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Dynamics of parathyroid hormone release and serum calcium regulation after surgery for primary hyperparathyroidism

World Journal of Surgery volume 16, pages 625–631 (1992)Cite this article

Abstract

Analysis of 14 patients with primary hyperparathyroidism (HPT) prior to and during the first year after parathyroid surgery disclosed that the operation was associated with rapid reductions of intact serum parathyroid hormone (PTH) and total serum and ionized plasma calcium values. A decreased urinary calcium excretion, a gradual elevation of renal calcium reabsorption, a transient reduction of serum calcitriol, and a late increase in 25-hydroxycholecalciferol values were also noted. Dynamic tests of parathyroid function by EDTA infusion and an oral calcium load revealed a sigmoidal relationship between serum PTH and calcium levels, and that parathyroid surgery induced considerable changes in both the position and slope of the dose-response curve. It was also apparent that PTH release was submaximally stimulated event at periods of hypocalcemia. The findings substantiate that adjustments of PTH release to acute alterations of serum calcium occur along the prevailing dose-response relationship, while stimuli being maintained for longer periods of time induce compensatory shifts in the position and slope of this curve. It is further suggested that unknown factors with PTH-like function may participate in the calcium regulation after surgery for primary HPT.

Résumé

L'étude de 14 patients atteints d'hyperparathyroïdie primaire (HPT) avant et durant la première année suivant la chirurgie a mis en évidence que l'intervention s'accompagnait d'une rapide diminution de la parathormone sérique (PTH) et des taux de calcium total et calcium ionisé plasmatiques. Une diminution de la calciurie, une élèvation progressive de la réabsorption rénale du calcium, une réduction transitoire du calcitriol sérique et une élèvation retardée du 25 hydroxycholecalciférol ont été également notées. Des tests dynamiques de la fonction parathyroïdienne par perfusion d'EDTA et charge orale en calcium ont montré une relation sigmoïde entre la PTH sérique et la calcémie. La chirurgie parathyroïdienne induit des modifications notables à la fois de la position et de la pente de la courbe dose-réponse. Il est également apparu que la libération de PTH était stimulée de façon sous maximale même en cas d'hypocalcémie. Ces résultats établissent que l'adjustement de la libération de PTH à des modifications brusques de la calcémie se fait selon la prévalence de la relation dose-réponse, tandis que des stimuli persistent sur de longues périodes induisent des changements de position et de pente de cette courbe. Il est de plus suggéré que des facteurs inconnus ayant une fonction PTH libre peuvent participer à la régulation du calcium après la chirurgie pour HPT primaire.

Resumen

El análisis de 14 pacientes con hiperparatiroidismo primario (HPT) realizado antes y durante el primer año siguiente a cirugía paratiroidea demostró que la operación estuvo asociada con una reducción rápida del nivel sérico de la hormona paratiroidea intacta (PTH) y de los valores séricos de calcio total y de calcio ionizado. También se observó una disminución en la excreción urinaria de calcio, una elevación gradual de la reabsorción renal de calcio, una reducción transitoria del calcitriol sérico y un incremento tardío de los valores de 25-hidroxicolecalciferol. Las pruebas dinámicas de función paratiroidea mediante la infusión de EDTA y una carga oral de calcio revelaron una relación que se expresa como curva sigmoidea entre los niveles séricos de PTH y los de calcio, y que la cirugía paratiroidea indujo cambios considerables tanto en la posición como en la inclinación de la curva dosis-dependiente. También resultó aparente que la liberación de PTH aparecía submáximamente estimulada aun en periodos de hipocalcemia. Los hallazgos confirman que los ajustes en la liberación de PTH, ante alteraciones agudas, en el nivel de calcio sérico se producen según la relación dosis-dependiente, en tanto que los estímulos sostenidos por más prolongados periodos de tiempo inducen cambios compensatorios en la posición y en la inclinación de la curva. Además, sugieren que otros factores desconocidos con funcíones similares a las de la PTH pueden tener participación en la regulación del calcio después de efectuada la cirugía para HPT primario.

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  1. Departments of Surgery, Clinical Chemistry, and Internal Medicine, Akademiska sjukhuset, Uppsala, Sweden

    Wilhelm Graf M.D., Jonas Rastad M.D., Göran Åkerström M.D., Leif Wide M.D. & Sverker Ljunghall M.D.

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  1. Wilhelm Graf M.D.
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  2. Jonas Rastad M.D.
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  3. Göran Åkerström M.D.
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  4. Leif Wide M.D.
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Graf, W., Rastad, J., Åkerström, G. et al. Dynamics of parathyroid hormone release and serum calcium regulation after surgery for primary hyperparathyroidism. World J. Surg. 16, 625–631 (1992). https://doi.org/10.1007/BF02067339

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Keywords

  • Primary Hyperparathyroidism
  • Calcium Regulation
  • Parathyroid Surgery
  • Calcium Reabsorption
  • Calcio