Journal of Endocrinological Investigation

, Volume 40, Issue 3, pp 241–256 | Cite as

How the reference values for serum parathyroid hormone concentration are (or should be) established?

  • J.-C. Souberbielle
  • F. Brazier
  • M.-L. Piketty
  • C. Cormier
  • S. Minisola
  • E. Cavalier


Well-validated reference values are necessary for a correct interpretation of a serum PTH concentration. Establishing PTH reference values needs recruiting a large reference population. Exclusion criteria for this population can be defined as any situation possibly inducing an increase or a decrease in PTH concentration. As recommended in the recent guidelines on the diagnosis and management of asymptomatic primary hyperparathyroidism, PTH reference values should be established in vitamin D-replete subjects with a normal renal function with possible stratification according to various factors such as age, gender, menopausal status, body mass index, and race. A consensus about analytical/pre-analytical aspects of PTH measurement is also needed with special emphasis on the nature of the sample (plasma or serum), the time and the fasting/non-fasting status of the blood sample. Our opinion is that blood sample for PTH measurement should be obtained in the morning after an overnight fast. Furthermore, despite longer stability of the PTH molecule in EDTA plasma, we prefer serum as it allows to measure calcium, a prerequisite for a correct interpretation of a PTH concentration, on the same sample. Once a consensus is reached, we believe an important international multicentre work should be performed to recruit a very extensive reference population of apparently healthy vitamin D-replete subjects with a normal renal function in order to establish the PTH normative data. Due to the huge inter-method variability in PTH measurement, a sufficient quantity of blood sample should be obtained to allow measurement with as many PTH kits as possible.


Parathyroid hormone (PTH) Vitamin D Reference values Primary hyperparathyroidism Chronic kidney disease 


Compliance with ethical standards

Conflict of interest

JCS reports lecture fees and/or travel/hotel expenses from DiaSorin, Roche Diagnostics, Abbott, Amgen, Shire, MSD, Lilly, Rottapharm, Meda. EC is consultant for IDS and DiaSorin and has received lecture fees from IDS, DiaSorin, Roche, Abbott, and Amgen. SM served as a speaker for Abiogen, Amgen, Diasorin, Eli Lilly, Italfarmaco, Fujii, Merck Sharp and Dohme, Takeda. He also served in advisory board of Amgen and Eli Lilly. FB, MLP, and CC have nothing to declare.

Ethical approval

Not applicable to this review article.

Informed consent

Not applicable to this review article.


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Copyright information

© Italian Society of Endocrinology (SIE) 2016

Authors and Affiliations

  • J.-C. Souberbielle
    • 1
    • 2
  • F. Brazier
    • 1
    • 2
  • M.-L. Piketty
    • 1
    • 2
  • C. Cormier
    • 3
  • S. Minisola
    • 4
  • E. Cavalier
    • 5
  1. 1.Service des Explorations FonctionnellesHôpital Necker-Enfants MaladesParisFrance
  2. 2.Université René DescartesParisFrance
  3. 3.Rheumatology DepartmentCochin University HospitalParisFrance
  4. 4.Ordinario di Medicina Interna, Responsabile UOC Medicina Interna e Malattie Metaboliche dell’Osso (TMC 04)« Sapienza » Università di RomaRomeItaly
  5. 5.Clinical Chemistry DepartmentSart Tilman University HospitalLiègeBelgium

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