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Calcified Tissue International

Erschienen in:

01.12.2008

Primary Hyperparathyroidism: Role of the Preoperative Oral Calcium Loading Test in the Differential Diagnosis Between Adenoma and Hyperplasia

verfasst von: P. Hagag, E. Kummer, M. Weiss

Erschienen in: Calcified Tissue International | Ausgabe 6/2008

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Abstract

Whereas the sensitivity of the membrane calcium receptors is decreased in parathyroid adenoma, extracellular calcium may reduce parathyroid hormone (PTH) secretion through the protein kinase C pathway in parathyroid hyperplasia. The aim of this study was to determine the role of a preoperative oral calcium loading test in the differential diagnosis between adenoma and hyperplasia. Twenty-two subjects with adenoma (group A, age ± standard error 56 ±2 years, female/male 15/7), 10 individuals with hyperplasia (group H, age 54 ±3, female/male 8/2), and 32 age and gender pair-matched controls (group C) underwent the test. Calcium and PTH were measured before and 60, 120, and 180 min after oral administration of 1 g of calcium (as gluconolactate). Product P was defined as minimal PTH concentration (pg/mL) × maximal calcium concentration (mg/dL) during the test. Ratio R was defined as relative PTH decline/relative calcium increase. The PTH decline during the test in group H was comparable to that of the controls. PTH decline <30%, Product P > 1,100, and Ratio R < 4 diagnosed adenoma with specificity of 100%, 90%, and 100%, respectively. PTH decline >60% diagnosed hyperplasia with specificity of 100%. The total accuracy of the test (65%) was comparable to that of technetium-99 m sestamibi scintigraphy (66%) and better than that of ultrasonography (58%). The test may discriminate patients with sporadic diffuse hyperplasia from individuals with solitary adenoma in cases of primary hyperparathyroidism with an indication for surgery.

Bringhurst FR, Demay MB, Kronenberg HM (2003) Hormones and disorders of mineral metabolism. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS (eds) Williams textbook of endocrinology, 10th edn. WB Saunders, Philadelphia, pp 1071–1303

Pattou F, Torres G, Mondragon-Sanchez A, Huglo D, N’Guyen H, Carnaille B, Proye C (1999) Correlation of parathyroid scanning and anatomy in 261 unselected patients with sporadic primary hyperparathyroidism. Surgery 126:1123–1131PubMedCrossRef

Carling T (2001) Molecular pathology of parathyroid tumors. Trends Endocrinol Metab 12:53–58PubMedCrossRef

Sanjuan X, Bryant BR, Sobel ME, Merino MI (1998) Clonality analysis of benign parathyroid lesions by human androgen receptor (HUMARA) gene assay. Endocr Pathol 9:293–300PubMedCrossRef

Yi Y, Nowak NJ, Pacchia AL, Morrison C (2008) Chromosome 11 genomic changes in parathyroid adenoma and hyperplasis: array CGH, FISH, and tissue microarrays. Genes Chromosomes Cancer 47:639–648PubMedCrossRef

Velázquez-Fernández D, Laurell C, Saqui-Salces M, Pantoja JP, Candanedo-Gonzalez F, Reza-Albarrán A, Gamboa-Dominguez A, Herrera MF (2006) Differential RNA expression profile by cDNA microarray in sporadic primary hyperparathyroidism (pHPT): primary parathyroid hyperplasia versus adenoma. World J Surg 30:705–713PubMedCrossRef

Mallette LE (1994) The functional and pathological spectrum of parathyroid abnormalities in hyperparathyroidism. In: Bilezikian JP, Marcus R, Levine MA (eds) The parathyroids: basic and clinical concepts. Raven Press, New York, pp 423–455

Corbetta S, Mantovani G, Lania A, Borgato S, Vicentini L, Beretta E, Faglia G, Di Blasis AM, Spada A (2000) Calcium-sensing receptor expression and signaling in human parathyroid adenomas and primary hyperplasia. Clin Endocrinol (Oxf) 52:339–348CrossRef

Brown EM, Gardner DG, Brennan MF, Marx SJ, Spiegel AM, Attie MF, Downs RW Jr, Doppman JL, Aurbach CD (1979) Calcium-regulated parathyroid hormone release in primary hyperparathyroidism: studies in vitro with dispersed parathyroid cells. Am J Med 66:923–931PubMedCrossRef

10.

