Goodman WG, Belin T, Gales B, Juppner H, Segre GV, Salusky IB
Calcium-regulated parathyroid hormone release in patients with mild or advanced secondary hyperparathyroidism

Kidney Int (Nov) 48:1553-1558 1995

The relative importance of parathyroid gland hyperplasia versus abnormal calcium-regulated PTH secretion in the genesis of hyperparathyroidism in renal failure is controversial although most would agree that the former plays the predominant role. The authors studied 26 patients with bone histological evidence of hyperparathyroidism treated with CCPD and 20 normal controls. They induced hypocalcemic PTH stimulation and hypercalcemic PTH suppression. The set-point (using the 4 parameter model) for PTH secretion and the slope of the Ca-PTH curve was the same in the two groups. The authors divided the renal failure patients into mild (PTH<400 pg/ml), moderate (PTH>400 but <600 pg/ml), and severe (PTH>600 pg/ml) hyperparathyroidism. The slopes and set-points did not differ in the three groups. The authors conclude that the degree of parathryoid gland hyperplasia may be a more important determinant of the severity of secondary hyperparathyroidism in patients with renal failure! (Delmez)

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CRF by problem area : Bone disease/aluminum