Measurement of intact parathyroid hormone in the diagnosis of hyperparathyroidism

1991 ◽  
Vol 125 (6) ◽  
pp. 668-674 ◽  
Author(s):  
Anders Bergenfelz ◽  
Stig Valdermarsson ◽  
Bo Ahrén
Keyword(s):  
Parathyroid Hormone ◽  
Plasma Level ◽  
Primary Hyperparathyroidism ◽  
Plasma Levels ◽  
Diagnostic Information ◽  
Intact Parathyroid Hormone ◽  
Infusion Test ◽  
Intact Pth ◽  
Baseline Plasma Level ◽  
Edta Infusion

Abstract. Plasma levels of parathyroid hormone were determined pre-operatively in 27 consecutive patients with clinical and biochemical signs of primary hyperparathyroidism, by the use of one assay recognizing the intact PTH molecule and one assay recognizing the mid-portion of PTH. Plasma levels of mid-molecule PTH were normal in 5 of the patients with primary hyperparathyroidism. In 4 of these patients, plasma levels of intact PTH were raised. Conversely, in 6 patients with primary hyperparathyroidism, intact PTH were normal pre-operatively. In 5 of these cases, plasma levels of mid-molecule PTH were raised. The EDTA infusion test was performed in 6 patients with normal baseline plasma level of intact PTH pre-operatively. The test correctly predicted all the patients in this group who were found to have primary hyperparathyroidism, as well as a patient with normal parathyroid glands found at operation. We conclude that some patients with primary hyperparathyroidism have normal baseline plasma levels of intact PTH. In these patients, plasma levels of mid-molecule PTH and an EDTA infusion test provide further diagnostic information.

Two-site assay of intact parathyroid hormone in primary hyperparathyroidism: studies in basal conditions, following adenoma removal and during calcium and EDTA infusion

1990 ◽  
Vol 190 (3) ◽  
pp. 239-248 ◽  
Author(s):  
Gianfranco Mazzuoli ◽  
Salvatore Minisola ◽  
Liliana Scarnecchia ◽  
Maria Teresa Pacitti ◽  
Vincenzo Carnevale ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Intact Parathyroid Hormone ◽  
Edta Infusion

scholarly journals A Case of Von Hippel–Lindau Disease with Bilateral Pheochromocytoma and Ectopic Hypersecretion of Intact Parathyroid Hormone in an Adolescent Girl

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Rym Belaid ◽  
Ibtissem Oueslati ◽  
Melika Chihaoui ◽  
Meriem Yazidi ◽  
Wafa Grira ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Adrenal Tumors ◽  
Intact Parathyroid Hormone ◽  
Intact Pth ◽  
High Accumulation ◽  
Von Hippel Lindau ◽  
Ectopic Secretion ◽  
Bilateral Pheochromocytoma ◽  
Von Hippel Lindau Disease

Von Hippel–Lindau disease is an autosomal dominant inherited syndrome predisposing to a variety of highly vascularised tumors in different organs. Although bilateral pheochromocytoma was reported in patients with von Hippel–Lindau disease, the coexistence of primary hyperparathyroidism is not a common condition. We report an observation of a primary hyperparathyroidism secondary to an ectopic secretion of intact parathyroid hormone in a 17-year-old girl with von Hippel–Lindau disease and bilateral pheochromocytoma. She presented with a newly diagnosed diabetes mellitus and a severe arterial hypertension. Blood tests disclosed hypercalcemia with increased intact PTH level. Cervical ultrasound and sestamibi scintigraphy were normal. Twenty-four-hour urinary normetanephrine level was highly elevated pointing to a catecholamine-secreting tumor. The abdominal computed tomography showed bilateral adrenal masses. MIBG scintigraphy exhibited a high accumulation of the tracer in both adrenal tumors. Genetic testing revealed a mutation of the VHL gene. The patient underwent a bilateral adrenalectomy. The postoperative outcome was marked by normalization of blood pressure, blood glucose, calcium, and PTH levels. In our case, the elevation of intact PTH and its spontaneous normalization after surgical treatment of pheochromocytomas confirms its ectopic secretion.

scholarly journals Parathyroid hormone: what are we measuring and does it matter?

