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A 6-hour human parathyroid hormone (1–34) infusion protocol: Studies in normal and hypoparathyroid subjects

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Summary

Parathyroid hormone (PTH)-resistant states are usually diagnosed by the failure of an acute PTH injection to elicit a rise in urinary cAMP and phosphate or, less commonly, by the failure of repeated PTH injections to raise serum calcium. We have established a 6 hour infusion of human PTH (1–34) which identifies PTH-resistant hypoparathyroid subjects on the basis of serum 1,25-dihydroxyvitamin D (1,25(OH)2D) and calcium responses. 1.25-Dihydroxyvitamin D levels increased by at least 58 pmol/liter and serum calcium by at least 0.1 mmol/liter in PTH-responsive hypoparathyroid subjects (n=6), whereas in pseudohypoparathyroid subjects (n=5) these levels rose by less than 22 pmol/liter and 0.06 mmol/liter respectively. The responsiveness of urinary phosphate excretion, expressed as the renal threshold phosphate concentration (TmPO4/GFR), to PTH also clearly separated the pseudohypoparathyroid patients from the other subjects. Differences in urinary calcium responses were observed though this parameter was less reliable in the identification of individual PTH-resistant or PTH-sensitive hypoparathyroid patients. Nephrogenous cAMP did not discriminate between groups when this protocol was used. This test has the potential to facilitate and extend the classification of PTH-resistant states.

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Authors and Affiliations

  1. Department of Endocrinology, Royal North Shore Hospital, 2065, Leonards, N.S.W., Australia

    A. McElduff, D. Lissner, M. Wilkinson, C. Cornish & S. Posen

  2. Department of Medicine, University of Sydney, 2065, Leonards, N.S.W., Australia

    A. McElduff, D. Lissner, M. Wilkinson, C. Cornish & S. Posen

Authors
  1. A. McElduff
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  2. D. Lissner
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  3. M. Wilkinson
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  4. C. Cornish
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  5. S. Posen
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McElduff, A., Lissner, D., Wilkinson, M. et al. A 6-hour human parathyroid hormone (1–34) infusion protocol: Studies in normal and hypoparathyroid subjects. Calcif Tissue Int 41, 267–273 (1987). https://doi.org/10.1007/BF02555228

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  • DOI: https://doi.org/10.1007/BF02555228

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