The paradox of blunted parathormone (PTH) secretion in patients with severe hypomagnesemia has been known for more than 20 years, but the underlying mechanism is not deciphered. We determined the effect of low magnesium on in vitro PTH release and on the signals triggered by activation of the calcium-sensing receptor (CaSR). Analogous to the in vivo situation, PTH release from dispersed parathyroid cells was suppressed under low magnesium. In parallel, the two major signaling pathways responsible for CaSR-triggered block of PTH secretion, the generation of inositol phosphates, and the inhibition of cAMP were enhanced. Desensitization or pertussis toxin-mediated inhibition of CaSR-stimulated signaling suppressed the effect of low magnesium, further confirming that magnesium acts within the axis CaSR-G-protein. However, the magnesium binding site responsible for inhibition of PTH secretion is not identical with the extracellular ion binding site of the CaSR, because the magnesium deficiency-dependent signal enhancement was not altered on CaSR receptor mutants with increased or decreased affinity for calcium and magnesium. By contrast, when the magnesium affinity of the G␣ subunit was decreased, CaSR activation was no longer affected by magnesium. Thus, the paradoxical block of PTH release under magnesium deficiency seems to be mediated through a novel mechanism involving an increase in the activity of G␣ subunits of heterotrimeric G-proteins.
Parathormone (PTH)1 secretion from the parathyroid gland is suppressed by high extracellular calcium and magnesium (1). The calcium-sensing receptor (CaSR) is responsible for the calcium-dependent inhibition of PTH secretion (2). Direct binding of calcium or magnesium activates the CaSR (3). Activation of the CaSR triggers G␣ q /G␣ i -mediated signaling pathways (4). Several mutations have been identified with increased activation of this receptor (5, 6). CaSR mutants with increased affinity/potency for the agonist calcium and in part enhanced constitutive activity led to permanent inhibition of PTH secretion (7). Therefore, patients with activated CaSR mutants suffer from hypoparathyroidism. A similar phenotype of blunted PTH secretion is seen in patients with severe magnesium deficiency (8 -10). This finding is unexpected since the effects of high magnesium on parathyroid hormone secretion are similar to those of calcium, and therefore, low magnesium should be expected to result in increased PTH secretion. And indeed, in contrast to patients, rats respond to severe hypomagnesemia with increased secretion of PTH (11,12). It is known that hypomagnesemia reflects intracellular magnesium deficiency (9). Thus, the site of magnesium action has been assumed to lie intracellularly (9). However, causality between blunted PTH secretion and magnesium deficiency is not established, although the magnesium paradox has been known for more than 20 years (8). In search for the mechanism we investigated the relationship between magnesium deficiency, PTH secretion, and CaSR-mediated signaling...