Skip to main content
SpringerLink
Log in

Diagnosis of normocalcemic hyperparathyroidism by oral calcium loading test

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

We evaluated the oral calcium-loading test (OCLT) in diagnosing normocalcemic primary hyperparathyroidism. Calcium and PTH levels were measured before, 60, 120 and 180 min after oral 1 g of calcium gluconolactate administration in 102 consecutive females with high circulating PTH levels, and 25 controls. Patients were classified as follows: Group A, patients with a parathyroid adenoma identified by two imaging modalities. Sub-Group AO, hyper-parathyroid patients [no.=13, mean age 59 yr (SD=10)] evaluated prior to parathyroidectomy. Sub-Group AH, non-operated hypercalcemic patients [no.=29, age 63 yr (SD=11)]. Sub-Group AN, normocalcemic non-operated women [no.=14, age 59 yr (SD=8)]. Group B, normo-calcemic individuals [no.=46, age 58 yr (SD=11)] with negative parathyroid imaging. Group C, control patients [no.= 25, age 56 yr (SD= 12)]. The concentrations of calcium and PTH overlapped in the normocalcemic groups during the OCLT. Product P, defined as circulating PTH nadir (pg/ml) × peak calcium concentration (mg/dl), better discriminated Sub-Group AN from Group B, AUC=0.98 (95% CI 0.95, 1.00) than did Ratio R, defined as relative PTH decline/relative calcium increment, AUC= 0.86 (95%CI 0.73, 0.99). Assuming normal threshold of Product P and Ratio R at 260 and 17 respectively, the combined parameters diagnose normocalcemic hyperparathyroid patients with 100% sensitivity and 87% specificity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lundgren E., Rastad J., Thurfjell E., Akerstrom G., Ljunghall S. Population-based screening for primary hyperparathyroidism with serum calcium and parathyroid hormone values in menopausal women. Surgery 1997, 121: 287–294.

    Article  CAS  PubMed  Google Scholar 

  2. Gunn I.R., Wallace J.R. Urine calcium and serum ionized calcium, total calcium and parathyroid hormone concentrations in the diagnosis of primary hyperparathyroidism and familial benign hypercalcemia. Ann. Clin. Biochem. 1992, 29: 52–58.

    Article  PubMed  Google Scholar 

  3. Bringhurst F.R., Demay M.B., Kronenberg H.M. Hormones and disorders of mineral metabolism. In: Wilson J.D., Foster D.W., Kronenberg H.M., Larsen P.R. (Eds.), Williams textbook of endocrinology, 9th ed. WB Saunders Company, Philadelphia, 1998, p. 1155.

    Google Scholar 

  4. Haden ST., Brown E.M., Hurwitz S., Scott J., El Hajj-Fuleihan G. The effects of age and gender on parathyroid hormone dynamics. Clin. Endocrinol. (Oxf.) 2000, 52: 329–338.

    Article  CAS  Google Scholar 

  5. Harris S.S., Soteriades E., Coolidge J.A.S., Mudgal S., Dawson-Hughes B. Vitamin D insufficiency and hyperparathyroidism in a low income, multiracial, elderly population. J. Clin. Endocrinol. Metab. 2000, 85: 4125–4130.

    CAS  PubMed  Google Scholar 

  6. Praet J.P., Peretz A., Mets T., Rozenberg S. Comparative study of the intestinal absorption of three salts of calcium in young and elderly women. J. Endocrinol. Invest. 1998, 21: 263–267.

    Article  CAS  PubMed  Google Scholar 

  7. Grey A.B., Evans M.C., Stapleton J.P., Reid I.R. Body weight and body mineral density in postmenopausal women with primary hyperparathyroidism. Ann. Intern. Med. 1994, 121: 745–749.

    Article  CAS  PubMed  Google Scholar 

  8. Lips P., Netelenbos J.C., van Doorn L., Hackeng W.H.L., Lips C.J.M. Stimulation and suppression of intact parathyroid hormone (PTH 1–84) in normal subjects and hyperparathyroid patients. Clin. Endocrinol. (Oxf.) 1991, 35: 35–40.

    Article  CAS  Google Scholar 

  9. NIH consensus development conference statement on primary hyperparathyroidism. J. Bone Miner. Res. 1991, 6 (Suppl. 2): S9.

    Google Scholar 

  10. McHenry C.R., Rosen I.B., Walfish P.G., Pollard A. Oral calcium loading test: diagnostic and physiologic implications in hyperparathyroidism. Surgery 1990, 108: 1026–1032.