McHenry CR, Rosen IB, Walfish PG, Pollard A (1990) Oral calcium loading test: diagnostic and physiologic implications in hyperparathyroidism. Surgery 108:1026–1032PubMed

11.

Reiss E, Canterbury JM (1969) Application of radioimmunoassay to differentiation of adenoma and hyperplasia and to preoperative localization of hyperfunctioning parathyroid glands. N Engl J Med 280:1381–1385PubMedCrossRef

12.

Schachter PP, Ayesh S, Matouk I, Schneider T, Czerniak A, Hochberg A (2007) Differential expression of kinase genes in primary hyperparathyroidism: adenoma versus normal and hyperplastic parathyroid tissue. Arch Pathol Lab Med 131:126–130PubMed

13.

Corbetta S, Lania A, Filopanti M, Vicentini L, Ballaré E, Spada A (2002) Mitogen-activated protein kinase cascade in human normal and tumoral parathyroid cells. J Clin Endocrinol Metab 87:2201–2205PubMedCrossRef

14.

Lips P, Netelenbos JC, van Doorn L, Hackeng WHL, Lips CJM (1991) Stimulation and suppression of intact parathyroid hormone (PTH 1–84) in normal subjects and hyperparathyroid patients. Clin Endocrinol (Oxf) 35:35–40CrossRef

15.

Bevilacqua M, Dominguez LJ, Righini V, Valdes V, Vago T, Leopaldi E, Baldi G, Barrella M, Barbagallo M (2006) Dissimilar PTH, gastrin, and calcitonin responses to oral calcium and peptones in hypocalciuric hypercalcemia, primary hyperparathyroidism, and normal subjects: a useful tool for differential diagnosis. J Bone Miner Res 21:406–412PubMedCrossRef

16.

Ray JM, Squires PE, Curtis SB, Meloche MR, Buchan AM (1997) Expression of the calcium-sensing receptor on human antral gastrin cells in cultures. J Clin Invest 99:2328–2333PubMedCrossRef

17.

Yao X, Forte JG (2003) Cell biology of acid secretion by the parietal cell. Annu Rev Physiol 65:103–131PubMedCrossRef

18.

Persson P, Hakanson R, Axelson J, Sundler F (1989) Gastrin releases a blood calcium lowering peptide from the acid-producing part of the rat stomach. Proc Natl Acad Sci USA 86:2834–2838PubMedCrossRef

19.

Hagag P, Revet-Zak I, Hod N, Horne T, Weiss M (2003) Diagnosis of normocalcemic hyperparathyroidism by oral calcium loading test. J Endocrinol Invest 26:327–332PubMed

20.

Meilstrup JW (2004) Ultrasound examination of the parathyroid glands. Otolaryngol Clin North Am 37:763–778PubMedCrossRef

21.

Bilezikian JP, Brandi ML, Rubin M, Silverberg SJ (2005) Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical features. J Intern Med 257:6–17PubMedCrossRef

22.

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

23.

Adami S, Muirhead N, Manning RM, Gleed JJ, Papapoulos SE, Sandler LM, Catto GR, O’Riordan JL (1982) Control of secretion of parathyroid hormone in secondary hyperparathyroidism. Clin Endocrinol (Oxf) 16:463–473CrossRef

24.

Guillemant J, Accarie C, Peres G, Guillemant S (2004) Acute effects of an oral calcium load on markers of bone metabolism during endurance cycling exercise in male athletes. Calcif Tissue Int 74:407–414PubMedCrossRef

25.

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

26.

Williams CP, Child DF, Hudson PR, Soysa LD, Davies GK, Davies MG, De Bolla AR (1996) Inappropriate phosphate excretion in idiopathic hypercalciuria: the key to a common cause and future treatment? J Clin Pathol 49:881–888PubMedCrossRef

27.

Tohme JF, Bilezikian JP, Clemens TL, Silgerberg SJ, Shane E, Lindsay R (1990) Suppression of parathyroid hormone secretion with oral calcium in normal subjects and patients with primary hyperparathyroidism. J Clin Endocrinol Metab 70:951–956PubMed

28.

