INTACT PARATHYROID-HORMONE IN PRIMARY HYPERPARATHYROIDISM

被引:26
作者
FLENTJE, D
SCHMIDTGAYK, H
FISCHER, S
STERN, J
BLIND, E
BUHR, H
HERFARTH, C
机构
[1] Department of Surgery, University of Heidelberg
关键词
calcium loading test; Hyperparathyroidism; intact parathyroid hormone;
D O I
10.1002/bjs.1800770217
中图分类号
R61 [外科手术学];
学科分类号
摘要
In 49 patients with primary hyperparathyroidism, intact parathyroid hormone (PTH) was measured with a recently developed immuno‐radiometric assay, and midregional PTH fragments (sequence 44–68) were measured with an established radioimmunoassay technique. In 47 normal subjects, the concentration of intact PTH ranged from 2·0 to 6·8pmol/l, and in 49 patients with primary hyperparathyroidism it ranged from 6·4 to 80·0 pmol/l. In contrast, midregional PTH fragments were normal in seven of 49 patients with primary hyperparathyroidism. In five healthy controls and in 12 patients with surgically confirmed primary hyperparathyroidism and serum calcium levels below 3·0 mmol/l, a rapid calcium loading test was performed. In healthy controls, intact PTH was in the low normal to subnormal range within 2·5–5·0 min, and had recovered within 15 min of calcium infusion. In patients with primary hyperparathyroidism, the calcium infusion also led to a 30–50 per cent decrease in intact PTH levels within 5·0–7·5 min after injection, with a slow recovery after 10–15 min. In six of the patients with only slightly elevated basal intact PTH, a suppression to the normal range was observed. In 24 patients (16 patients with a solitary adenoma and eight patients with four‐gland hyperplasia) the intact PTH levels were followed intraoperatively during para‐thyroidectomy, revealing a significantly different rate of decline for single adenomas compared with hyperplasia during the first 15 min after removal of the primary enlarged gland. Intact PTH values remained constantly elevated in one patient with primary hyperparathyroidism and an unsuccessful neck exploration. These results confirm that (a) the measurement of intact PTH in patients with primary hyperparathyroidism is superior to the measurement of midregional fragments; (b) PTH secretion in primary hyperparathyroidism is not totally autonomous; and (c) intraoperative monitoring of intact PTH values could be used to monitor the success of surgery. Copyright © 1990 British Journal of Surgery Society Ltd.
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收藏
页码:168 / 172
页数:5
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