Summary
Early effects of parathyroid hormone (PTH) deficiency were studied in 12 patients with primary hyperparathyroidism due to single parathyroid adenoma by following the precise time course of changes in plasma calcium (Ca) and immunoreactive parathyroid hormone (iPTH) after parathyroid surgery and by prelabeling 2 patients with radiocalcium (Ca*). Surgical removal of the adenoma was immediately followed by a sudden increase in plasma Ca which preceded the usual fall. The increase in plasma Ca commenced simultaneously with the fall in iPTH and was accompanied by a parallel increase in specific activity (sp. act.) of plasma Ca*. Specific activity continued to rise for 2 h in both prelabeled patients, whereas blood calcium was already falling thereafter reaching a markedly low removal rate constant as long as plasma Ca decreased. When plasma Ca began to rise, sp. act. resumed a descending course.
Our findings indicate that the initial hypercalemia depends on PTH withdrawal and results from a rapid flux into general extracellular fluid (ECF) of calcium coming from a compartment with higher sp. act., contained within the miscible pool, immediately followed by a reduction in calcium transfer from bone. These results suggest that acute PTH deficiency determines an outflow of calcium from bone cells and support the theory that PTH initiates its action by modifying their intracellular calcium content.
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Care, A.D., Keynes, W.M., Duncan, T.: An investigation into the parathyroid origin of calcitonin, J. Endocrinol.34:299–318, 1966
Haas, H.G., Affolter, H., Dubach, V.C.: Evidence for a calcitonin effect in man, Acta Endocrinol. (Kbh.)48:132–136, 1965
Tiselius, P., Engfeldt, B., Porath, J., Wallenius, G., Werner, I.: some preliminary experiments with purified human parathyroid extracts, Metabolism13:929–933, 1964
Parsons, J. A., Robinson, C.J.: Calcium shift into bone causing transient hypocalcemia after injection of parathyroid hormone, Nature230:581–582, 1971
Parsons, J.A., Neer, R.M., Potts, J.T.: Initial fall of plasma calcium after intravenous injection of parathyroid hormone, Endocrinology89:735–740, 1971
Parsons, J.A., Robinson, C.J.: Further evidence that the initial calcium shift into bone is a primary response to parathyroid hormone. In S. Taylor (ed.): Endocrinology 1971, pp. 358–362. Heinemann Medical Books, London, 1972
Parsons, J.A.: Parathyroid physiology and the skeleton. In G.H. Bourne (ed.): The Biochemistry and Physiology of Bone, vol. IV, pp. 159–226. Academic Press, New York, 1976
Dziak, R., Stern, P.H.: Calcium transport in isolated bone cells. III. Effects of parathyroid hormone and cyclic 3′,5′AMP, Endocrinology97:1281–1287, 1975
Robertson, W.G., Peacock, M., Atkins, D., Webster, L.A.: The effects of parathyroid hormone on the uptake and release of calcium by bone in tissue culture, Clin. Scien.43:715–718, 1972
Wills, M.R., Gray, B.C.: Micro-method for the estimation of calcium by Auto-Analyzer, J. Clin. Pathol.17:687–689, 1964
Hurst, R.C.: The determination of nucleotide phosphorus with a stannous chloride-hydrazine sulphate reagent, Can. J. Biochem.42:287–292, 1964
Failing, J.F. Jr., Buckley, M.W., Zak, B.: Automatic determination of serum proteins, Am. J. Clin. Pathol.33:83–88, 1960
Arnaud, C.D., Tsao, H.S., Littledike, T.: Radioimmunoassay of human parathyroid hormone in serum, J. Clin. Invest.50:21–34, 1971
Berson, S.A., Yalow, R.S.: Radioimmunoassays of peptide hormones in plasma, N. Engl. J. Med.277:640–647, 1967
Reiss, E., Canterbury, J.M., Egdahl, R.H.: Experience with radioimmunoassay of parathyroid hormone in human sera, Trans. Assoc. Am. Physicians81:104–107, 1968
Parfitt, A.M.: The action of parathyroid hormone on bone: relation to bone remodelling and turnover, calcium homeostasis and metabolic bone disease, Metabolism25:909–955, 1976
Talmage, R.V.: Calcium homeostasis: calcium transport parathyroid action, Clin. Orthop.67:210–224, 1969
Nichols, G., Rogers, P.: Bone cell calcium stores: their size, location and kinetics of exchange, Calcif. Tissue Res.9:80–94, 1972
Rasmussen, H., Goodman, D.B.P., Friedmann, N., Allen, J.E., Kurokawa, K.: Ionic control of metabolism. In G.D. Aurbach (ed): Handbook of Physiology, vol. VII, pp. 225–264. American Physiological Society, Washington, D.C., 1976
Davis, W.L., Matthews, J.L., Martin, J.H., Kennedy, J.W. III: The endosteum as a functional membrane, In R.V. Talmage, M. Owen, J.A. Parsons (eds.): Calcium Regulating Hormone, pp. 275–283, Excerpta Medica, Amsterdam, 1975
Matthews, J.L., Martin, J.H.: Intracellular transport of calcium and its relationship to homeostasis and mineralization. An electron microscopy study, Am. J. Med.50:589–597, 1971
Neumann, W.F., Ramp, W.K.: The concept of a bone membrane: some implications. In G. Nichols, R.H. Wassermann (eds.): Cellular Mechanism for Calcium Transfer and Homeostasis, pp. 197–209. Academic Press, New York, 1971
Ramp, W.K.: Cellular control of calcium movements in bone. Interrelationship of the bone membrane, parathyroid hormone and alkaline phosphate, Clin. Orthop. Rel. Res.106:311–322, 1975
Heaney, R.P.: Evaluation, and interpretation of calcium kinetic data in man. Clin. Orthop.31:153–183, 1963
Heaney, R.P.: Calcium kinetics in plasma: as they apply to the measurements of bone formation and resorption rates. In G.H. Bourne (ed.): The biochemistry and Physiology of Bone, vol. IV, pp. 105–133. Academic Press, New York, 1976
Talmage, R.V., Coope, C.W., Park, H.Z.: Regulation of calcium transport in bone by parathyroid hormone, Vitam. Horm.28:103–140, 1970
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Mazzuoli, G.F., D’Erasmo, E., Scarda, A. et al. Significance of early increase in stable and radioactive plasma calcium after parathyroidectomy in primary hyperparathyroidism. Calcif Tissue Int 29, 185–191 (1979). https://doi.org/10.1007/BF02408079
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DOI: https://doi.org/10.1007/BF02408079