Parathyroid hormone and calcium homeostasis in acute pancreatitis

Abstract

Sequential daily measurements of plasma parathyroid hormone (PTH) have been performed in 89 patients with acute pancreatitis. A total of 439 PTH assays was obtained during 98 episodes of the disease. Three main patterns of PTH response were found. These responses were correlated with severity of disease graded by objective criteria and also to corrected serum calcium levels. The first type of PTH response was characterized by significantly elevated PTH levels soon after hospitalization with a subsequent decrease in levels to within the normal range by the third or fourth day of illness. This type of response was specifically associated with transient severe hypocalcaemia (corrected calcium less than 2.0 mmol/l). It was also associated with the most severe forms of disease and 6 of the 7 deaths. The second type of PTH response revealed initial PTH values in the upper level of the normal range (400--600 ng/l) while persistently low PTH levels were characteristic of the third type of response. Persistently low PTH levels were associated with normocalcaemia, and no patient in this group died. None of a group of 14 control patients exhibited the type 1 PTH response. An effective PTH response to an unidentified hypocalcaemic stimulus results in satisfactory calcium homeostasis in most patients with acute pancreatitis.

Vitamin D Deficiency as an Ignored Cause of Hypocalcemia in Acute Illness: Report of 2 Cases and Review of Literature

“…The PTH value was normalized in a short term as seen in previous reports in which a similar spontaneous decline of PTH concentration within 4-10 days was described [19,21,22]. The decrease in PTH by ergocalciferol supplementation should have been slower in a chronic vitamin D deficient state.…”

“…Hypocalcemia and consequent hyperparathyroidism are common in acute illness such as sepsis, acute pancreatitis, or major surgery, and they have been reported to predict mortality in these settings [15][16][17][18][19][20][21][22]. Although vitamin D deficiency is frequent and it has been described as a cause of hypocalcemia, it has received little attention and only few reports scrutinized vitamin D status and response in acute disease [23][24][25][26].…”

Invited commentary

“…Nevertheless, falls in ionized calcium do occur very early in the disease process in the most ill patients. These falls have been well documented recently from Liverpool [15] in results consistent with the sequential data study on PTH assays in 90 patients carried out in Glasgow [16]. The PTH levels are highest on admission and tend to fall gradually throughout the first 4 or 5 days of illness coinciding with a restoration of ionized calcium toward normal.…”

“…Very occasionally, calcium gluconate may be indicated intravenously in fairly large dosage. The PTH data [16] clarified some earlier confusing literature based on insufficient sequential studies of PTH in individual patients [17][18][19][20]. The cause of the fall in ionized calcium is still undetermined but, in the most severely ill patients, may be due to a flux of the ion from extracellular to intracellular, while not excluding the possible important role of binding of calcium ions in the fat necrosis process.…”

Parathyroid Hormone Secretion and Target Organ Response in Experimental Acute Pancreatitis

“…Over the 7 days, these rats lost weight (from 29 (Fig 3). Extravasated red blood cells as well as incipient proliferation ofimmature fibro¬ blasts characterized the acute pancreatitis at this point.…”