Graf W, Rastad J, Akerström G, Wide L, Ljunghall S
Department of Surgery, Akademiska sjukhuset, Uppsala, Sweden.
World J Surg. 1992 Jul-Aug;16(4):625-31. doi: 10.1007/BF02067339.
Analysis of 14 patients with primary hyperparathyroidism (HPT) prior to and during the first year after parathyroid surgery disclosed that the operation was associated with rapid reductions of intact serum parathyroid hormone (PTH) and total serum and ionized plasma calcium values. A decreased urinary calcium excretion, a gradual elevation of renal calcium reabsorption, a transient reduction of serum calcitriol, and a late increase in 25-hydroxycholecalciferol values were also noted. Dynamic tests of parathyroid function by EDTA infusion and an oral calcium load revealed a sigmoidal relationship between serum PTH and calcium levels, and that parathyroid surgery induced considerable changes in both the position and slope of the dose-response curve. It was also apparent that PTH release was submaximally stimulated event at periods of hypocalcemia. The findings substantiate that adjustments of PTH release to acute alterations of serum calcium occur along the prevailing dose-response relationship, while stimuli being maintained for longer periods of time induce compensatory shifts in the position and slope of this curve. It is further suggested that unknown factors with PTH-like function may participate in the calcium regulation after surgery for primary HPT.
对14例原发性甲状旁腺功能亢进症（HPT）患者在甲状旁腺手术前及术后第一年期间进行分析发现，该手术与血清完整甲状旁腺激素（PTH）、血清总钙和离子钙水平的快速降低相关。还观察到尿钙排泄减少、肾钙重吸收逐渐升高、血清骨化三醇短暂降低以及25-羟胆钙化醇值后期升高。通过静脉输注乙二胺四乙酸（EDTA）和口服钙负荷进行的甲状旁腺功能动态试验显示，血清PTH与钙水平之间呈S形关系，并且甲状旁腺手术导致剂量反应曲线的位置和斜率均发生显著变化。同样明显的是，在低钙血症期间，PTH释放受到的刺激未达到最大值。这些发现证实，PTH释放根据血清钙的急性变化进行调整是沿着主要的剂量反应关系发生的，而长时间维持的刺激会导致该曲线的位置和斜率发生代偿性变化。进一步表明，具有PTH样功能的未知因素可能参与原发性HPT手术后的钙调节。