2002 ◽  
Vol 39 (3) ◽  
pp. 169-172 ◽  
Author(s):  
Aubrey Blumsohn ◽  
Amna Al Hadari
Keyword(s):  
Vitamin D ◽  
Renal Failure ◽  
Parathyroid Hormone ◽  
Chronic Renal Failure ◽  
Primary Hyperparathyroidism ◽  
Intact Parathyroid Hormone ◽  
Intact Pth ◽  
Improve Outcome ◽  
Shed Light ◽  
Improved Outcome

Immunometric assays claiming to determine intact parathyroid hormone (PTH) generally cross-react with N-truncated forms such as PTH(7-84). Laboratories need to examine the relevance of new assays with probable PTH(1-84) specificity. It is logical that assays should measure what they state they do. However, it seems unlikely that use of older 'intact' PTH assays will affect the clinical interpretation of results in primary hyperparathyroidism or vitamin D deficiency. It is plausible that appropriate application of new PTH assays could improve outcome in chronic renal failure. However, it has never been suggested that straightforward replacement of existing assays with new PTH(1-84) assays will lead to this improved outcome. A better understanding of PTH fragments and their interaction with PTH receptors may shed light on the relevance of different PTH assays. In the meantime, older technologies will continue to work well for the vast majority of patients.

Thallium-Technetium Subtraction Scintigraphy of Enlarged Parathyroid Glands after Calcitonin Stimulation of Parathyroid Hormone Secretion

1992 ◽  
Vol 33 (4) ◽  
pp. 319-322 ◽  
Author(s):  
A. Bergenfelz ◽  
J. Tennvall ◽  
B. Ahrén
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Plasma Levels ◽  
Hormone Secretion ◽  
Serum Levels ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Intact Parathyroid Hormone ◽  
Stimulation Of ◽  
Subtraction Scintigraphy

To improve the sensitivity of thallium-technetium subtraction scintigraphy for preoperative localization procedure of enlarged parathyroid glands in primary hyperparathyroidism, we administered calcitonin intramuscularly 4 hours before the scintigraphy in 14 consecutive patients. Injection of calcitonin reduced plasma levels of ionized calcium from 1.47 ± 0.10 mmol/l to 1.41 ± 0.09 mmol/l (p < 0.01). Concomitantly, serum levels of intact parathyroid hormone increased from 6.4 ± 2.5 pmol/l to 7.9 ± 2.6 pmol/l (p < 0.001). The scintigram after calcitonin injection visualized 11 adenomas (sensitivity 78%) compared to only 9 (sensitivity 64%) in conventional scintigrams. In addition, 5 of the adenomas were more distinctly imaged in the scintigram after calcitonin injection, whereas in only one patient was the conventional scintigram better. Thus, the calcitonin injection improved the scintigram in 7 cases and was inferior in only one case (p = 0.031). We conclude that stimulation of parathyroid hormone secretion with calcitonin results in a better preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism.

Intact parathyroid hormone levels and primary hyperparathyroidism

2017 ◽  
pp. 1-5 ◽  
Author(s):  
Haidar Al-Hraishawi ◽  
Peter J. Dellatore ◽  
Xinjiang Cai ◽  
Xiangbing Wang
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Intact Parathyroid Hormone ◽  
Hormone Levels

scholarly journals Pre-operative Localisation of the Parathyroid Glands in Secondary Hyperparathyroidism: A Retrospective Cohort Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Takahisa Hiramitsu ◽  
Toshihide Tomosugi ◽  
Manabu Okada ◽  
Kenta Futamura ◽  
Makoto Tsujita ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cohort Study ◽  
Parathyroid Hormone ◽  
Secondary Hyperparathyroidism ◽  
Retrospective Cohort ◽  
Parathyroid Glands ◽  
Imaging Modalities ◽  
Intact Parathyroid Hormone ◽  
Intact Pth ◽  
Persistent Hyperparathyroidism

