray findings, with particular reference to the relationship of arteriosclerosis and diabetes — Bull. Buffalo Gen. Hosp.2, 35–41, 1924.
Bradford M. M.: A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein dye binding — Analyt. Biochem.72, 248–257, 1986.
Christiansen N. J.: Muscle blood flow measured by xenon and vascular calcification in diabetics — Acta med. scand.183, 449–454, 1968.
Edmonds M. E., Morrison N., Laws J. W., Watkins P. J.: Medial arterial calcification and diabetic neuropathy — Brit. med. J.284, 928–930, 1982.
Edmonds M. E., Roberts V. C., Watkins P. J.: Blood flow in the diabetic neuropathic foot — Diabetologia22, 6–8, 1982.
Ewing D. J., Martyn C. N., Young R. J., Clarke B. F.: The value of cardiovascular autonomic function test: 10 years experience in diabetes — Diabet. Care8, 491–498, 1985.
Ferrier T. M.: Radiologically demonstrable arterial calcification in diabetes mellitus — Aust. Ann. Med.13, 222–226, 1967.
Frank R. N.: Diabetic retinopathy: current concepts of evaluation and treatment. In:Watkins P. J. (Ed.): Long-term Complications of Diabetes. W. B. Saunders Ltd., London, 1986; p. 933–969.
Katzeff H. L., Savage P. J., Barelay-White B., Nagulesparan M., Bennett P. H.: C-peptide measurement in the differentiation of Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes mellitus — Diabetologia28, 264–268, 1985.
Kerper A. H., Collier W. D.: Pathological changes in arteries following partial denervation — Proc. Soc. exp. Biol. (N.Y.)24, 492–494, 1926.
Lie J. T.: The structure of the normal vascular system and its reactive changes. In:Jurgens J. L., Spittel J. A., Foxenbun J. A. II (Eds): Peripheral Vascular Disease. W. B. Saunders Ltd., London, 1980; pp. 51–81.
Mönckeberg J. G.: Über die reine Mediaverklekung der Extremitatenarterien und ihr Verhalten zür Arteriosklerose — Virchows Arch. (path. Anat.)171, 141–167, 1903.
Morgan A. J.: Mineralized deposits in the thoracic aorta of aged rats: ultrastructural and electron probe X-ray microanalysis study — Exp. Gerontol.5, 563–573, 1980.
Parfitt A. M.: Soft-tissue calcification in uremia — Arch. intern. Med.124, 544–556, 1969.
Ricordi L., Rossi M., Marti G., Finardi G., Fratino P., Bernardi L.: Hypertension in diabetes: an additional factor determining autonomic neuropathy? — Diabet. Nutr. Metabol.2, 269–275, 1989.
Rose C. A., Blackburn H.: Cardiovascular survey methods. WHO Monograph Series 56, Geneva, 1968.
Rotar J.: The autonomic nervous system. Akademia Kiadó, Budapest, 1966.
Silbert S., Lippman H. I., Gordon E.: Mönckeberg’s arteriosclerosis — J. Amer. med. Ass.151, 191–210, 1953.
Sinha S., Munichoodappa C. S., Kozak G. P.: Neuroarthropathy (Charcot joints) in diabetes mellitus — Medicine (Baltimore)51, 191–210, 1982.
Snedecor G. W., Cochran W. G.: Statistical methods. 6th Ed., Iowa State University Press, Ames/IA, 1974.
Spallone V., Tomei E., Spartera C., Sideri G., Bolea A., Laglia P., Petrassi C., Savina A., Menzinger G.: Sclerosi di Mönckeberg ed alterazioni di flusso nella neuropatia diabetica — G. ital. Diabetol6, 13–20, 1986.
Stickland M. H., Perkins C. M., Wales J. K.: The measurement of hemoglobin A1c by isoelectric focusing in diabetic patients — Diabetologia22, 315–317, 1982.
WHO Expert Committee: Arterial hypertension. World Health Organization Technical Report Series 628, World Health Organization, Geneva, 1978.
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Gentile, S., Bizzarro, A., Marmo, R. et al. Medial arterial calcification and diabetic neuropathy. Acta diabet. lat 27, 243–253 (1990). https://doi.org/10.1007/BF02581336
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DOI: https://doi.org/10.1007/BF02581336