A Test for Abnormally Large Amounts of Parathyroid Hormone in the Blood

Hamilton, Bengt; Highman, Walter J.

doi:10.1172/jci100761

Cited by 13 publications

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“…Serum phosphorus was determined by the method of Fiske and Subbarow (15). The method of Hamilton and Schwartz (16), slightly modified (17), was used to detect hyperactivity of the parathyr.oid glands. This method consists of measuring the rise of the serum calcium of a rabbit into which 30 cc.…”

Section: Methodsmentioning

confidence: 99%

Hyperparathyroidism in Kidney Disease

Highman

Hamilton²

1937

J. Clin. Invest.

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Extensive investigations of the parathyroid glands were instigated by the cure of generalized osteitis fibrosa cystica by surgical removal of a parathyroid adenoma by Mandl (1) in 1925. It was early noted that renal calculi were often found in cases of parathyroid tumor (2). Later work showed that these stones consisted chiefly of calcium phosphate and that the tendency to their formation was definitely decreased when the urine was made more acid (3). Removal of the parathyroid tumor. resulted in the disappearance of this tendency to calculus formation and of the alkalinity of the urine.Albright, Baird, Cope, and Bloomberg (4), in their discussion of 83 cases of parathyroid tumor with hyperparathyroidism, brought out the fact that 43 of these showed clinical evidence of renal damage. These kidney lesions were attributed to damage resulting from the deposition of calcium in the renal parenchyma or to the formation of calculi in the pelves, such calcium depositions being manifestations of primary hyperparathyroidism. However, these authors suggested the possibility that parathyroid enlargement may be secondary to renal impairment: " It seems conceivable therefore that a chronic renal insufficiency with phosphate retention and a high inorganic phosphorus level might likewise cause hyperplasia of all parathyroid tissue which might go on to multiple tumor formation" and later, "In these cases the kidney damage may be the cause and not the result of the parathyroid tumors."p Bergstrand (5) studied the parathyroid glands in an extensive series of autopsies, and in most of the cases where he found them enlarged, there was also some damage to the kidneys. Pappenheimer and Wilens (6) carefully weighed the parathyroid glands from a large series of necropsies. They found the parathyroids taken from unselected nephritics to average more than 50 per cent greater in weight than those taken from non-nephritic controls. Seven severe nephritics showed an increase of 109 per cent over the same control series. The enlargement was diffusely hyperplastic in character, resembling the enlargement which has been reported in rickets (7,8), and which may exist in pregnancy (9, 10). Adenomata were found in only three of 56 nephritics and in two of 74 controls. Jarrett, Peters, and Pappenheimer (11) report that they have induced a similar enlargement of the parathyroids by producing chronic renal insufficiency in rats.In previous reports from this laboratory evidence of functional hyperactivity of the parathyroid glands in rickets (12) and in pregnancy (13) has been presented. We have used the same approach in our investigation of parathyroid activity in the present series of nephritic patients,' to determine whether the hyperplasia noted by Pappenheimer and Wilens (6) is accompanied by a hyperfunction. The patients were selected on the basis of elevation of the blood urea nitrogen, most of them having chronic rather than acute renal insufficiency. The controls were thirtyeight normal persons-thirty women and eight men. Determinations of ca...

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Section: Methodsmentioning

confidence: 99%

Hyperparathyroidism in Kidney Disease

Highman

Hamilton²

1937

J. Clin. Invest.

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“…These authors performed the test on the blood of 38 normal individuals; in these experiments the greatest rise in rabbits' serum calcium obtained in any experiment at either the three-hour or five-hour period after injection of the blood into the rabbits was 023 mM. per liter (2). These findings in normal individuals are used as a control basis; the finding of an increase of 0.30 mM.…”

Section: Review Of Literaturementioning

confidence: 99%

“…In 1936 Hamilton and Highman (2) presented certain modifications of this test designed to make the method particularly applicable to the detection of abnormally large amounts of parathyroid hormone in the blood of patients suspected of having increased parathyroid function. The test consists, briefly, in measuring the increase in the serum calcium of a rabbit at definite intervals after the rabbit has received an intramuscular injection of the blood or preparation containing parathyroid hormone, the animal being given amounts of calcium chloride solution by stomach tube at definite periods during the experiment.…”

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Experience With the Hamilton and Highman Test for Parathyroid Hyperfunction in Chronic Nephritis, Toxic Goiter, and Paget's Disease of Bone

Gilligan¹,

Volk²,

Gargill³

1938

J. Clin. Invest.

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In 1932 Hamilton and Schwartz (1) described a method for the detection of small amounts of parathyroid hormone, three to five units, in preparations of the hormone and in blood. In 1936 Hamilton and Highman (2) presented certain modifications of this test designed to make the method particularly applicable to the detection of abnormally large amounts of parathyroid hormone in the blood of patients suspected of having increased parathyroid function. The test consists, briefly, in measuring the increase in the serum calcium of a rabbit at definite intervals after the rabbit has received an intramuscular injection of the blood or preparation containing parathyroid hormone, the animal being given amounts of calcium chloride solution by stomach tube at definite periods during the experiment.In Highman and Hamilton found abnormally great amounts of parathyroid hormone in the blood of 20 of 23 patients with chronic nephritis and elevated blood urea nitrogen (12). Shelling and Remsen (13) reported a case of renal rickets with elevated concentrations of nitrogen and inorganic phosphorus in the blood, which case showed increased parathyroid hormone in the blood according to the Hamilton and Schwartz test, and at postmortem examination showed four markedly enlarged parathyroid glandules. These authors mention that the results of the Hamilton and Schwartz test were negative in other cases of renal rickets. Bass and Paxter (38) recently performed the "Hamilton test" on two occasions in one patient with renal rickets; on one of these occasions the result was " suggestively positive," on the other trial, negative. 641

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“…Some years ago we described a method, since somewhat modified, for the demonstration of small amounts of parathyroid hormone (5,6), and it was found that the hyperparathyroidism of rickets could be demonstrated by the use of only 30 cc., or less, of the blood from rachitic rabbits (7). The method is, briefly, as follows.…”

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confidence: 99%