Sanchez CP, Goodman WG, Ramirez JA, Gales B, Belin R, Segre
GV, Salusky AB
Calcium-regulated parathyroid hormone secretion in adynamic
renal osteodystrophy
Kidney Int
(Sep) 48:838-843 1995
The acute effects of hypocalcemic and hypercalcemia on PTH
secretion was studied in 30 teenagers on peritoneal dialysis and
20 healthy volunteers. Eight of the 30 had adynamic bone and 22
had histological evidence of osteitis fibrosa. The sigmoidal
curve depicting the relationship between I Ca and serum PTH (% of
maximum) showed no difference in the set-point (defined as the I
Ca level at which the PTH level is halfway between the maximum
value during hypocalcemia and minimum value during hypercalcemia)
between the three groups. The slope of the curves at the
set-point was the same in the osteitis and normal groups but
lower in the adynamic group suggesting an insensitivity to acute
changes in calcium levels. The authors conclude that
abnormalities in the set-point do not account for differences in
PTH levels in adynamic and osteitis bone lesions. They speculate
that the differences in PTH levels are due to the larger size of
the gland in osteitis fibrosa.
Comment: A well-done study in an area with much conflicting data
reflecting differences in methodology and, perhaps, severity of
the hyperparathyroidism. The size of the glands was not
assessed.
(Delmez)
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