Stimulation and suppression of intact parathyroid hormone (PTH1–84) in normal subjects and hyperparathyroid patients

Lips, Paul; Netelenbos, J. C.; Doorn, Leni van; Hackeng, W. H. L.; Llps, Cees J. M.

doi:10.1111/j.1365-2265.1991.tb03493.x

Cited by 38 publications

(20 citation statements)

References 15 publications

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“…parathyroid adenoma or hyperplasia) parathyroid cells (9)(10)(11)15), and both cell types reduce their PTH secretion in response to a rise in serum calcium either in vitro (30) or in vivo (11,22,(30)(31)(32)(33). However, cells from patients with PHP appear less sensitive to calcium-loading suppression than normal parathyroid cells (30,32,34,35). On this basis calcium-loading suppression tests were proposed as tools for the diagnosis of PHP with various modalities (oral or i.v.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a standardized short-time calcium suppression test in healthy subjects: interest for the diagnosis of primary hyperparathyroidism

et al. 2007

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Objective: The diagnosis of primary hyperparathyroidism (PHP) can be difficult in patients with normal plasma calcium or parathyroid hormone (PTH) levels. We perfected a standardized short-time i.v. calcium loading test in healthy controls (HC) and compared the results with those of patients with PHP. Methods: Sixteen HC received 0.33 mmol/kg calcium gluconate intravenously for 3 h. Plasma calcium and serum PTH levels (assayed with immunoluminescent sandwich methods) were measured before, at the end of the infusion and 3 h later. Results were compared with those of 16 PHP patients. Results: In HC, basal total plasma calcium (meanGS.E.M.) was 2.33G0.02 mmol/l. At the end of calcium loading, calcemia reached 3.21G0.05 mmol/l and decreased to 2.94G0.08 mmol/l 3 h later. In PHP patients, basal plasma calcium was 2.54G0.03 mmol/l and reached similar values as in HC during the testing. Basal serum PTH levels were 32.5G3.3 ng/l in HC and 86.9G6.3 ng/l in PHP. At the end of calcium loading, they dropped to 8.8G0.6 ng/l (HC) and to 31.4G4.2 ng/l (PHP). Three hours later, they were 11.6G0.8 and 39.8G4.0 ng/l respectively. There was a cut-off in serum PTH values between the two groups at the end of calcium loading and 3 h later. Conclusion: The standardized short-time PTH suppression test appears reliable to differentiate healthy subjects from PHP whose serum PTH levels remain O14 and O23 ng/ml respectively at the end of loading and 3 h later. This well-tolerated and easily performed test could be used for the diagnosis of PHP in patients suspected for the disease despite the normality of some basal biological markers.

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Section: Discussionmentioning

confidence: 99%

Evaluation of a standardized short-time calcium suppression test in healthy subjects: interest for the diagnosis of primary hyperparathyroidism

et al. 2007

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“…An oral calcium supplement of 1000 mg decreases serum PTH within one hour [19]. Calcium supplementation can reduce serum PTH during 24 h [20].…”

Section: The Influence Of Calcium Intake On the Required Serum 25(oh)dmentioning

confidence: 99%

Which circulating level of 25-hydroxyvitamin D is appropriate?

Lips

2004

The Journal of Steroid Biochemistry and Molecular Biology

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306

262

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“…In primary hyperparathyroidism approximately half of patients apparently have essentially autonomous parathyroid function, while the others retain the capacity for suppression despite impaired sensitivity or a set-point abnormality [14]. Actually it has been reported that intravenous calcium infusion inhibits PTH secretion from the adenoma via CaSR activation [15,16]. Many reports have stated that hypercalcemia due to parathyroid adenomas is responsive to calcimimetics, indicating this regulation of PTH through the CaCaSR signaling pathway [17].…”

Section: Discussionmentioning

confidence: 99%

“…He was referred to an endocrinologist because of hypercalcemia (corrected calcium (cCa) 15.0 mg/dl) that happened to be detected during an outpatient examination to rule out malignancy. He was also found to have hypophosphatemia (1.7 mg/dl), elevated iPTH level (220 pg/ml), elevated 1,25(OH)2 vitamin D level (76.4 pg/ml), and mild renal insufficiency (s-Cr 1.59 mg/dl), and hospital admission was planned for further examinations.…”

Section: Case Reportmentioning

confidence: 99%

An Instructive Case Suggesting Cyclical Primary Hyperparathyroidism

et al. 2006

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Abstract. We report an instructive case of primary hyperparathyroidism in which cyclical secretion of PTH may have caused repeated hypercalcemic crises followed by temporary remission with a spontaneous drop in PTH. A 64-year-old man was admitted to our hospital twice with severe hypercalcemic crisis (corrected calcium (cCa) 15.0 mg/dl and 16.7 mg/dl) accompanied by an increase in intact PTH (220 pg/ml and 470 pg/ml). During both events, the serum PTH values spontaneously dropped followed by remission of the hypercalcemia. The tumor, detected at the left-upper side, showed neither vascularity on ultrasound examination nor washout delay on MIBI scintigraphy, suggesting that two parathyroid adenoma infarctions had occurred. Cervical exploration was undertaken. The histopathological examinations confirmed that the tumor was parathyroid adenoma. Contrary to our expectation, however, it did not reveal necrotic tissue that would indicate recent infarction. The findings in this case may be explained by cyclical secretion of PTH from a parathyroid adenoma. Although cyclical Cushing's syndrome is well known, to our knowledge this is the first documented case suggesting cyclical primary hyperparathyroidism.

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Stimulation and suppression of intact parathyroid hormone (PTH1–84) in normal subjects and hyperparathyroid patients

Cited by 38 publications

References 15 publications

Evaluation of a standardized short-time calcium suppression test in healthy subjects: interest for the diagnosis of primary hyperparathyroidism

Evaluation of a standardized short-time calcium suppression test in healthy subjects: interest for the diagnosis of primary hyperparathyroidism

Which circulating level of 25-hydroxyvitamin D is appropriate?

An Instructive Case Suggesting Cyclical Primary Hyperparathyroidism

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