    CAS  PubMed  Google Scholar 

  11. Monchik J.M., Lamberton R.P., Roth U. Role of the oral calcium-loading test with measurement of intact parathyroid hormone in the diagnosis of symptomatic subtle primary hyperparathyroidism. Surgery 1992, 112: 1103–1110.

    CAS  PubMed  Google Scholar 

  12. Cadiot G., Houillier P., Allouch A., Paillard M., Mignon M. Oral calcium tolerance test in the early diagnosis of primary hyperparathyroidism and multiple endocrine neoplasia type 1 in patients with the Zollinger-Ellison syndrome. Gut 1996, 39: 273–278.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Williams C.P., Child D.F., Hudson P.R., et al. Inappropriate phosphate excretion in idiopathic hypercalciuria: the key to a common cause and future treatment. J. Clin. Pathol. 1996, 49: 881–888.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. St John A., Thomas M., Dick I., Young P., Prince R.L. Parathyroid function in mild to moderate renal failure: evaluation by oral calcium suppression test. J. Clin. Endocrinol. Metab. 1994, 78: 1436–1438.

    CAS  PubMed  Google Scholar 

  15. Broadus A.E., Horst R.L., Littledike E.T., Mahaffey J.E., Rasmussen H. Primary hyperparathyroidism with intermittent hypercalcemia: serial observations and simple diagnosis by means of an oral calcium tolerance test. Clin. Endocrinol. (Oxf.) 1980, 12: 225–235.

    Article  CAS  Google Scholar 

  16. Marx S.J. Hyperparathyroid and hypoparathyroid disorders. N. Engl. J. Med. 2000, 343: 1863–1875.

    Article  CAS  PubMed  Google Scholar 

  17. Corbetta S., Mantovani G., Lania A., et al. Calcium-sensing receptor expression and signalling in human parathyroid adenomas and primary hyperplasia. Clin. Endocrinol. (Oxf.) 2000, 52: 339–348.

    Article  CAS  Google Scholar 

  18. Leboff M.S., Shoback D., Brown E.M., et al. Regulation of parathyroid hormone release and cytosolic calcium by extra cellular calcium in dispersed and cultured bovine and pathological human parathyroid cells. J. Clin. Invest. 1985, 75: 49–57.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Kifor O., Moore F.D., Wang P., et al. Reduced immunostaining for the extracellular Ca2+-sensing receptor in primary and uremic secondary hyperparathyroidism. J. Clin. Endocrinol. Metab. 1996, 81:1598–1606.

    CAS  PubMed  Google Scholar 

  20. Chen Y.H., Lee A.J., Lin C.S., et al. Oral calcium loading test and response to diuretics in normal Taiwanese school children. Pediatr. Nephrol. 1996, 10: 175–179.

    Article  CAS  PubMed  Google Scholar 

  21. Goldray D., Mizrahi-Sasson E., Merdler C., et al. Vitamin D deficiency in elderly patients in a general hospital. J. Am. Geriatr. Soc. 1989, 37: 589–592.

    CAS  PubMed  Google Scholar 

  22. Heilberg I.P., Martini L.A., Draibe S.A., Ajzen H., Ramos O.L., Schor N. Sensitivity to calcium intake in calcium stone forming patients. Nephron 1996, 73: 145–153.

    Article  CAS  PubMed  Google Scholar 

  23. Pattou F., Torres G., Mondragon-Sanchez A., et al. Correlation of parathyroid scanning and anatomy in 261 unselected patients with sporadic primary hyperparathyroidism. Surgery 1999, 126: 1123–1131.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Endocrine Institute, “Assaf Harofeh” Medical Center, Zerifin, 70300, Israel

    Philippe Hagag, I. Revet-Zak & M. Weiss

  2. Department of Nuclear Medicine, “Assaf Harofeh” Medical Center, Zerifin, Israel

    N. Hod & T. Horne

  3. Department of Internal Medicine, “Assaf Harofeh” Medical Center, Zerifin, Israel

    M. J. Rapoport

  4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Philippe Hagag, T. Horne, M. J. Rapoport & M. Weiss

Authors
  1. Philippe Hagag
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Revet-Zak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Hod
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Horne
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. J. Rapoport
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philippe Hagag.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hagag, P., Revet-Zak, I., Hod, N. et al. Diagnosis of normocalcemic hyperparathyroidism by oral calcium loading test. J Endocrinol Invest 26, 327–332 (2003). https://doi.org/10.1007/BF03345180

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03345180

Key-words

Search

Navigation