Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States; Department of Pathology, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States.
Adv Clin Chem. 2021;101:41-93. doi: 10.1016/bs.acc.2020.06.005. Epub 2020 Jul 20.
Parathyroid hormone is an essential regulator of extracellular calcium and phosphate. PTH enhances calcium reabsorption while inhibiting phosphate reabsorption in the kidneys, increases the synthesis of 1,25-dihydroxyvitamin D, which then increases gastrointestinal absorption of calcium, and increases bone resorption to increase calcium and phosphate. Parathyroid disease can be an isolated endocrine disorder or part of a complex syndrome. Genetic mutations can account for diseases of parathyroid gland formulation, dysregulation of parathyroid hormone synthesis or secretion, and destruction of the parathyroid glands. Over the years, a number of different options are available for the treatment of different types of parathyroid disease. Therapeutic options include surgical removal of hypersecreting parathyroid tissue, administration of parathyroid hormone, vitamin D, activated vitamin D, calcium, phosphate binders, calcium-sensing receptor, and vitamin D receptor activators to name a few. The accurate assessment of parathyroid hormone also provides essential biochemical information to properly diagnose parathyroid disease. Currently available immunoassays may overestimate or underestimate bioactive parathyroid hormone because of interferences from truncated parathyroid hormone fragments, phosphorylation of parathyroid hormone, and oxidation of amino acids of parathyroid hormone.
甲状旁腺激素是细胞外钙和磷的重要调节剂。甲状旁腺激素促进钙重吸收，同时抑制肾脏中磷的重吸收，增加 1,25-二羟维生素 D 的合成，从而增加胃肠道对钙的吸收，并增加骨吸收以增加钙和磷。甲状旁腺疾病可以是一种孤立的内分泌紊乱，也可以是复杂综合征的一部分。基因突变可以导致甲状旁腺形成、甲状旁腺激素合成或分泌失调以及甲状旁腺破坏的疾病。多年来，已经有许多不同的选择可用于治疗不同类型的甲状旁腺疾病。治疗选择包括手术切除过度分泌的甲状旁腺组织、给予甲状旁腺激素、维生素 D、活性维生素 D、钙、磷结合剂、钙敏感受体和维生素 D 受体激动剂等。甲状旁腺激素的准确评估还提供了必要的生化信息，以正确诊断甲状旁腺疾病。目前可用的免疫测定法可能会高估或低估生物活性甲状旁腺激素，因为存在截短的甲状旁腺激素片段、甲状旁腺激素的磷酸化和甲状旁腺激素氨基酸的氧化等干扰。