Mayer GP, Habener JF, Potts JT Jr (1976) Parathyroid hormone secretion in vivo. Demonstration of a calcium-independent, nonsuppressible component of secretion. J Clin Invest 57:678–683PubMedCrossRef

29.

Broadus AE, Horst RL, Littledike ET, Mahaffey JE, Rasmussen H (1980) Primary hyperparathyroidism with intermittent hypercalcaemia: serial observations and simple diagnosis by means of an oral calcium tolerance test. Clin Endocrinol (Oxf) 12:225–235CrossRef

30.

Madvig P, Young G, Marcus R (1984) Assessment of adenosine 3′,5′-monophosphate excretion and an oral calcium tolerance test in the diagnosis of mild primary hyperparathyroidism. J Clin Endocrinol Metab 58:480–487PubMedCrossRef

31.

Murray TM, Peacock M, Powell D, Monchik JM, Potts JT Jr (1972) Non-autonomy of hormone secretion in primary hyperparathyroidism. Clin Endocrinol (Oxf) 1:235–246CrossRef

32.

Brown EM, Broadus AE, Brennan MF, Gardner DG, Marx SJ, Spiegel AM, Downs RW Jr, Attie M, Aurbach AD (1979) Direct comparison in vivo and in vitro of suppressibility of parathyroid function by calcium in primary hyperparathyroidism. J Clin Endocrinol Metab 48:604–610PubMed

33.

Monchik JM, Lamberton RP, Roth U (1992) Role of the oral calcium-loading test with measurement of intact parathyroid hormone in the diagnosis of symptomatic subtle primary hyperparathyroidism. Surgery 112:1103–1110PubMed

34.

Ugur O, Bozkurt MF, Hamaloglu E, Sokmensuer C, Etikan I, Ugur Y, Sayek I, Gulec SA (2004) Clinicopathologic and radiopharmacokinetic factors affecting gamma probe-guided parathyroidectomy. Arch Surg 139:1175–1179PubMedCrossRef

35.

Bhansali A, Masodi SR, Bhadada S, Mittal BR, Belura A, Singh P (2006) Ultrasonography in detection of single and multiple abnormal parathyroid glands in primary hyperparathyroidism: comparison with radionuclide scintigraphy and surgery. Clin Endocrinol (Oxf) 65:340–345CrossRef

36.

Henry JF, Sebag F, Tamagnini P, Forman C, Silaghi H (2004) Endoscopic parathyroid surgery: results of 365 consecutive procedures. World J Surg 28:1219–1223PubMedCrossRef

37.

Udelsman R (2002) Six hundred fifty six consecutive explorations for primary hyperparathyroidism. Ann Surg 235:665–672PubMedCrossRef

38.

Saaristo RA, Salmi JJ, Koobi T, Turjanmaa V, Sand JA, Nordback IH (2002) Intraoperative localization of parathyroid glands with gamma counter probe in primary hyperparathyroidism: a prospective study. J Am Coll Surg 195:19–22PubMedCrossRef

39.

Marx SJ (2000) Hyperparathyroid and hypoparathyroid disorders. N Engl J Med 343:1863–1875PubMedCrossRef

40.

Miura D, Wada N, Arici C, Morita E, Duh QY, Clark OH (2002) Does intraoperative quick parathyroid hormone assay improve the results of parathyroidectomy? World J Surg 26:926–930PubMedCrossRef

41.

McGill J, Sturgeon C, Kaplan SP, Chiu B, Kaplan EL, Angelos P (2008) How does the operative strategy for primary hyperparathyroidism impact the findings and cure rate? A comparison of 800 parathyroidectomies. J Am Coll Surg 207:246–249PubMedCrossRef

Titel: Primary Hyperparathyroidism: Role of the Preoperative Oral Calcium Loading Test in the Differential Diagnosis Between Adenoma and Hyperplasia
verfasst von: P. Hagag
E. Kummer
M. Weiss
Publikationsdatum: 01.12.2008
Verlag: Springer-Verlag
Erschienen in: Calcified Tissue International / Ausgabe 6/2008
Print ISSN: 0171-967X
Elektronische ISSN: 1432-0827
DOI: https://doi.org/10.1007/s00223-008-9191-9

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