Department of Internal Medicine, Endocrinology Section, Clinical Center of Montenegro, Kruševac bb, Podgorica, 81000, Montenegro.
Faculty of Medicine, University of Montenegro, Podgorica, 81000, Montenegro.
Hormones (Athens). 2022 Jun;21(2):261-270. doi: 10.1007/s42000-022-00353-2. Epub 2022 Feb 1.
While activation of the calcium (Ca) sensing receptor (CaSR) suppresses parathyroid hormone (PTH) secretion, calcitonin (CT) secretion is stimulated via CaSR. The aim of this study was to evaluate PTH and CT responses during a calcium infusion test (CIT) in patients with primary hyperparathyroidism (PHPT).
This pivotal prospective study included 64 patients (44 PHPT patients vs. 20 healthy controls [HCs], median age 57 [25-79] vs. 56 [39-74] years). All PHPT patients underwent parathyroidectomy (PTX). A week before and 1 month after PTX, the CIT was performed (bolus infusion of Ca gluconate 0.2 ml/kg body weight), followed by plasma sampling for Ca, PTH, and CT at 0, 1, 2, 3, 5, 8, and 10 min.
PTH suppression was lower in PHPT patients compared to HCs (49.82 vs. 64.06%, p = 0.006), but after PTX suppression, it was higher (76.3%, p < 0.001). PHPT patients had attenuated CT response vs. HCs during the CIT (3.1- vs. 8.0-fold increase, p < 0.001), but after PTX, it improved (5.8-fold increase). The PTHmin > 19.3 ng/l and CTmax ≤ 27.5 ng/l cut-off values predict diagnosis of PHPT (sensitivity 90.9%, 97.7%, and specificity 100%, 75%, respectively). Patients with adenoma had lower basal CT levels vs. hyperplasia both before and after PTX (4.5 vs. 6.8 and 5.4 vs. 7.9 ng/l, respectively, p = 0.008, p = 0.018).
PTH and CT responses during the CIT in PHPT patients may be an additional diagnostic tool. The CIT could play a role in both the diagnosis of PHPT and in the differential diagnosis between adenoma and hyperplasia.
钙敏感受体（CaSR）的激活可抑制甲状旁腺激素（PTH）的分泌，而 CT 分泌则通过 CaSR 受到刺激。本研究旨在评估原发性甲状旁腺功能亢进症（PHPT）患者在钙输注试验（CIT）期间 PTH 和 CT 的反应。
这是一项关键的前瞻性研究，纳入了 64 名患者（44 名 PHPT 患者与 20 名健康对照者，中位年龄 57 [25-79] 岁与 56 [39-74] 岁）。所有 PHPT 患者均接受甲状旁腺切除术（PTX）。在 PTX 前 1 周和 1 个月时进行 CIT（静脉推注葡萄糖酸钙 0.2ml/kg 体重），随后在 0、1、2、3、5、8 和 10 分钟时采集血浆样本，用于检测 Ca、PTH 和 CT。
与健康对照组相比，PHPT 患者的 PTH 抑制程度较低（49.82% vs. 64.06%，p=0.006），但在 PTX 后抑制程度更高（76.3%，p<0.001）。与健康对照组相比，在 CIT 期间，PHPT 患者的 CT 反应减弱（3.1- vs. 8.0 倍增加，p<0.001），但在 PTX 后有所改善（5.8 倍增加）。PTHmin>19.3ng/l 和 CTmax≤27.5ng/l 的截断值可预测 PHPT 的诊断（敏感性分别为 90.9%、97.7%和特异性分别为 100%、75%）。腺瘤患者在 PTX 前后的基础 CT 水平均低于增生患者（分别为 4.5ng/l vs. 6.8ng/l 和 5.4ng/l vs. 7.9ng/l，p=0.008，p=0.018）。
PHPT 患者在 CIT 期间的 PTH 和 CT 反应可能是一种额外的诊断工具。CIT 可在 PHPT 的诊断以及腺瘤和增生的鉴别诊断中发挥作用。
