Felsenfeld AJ, Jara A, Pahl M, Bover J, Rodriguez M
Differences in dynamics of parathyroid hormone secretion in
hemodialysis patients with marked secondary hyperparathyroidism
J Am Soc Nephrol
(Nov) 6:1371-1378 1995
These authors identified 21 patients with PTH levels >500 pg/ml
(intact PTH, nl up to 65) and divided them into 2 groups with a serum
calcium < 9 mg/dl (n=8) or >9 (n=13). They then compared the two groups
response to PTH stimulation (using a dialysate calcium of 1 mEq/L) or PTH
suppression (using a dialysate calcium of 4 mEq/L). They found that
both in absolute numbers and percentages the hypocalcemic patients were
more suppressible and less stimulatable. The authors were quite
conservative in their interpretation, suggesting that the hypocalcemic
patients might be more responsive to treatment, particularly with
calcitriol.
Comment: I would extend these interpretations to say that
the patients
with hypocalcemia and high PTH are behaving quite physiologically and
their PTH remains appropriate in its response. Such patients are quite
liable to respond, therapeutically, to appropriate correction of their
calcium by whatever means are used. In contrast, patients who have PTH
elevation despite a normal or elevated calcium are already demonstrating,
either because of size of gland or change to a more adenomatous picture,
a state less likely to respond to medical therapy.
(Sherrard)
To go back use the BACK button on your browser.
Otherwise click on the desired link to this article below:
CRF by problem area :
Bone disease/aluminum