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Different PTH response to oral peptone load and oral calcium load in patients with normocalcemic primary hyperparathyroidism, primary hyperparathyroidism, and healthy subjects.

Abstract

BACKGROUND
Normocalcemic primary hyperparathyroidism (PHPT-N) is a condition that may have similar long-term implications to primary hyperparathyroidism (PHPT); however, differential diagnosis and treatment for parathyroid disorders are not clearly defined. We investigated the effect of an oral peptone and an oral calcium load on calcium-regulating hormones in PHPT-N compared with PHPT and healthy controls to provide a new potential diagnostic tool.
DESIGN
Case-control study.
METHODS
We evaluated serum gastrin, PTH, ionized calcium, and phosphate responses to oral calcium (1 g) and peptone (10 g) load in 22 PHPT and 20 PHPT-N patients matched for PTH serum values. Moreover, 30 healthy subjects were enrolled as controls. In 12 patients for each group, we also performed the oral peptone test adding aluminum hydroxide (AH) to suppress phosphate absorption.
RESULTS
In PHPT patients, PTH increased significantly 30 min after the oral peptone load, while no significant increase was found in PHPT-N and controls. After oral calcium load, PTH remained stable in PHPT while it decreased dramatically in PHPT-N patients, and ionized calcium increased significantly in each of the three groups. Peptones plus AH induced a blunted PTH increase in the three groups.
CONCLUSIONS
Considering the marked difference in PTH response elicited by peptones in PHPT compared with PHPT-N, we suggest that the oral peptone test could be added to the diagnostic evaluation of PHPT patients. In case of absent response to peptones, patients should have their serum calcium levels assessed twice a year in accordance with recent guidelines.

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  • Publisher Full Text

    • Authors

    Invernizzi M, Carda S, Righini V, Baricich A, Cisari C, Bevilacqua M

    Institution

    Physical and Rehabilitation Medicine, Department of Health Sciences, University of Eastern Piedmont A. Avogadro, AOU Maggiore della Carità, Viale Piazza D'armi 1, 28100 Novara, Italy. marco.invernizzi@med.unipmn.it

    Source

    European journal of endocrinology / European Federation of Endocrine Societies 167:4 2012 Oct pg 491-7

    MeSH

    Administration, Oral
    Aged
    Calcium
    Diagnosis, Differential
    Diagnostic Techniques, Endocrine
    Dose-Response Relationship, Drug
    Female
    Health
    Humans
    Hyperparathyroidism, Primary
    Male
    Middle Aged
    Parathyroid Hormone
    Peptones
    Reference Values

    Pub Type(s)

    Controlled Clinical Trial
    Journal Article

    Language

    eng

    PubMed ID

    22872468