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Calcium, phosphate, vitamin D, and the parathyroid

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Abstract

The main factors which regulate parathyroid hormone (PTH) production are calcium, phosphate, vitamin D, and estrogens. Hypocalcemia leads to increased PTH secretion in seconds and minutes, gene expression in hours, and parathyroid (PT) cell number in weeks and months. Hypercalcemia leads to a decrease in PTH secretion by its action on the PT cell calcium receptor and no decrease in PTH mRNA levels. There is now convincing evidence that phosphate regulates the PT, independent of its effect on serum calcium and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3]. In vivo in rats hypophosphatemia markedly decreases PTH mRNA and serum intact PTH levels, independent of its effect on serum calcium and 1,25(OH)2D3. Clinical studies also indicate that phosphate regulates the PT independent of its effect on calcium and 1,25(OH)2D3; 1,25(OH)2D3 itself has a marked effect on the PT, where it decreases PTH gene transcrption by a direct action on the PT. The application of basic science findings of how calcium, phosphate, and 1,25(OH)2D3 regulate the PT has led to an efficient and safe prescription for the management of the secondary hyperparathyroidism of chronic renal failure, which is the maintenance of a normal serum calcium and phosphate and the careful use of 1,25(OH)2D3.

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Authors and Affiliations

  1. Minerva Center for Calcium and Bone Metabolism, Nephrology Services, Hadassah University Hospital, Hebrew University Hadassah Medical School, PO Box 12000, 91120, Jerusalem, Israel

    Keith H. Marks, Rachel Kilav, Tally Naveh-Many & Justin Silver

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  1. Keith H. Marks
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  2. Rachel Kilav
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  3. Tally Naveh-Many
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  4. Justin Silver
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Marks, K.H., Kilav, R., Naveh-Many, T. et al. Calcium, phosphate, vitamin D, and the parathyroid. Pediatr Nephrol 10, 364–367 (1996). https://doi.org/10.1007/BF00866787

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  • DOI: https://doi.org/10.1007/BF00866787

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