Abstract Complete parathyroidectomy (PTx) is essential during total PTx for secondary hyperparathyroidism (SHPT) to prevent recurrent and persistent hyperparathyroidism. Pre-operative imaging evaluations, including computed tomography (CT), ultrasonography (US), and Tc-99m sestamibi (MIBI) scans, are commonly performed. Between June 2009 and January 2016, 291 patients underwent PTx for SHPT after pre-operative evaluations involving CT, US, and MIBI scans, and the diagnostic accuracies of these imaging modalities for identifying the parathyroid glands were evaluated in 177 patients whose intact parathyroid hormone (PTH) levels were <9 pg/mL after the initial PTx. Additional PTx procedures were performed on 7 of 114 patients whose intact PTH levels were >9 ng/mL after PTx, and the diagnostic validities of the imaging modalities for the remnant parathyroid glands were evaluated. A combination of CT, US, and MIBI scans achieved the highest diagnostic accuracy (75%) for locating bilateral upper and lower parathyroid glands before initial PTx. The accuracies of CT, US, and MIBI scans with respect to locating remnant parathyroid glands before additional PTx were 100%, 28.6%, and 100%, respectively. A combination of CT, US, and MIBI scans is useful for initial PTx for SHPT, and CT and MIBI scans are useful imaging modalities for additional PTx procedures.

A non-(1–84) circulating parathyroid hormone (PTH) fragment interferes significantly with intact PTH commercial assay measurements in uremic samples

1998 ◽  
Vol 44 (4) ◽  
pp. 805-809 ◽  
Author(s):  
Raymond Lepage ◽  
Louise Roy ◽  
Jean-Hugues Brossard ◽  
Louise Rousseau ◽  
Claude Dorais ◽  
...  
Keyword(s):  
Renal Failure ◽  
Parathyroid Hormone ◽  
Molecular Form ◽  
Diagnostic System ◽  
Intact Parathyroid Hormone ◽  
Intact Pth ◽  
Hplc Profiles ◽  
Uremic Patients ◽  
Commercial Kits ◽  
Carboxy Terminal

Abstract We have previously shown that the Nichols assay for intact parathyroid hormone (I-PTH) reacts with a non-(1–84) molecular form of PTH. This form behaves as a carboxy-terminal fragment and accumulates in renal failure, accounting for 40–60% of the measured immunoreactivity. We wanted to see whether this was a common event with other commercial two-site I-PTH assays. We thus compared the ability of three commercial kits [Nichols (NL), Incstar (IT), and Diagnostic System Laboratories (DSL)] to measure I-PTH in 112 renal failure patients and to detect hPTH(1–84) and non-(1–84)PTH on HPLC profiles of serum pools from uremic patients with I-PTH concentrations of 10–100 pmol/L. The behavior of synthetic hPTH(7–84), a fragment possibly related to non-(1–84)PTH was also compared with hPTH(1–84) in the three assays. The I-PTH concentrations measured with the three assays in the 112 uremic samples were highly related (r2 ≥ 0.89, P &lt;0.0001), and the values measured with NL were, on average, 23% higher than IT. Values measured with DSL were 23% and 56% higher than IT for values less than and more than 40 pmol/L, respectively. The three assays detected two HPLC peaks on four different profiles corresponding to hPTH(1–84) and non-(1–84)PTH. This last peak represented 36 ± 8.4% of the immunoreactivity with NL, 24 ± 5.5% with IT, and 25 ± 2.8% with DSL (NL vs IT or DSL: P &lt;0.05). These differences were confirmed by a 50% lower immunoreactivity to hPTH(7–84) compared with hPTH(1–84) for IT and DSL but not for NL. These results suggest that most of the two-site I-PTH assays would cross-react with non-(1–84)PTH material, thus explaining about one-half of the 2–2.5 × higher I-PTH concentrations reported in uremic patients without bone involvement than in subjects without uremia.

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