Brismar K, Werner S, Bucht E, Wetterberg L
J Pineal Res. 1987;4(3):277-85. doi: 10.1111/j.1600-079x.1987.tb00865.x.
The aim of the present study was to determine the diurnal secretion of melatonin, cortisol, prolactin, and calcitonin during chronic parathyroid hormone-dependent hypercalcemia. Eight women, aged 40-76 years, with primary hyperparathyroidism (PHPT) were studied before and after surgical removal of a parathyroid adenoma. The hormone concentrations in blood were determined at 08, 12, 16, 22, 02, 04, and 06 h. Concomitantly, the excretion of melatonin and cortisol in urine between 07-19 h and 19-07 h, and the clearance of calcium and creatinine were measured. Nyctohemeral serum prolactin and calcitonin were unaffected by moderate parathyroid hormone-dependent hypercalcemia. In contrast, serum cortisol and melatonin were significantly higher during active disease than after surgical cure. Mean 24-h variation of serum cortisol was 349 +/- 34 nmol/liter vs. 223 +/- 17 nmol/liter and mean serum melatonin was 0.13 +/- 0.04 nmol/liter vs. 0.06 +/- 0.02 nmol/liter. Endogenous creatinine clearance was similar before and after surgery, while the clearance of melatonin and cortisol significantly increased after surgery, indicating an increased tubular reabsorption of both hormones during active disease. Fasting morning glucose concentrations were also significantly decreased after successful surgery, 6.1 +/- 0.6 vs. 5.2 +/- 0.5 mmol/liter. It is suggested that the relative hypercortisolism may be the cause of the glucose intolerance in primary hyperparathyroidism. Three to 4 months after surgical cure the serum melatonin levels were significantly lower than those seen in age-matched controls, indicating a melatonin insufficiency in patients successfully treated for PHPT. The meaning of this finding is not yet understood but might be of importance in the development of primary hyperparathyroidism.
本研究的目的是确定慢性甲状旁腺激素依赖性高钙血症期间褪黑素、皮质醇、催乳素和降钙素的昼夜分泌情况。对8名年龄在40 - 76岁之间的原发性甲状旁腺功能亢进症（PHPT）女性患者在手术切除甲状旁腺腺瘤前后进行了研究。在08、12、16、22、02、04和06时测定血液中的激素浓度。同时，测量了07 - 19时和19 - 07时尿液中褪黑素和皮质醇的排泄量，以及钙和肌酐的清除率。昼夜血清催乳素和降钙素不受中度甲状旁腺激素依赖性高钙血症的影响。相比之下，在疾病活动期血清皮质醇和褪黑素明显高于手术治愈后。血清皮质醇的平均24小时变化为349±34 nmol/升，而手术治愈后为223±17 nmol/升；血清褪黑素平均为0.13±0.04 nmol/升，而手术治愈后为0.06±0.02 nmol/升。手术前后内源性肌酐清除率相似，而褪黑素和皮质醇的清除率在手术后显著增加，表明在疾病活动期这两种激素的肾小管重吸收增加。成功手术后空腹早晨血糖浓度也显著降低，从6.1±0.6降至5.2±0.5 mmol/升。提示相对皮质醇增多可能是原发性甲状旁腺功能亢进症中葡萄糖不耐受的原因。手术治愈3至4个月后，血清褪黑素水平明显低于年龄匹配的对照组，表明成功治疗PHPT的患者存在褪黑素不足。这一发现的意义尚不清楚，但可能在原发性甲状旁腺功能亢进症的发生发展中具有重要意义。
