The calcium/parathyroid hormone concept of the parathyroid glands.

Plasma ionized calcium is the major determinant of parathyroid hormone (PTH) secretion. The minute-to-minute secretory response of the parathyroids to changes in plasma ionized calcium is described by the calcium/PTH concept, but the detailed mechanism is not yet well understood. The recent cloning of a calcium-sensing receptor in the plasma membrane of the parathyroid cells will probably yield important information concerning the mechanisms by which calcium and other ions control the parathyroid function. It is likely that autocrine and paracrine factors also participate in the regulation of PTH secretion. PTH, chromogranin A, chromogranin A-related peptides and endothelin-1 have been suggested as autocrine factors. More documentation is needed on the impact of these factors in the physiology of the parathyroid gland. In-vivo investigations of the parathyroid function are difficult to interpret because of the complexity of the PTH secretory response to hypo- and hypercalcaemia. Rate dependency and the ability of the parathyroids to sense the direction of changes in calcium make the existing models for investigating the calcium/PTH relationship inappropriate. In vitro, the models are compromised by a rapid drop in the expression of the calcium-sensing receptor of the cultured parathyroid cells. We, therefore, recommend caution when using the calcium/PTH concept in clinical or experimental investigations.