The Functional Pathology of Hyper-Parathyroidism

Bulger, Harold A.; Dixon, Henry H.; Barr, David P.; Schregardus, Olive

doi:10.1172/jci100291

Cited by 41 publications

(18 citation statements)

References 29 publications

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“…WVe did not try phosphate ingestion on the one case of proven parathyroid tumor which we have had the opportunity to study in our clinic. That such patients, however, respond in a similar fashion is shown by the experiments of Bulger, Dixon, Barr and Schregardus (14). Their patient I belonged in this group and before operation phosphate ingestion produced changes similar to those reported in this paper.…”

Section: B Secondary Hyperparathyroidismsupporting

confidence: 86%

Studies in Parathyroid Physiology

Albright¹,

Bauer²,

Claflin³

et al. 1932

J. Clin. Invest.

134

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In the second paper of this series (1) the disorders of calcium phosphate metabolism were divided into three fundamental groups. It was believed that under normal conditions body fluids contain all the calcium phosphate which that particular fluid system can hold at that particular time. The first and commonest group was that in which the body fluids contain less than this saturating amount of calcium phosphate. Because of this, calcium phosphate is not deposited into osteoid tissue with the resulting pathological picture of wide osteoid seams on the trabeculae (cf. rickets and osteomalacia). The second group was that in which the body fluids, because of certain extraordinary circumstances, contain more than the normal quota of calcium phosphate and deposition in tissues other than osteoid tissue results (e.g. ergosterol poisoning and cases of metastatic malignancy and myeloma). Finally, a third possibility presented itself. It is conceivable that the body fluids might contain a normal saturating amount of calcium phosphate, but that the proportion of the calcium ions to the phosphate ions might be abnormal. Such, it was believed, is the disorder in diseases of the parathyroid glands. To recapitulate then, we conceived of three possible variations from the normal saturation of body fluids with calcium phosphate: (a) subsaturation, (b) supersaturation, and (c) anomalous-saturation (i.e. quantitatively normally but qualitatively abnormally saturated).In the first paper of this series (2), the hypothesis was advanced that this abnormality in the relation of the calcium ion to the phosphate ion in parathyroid disorders was dependent upon changes in phosphorus excretion in the urine brought about by the parathyroid hormone. Thus it was believed that on administration of the parathyroid hormone the first effect was an increased phosphorus excretion; that this resulted in a decreased serum inorganic phosphorus; that this tended to leave the serum's capacity to take up calcium phosphate unfulfilled; that calcium

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Section: B Secondary Hyperparathyroidismsupporting

confidence: 86%

Studies in Parathyroid Physiology

Albright¹,

Bauer²,

Claflin³

et al. 1932

J. Clin. Invest.

134

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“…Just as with calcium, the urinary phosphorus excretion was reduced, but the fecal excretion was essentially normal. Thus, just as a high partition of phosphorus in the urine as compared with the feces is characteristic of hyperparathyroidism (12), the opposite is the case in parathyroid tetany. I.1.…”

Section: Thyroid On Calcium and Phosphorusmentioning

confidence: 99%

Studies of Calcium and Phosphorus Metabolism

Aub¹,

Albright²,

Bauer³

et al. 1932

J. Clin. Invest.

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Following the observation by Aub, Bauer, Heath, and Ropes (1), that the thyroid hormone exerts a marked effect upon the excretion of calcium, it became of interest to determine the therapeutic effect of this internal secretion upon the calcium metabolism in tetany. In hyperthyroidism, although the blood calcium and phosphorus levels are essentially normal, the calcium and phosphorus excretions are abnormally high. Tetany of the low calcium variety, however, has been shown to have an abnormally low calcium excretion associated with the abnormally low blood calcium level. The primary purpose of these metabolic studies was to study the influence of thyroid medication on the level of calcium and phosphorus in the blood and excreta of patients suffering from tetany. Other observations, however, were made for comparison and this paper includes data illustrating the influence on inorganic salt metabolism of:1. Hypoparathyroidism, 2. Chronic steatorrhea complicated by tetany, 3. The immediate and prolonged use of parathyroid and thyroid medication in the tetany of hypoparathyroidism, and 4. The production of acidosis in the above types of tetany. The data reported in this paper were obtained from three cases of tetany which we observed over prolonged periods. K. L. (Case I) had severe, chronic parathyroid tetany which was precipitated by two radical thyroidectomies for very mild Graves' disease. The tetany eventually could not be controlled, and the patient died. B. W. (Case II) 1 apparently had idiopathic parathyroid tetany. DeLaB. (Case III),' a young woman with tetany produced by celiac disease or steatorrhea, was similar to patients reported by Blumgart (2), Thaysen (3), Holmes and Starr (4), Linder and Harris (5), and Hunter (6). The summaries of the case histories are attached to the end of this paper. These cases were studied in Cases II and III are further discussed in other papers (9, 10, 11). 211

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It has long been known that oral or intravenous administration of phosphate salts lowers the serum calcium concentration in normal animals (1, 2) and in hypercalcemic human subjects (3)(4)(5)

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confidence: 99%

“…It has long been known that oral or intravenous administration of phosphate salts lowers the serum calcium concentration in normal animals (1,2) and in hypercalcemic human subjects (3)(4)(5). Re-cently, interest has been renewed in the clinical use of phosphate therapy to control life-threatening hypercalcemia because of the relative ineffectiveness or toxicity of other modes of therapy (6,7).…”

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confidence: 99%