A Study of the Renal Excretion of Calcium by the Production of a Constant Level of Hypercalcemia in Normal and Abnormal Human Subjects

1971 ◽  
Vol 49 (5) ◽  
pp. 469-478 ◽  
Author(s):  
William H. Shaw
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Incidental Finding ◽  
Human Subjects ◽  
Renal Calculi ◽  
Normal Subjects ◽  
Urinary Calcium ◽  
Constant Level ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion

The relationship between urinary calcium excretion and serum calcium was studied at stable serum calcium levels, both normal and elevated. The linearity of this relationship being known, the slope of this line could be determined by sampling only at its lower and upper ends, that is, by measuring urine and serum calcium at a resting level and at a constant level of hypercalcemia produced by a calcium infusion. This method permitted three sets of measurements at each of the two levels, and also tended to eliminate the factor of renal delay time. The procedure was performed with normal subjects, with normals given vitamin D2 or parathyroid extract, and with subjects having hyperparathyroidism, sarcoidosis, and recurrent renal calculi. In the normal subjects the gradient of the slope appeared to indicate that there is no maximal tubular reabsorptive capacity for calcium, in the range sampled at any rate. The slopes of the various abnormal subjects mostly did not differ markedly from those of the normals. One incidental finding was that resting levels of urinary calcium excretion were significantly depressed 24 h following vitamin D2 administration, despite unchanged serum calcium levels.

scholarly journals Vitamin D Repletion in Patients with Primary Hyperparathyroidism and Coexistent Vitamin D Insufficiency

2005 ◽  
Vol 90 (4) ◽  
pp. 2122-2126 ◽  
Author(s):  
Andrew Grey ◽  
Jenny Lucas ◽  
Anne Horne ◽  
Greg Gamble ◽  
James S. Davidson ◽  
...  
Keyword(s):  
Vitamin D ◽  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Serum Alkaline Phosphatase ◽  
Vitamin D Insufficiency ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Total Serum ◽  
Calcium Excretion ◽  
Intact Pth

Abstract Vitamin D insufficiency is common in patients with primary hyperparathyroidism (PHPT) and may be associated with more severe and progressive disease. Uncertainty exists, however, as to whether repletion of vitamin D should be undertaken in patients with PHPT. Here we report the effects of vitamin D repletion on biochemical outcomes over 1 yr in a group of 21 patients with mild PHPT [serum calcium <12 mg/dl (3 mmol/liter)] and coexistent vitamin D insufficiency [serum 25 hydroxyvitamin D [25(OH)D] <20 μg/liter (50 nmol/liter)]. In response to vitamin D repletion to a serum 25(OH)D level greater than 20 μg/liter (50 nmol/liter), mean levels of serum calcium and phosphate did not change, and serum calcium did not exceed 12 mg/dl (3 mmol/liter) in any patient. Levels of intact PTH fell by 24% at 6 months (P < 0.01) and 26% at 12 months (P < 0.01). There was an inverse relationship between the change in serum 25(OH)D and that in intact PTH (r = −0.43, P = 0.056). At 12 months, total serum alkaline phosphatase was significantly lower, and urine N-telopeptides tended to be lower than baseline values (P = 0.02 and 0.13, respectively). In two patients, 24-h urinary calcium excretion rose to exceed 400 mg/d, but the group mean 24-h urinary calcium excretion did not change. These preliminary data suggest that vitamin D repletion in patients with PHPT does not exacerbate hypercalcemia and may decrease levels of PTH and bone turnover. Some patients with PHPT may experience an increase in urinary calcium excretion after vitamin D repletion.

scholarly journals Association of Urinary Calcium Excretion with Serum Calcium and Vitamin D Levels

2014 ◽  
Vol 10 (3) ◽  
pp. 452-462 ◽  
Author(s):  
Anita Rathod ◽  
Olivier Bonny ◽  
Idris Guessous ◽  
Paolo M. Suter ◽  
David Conen ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Vitamin D Levels

scholarly journals Therapy of Hypoparathyroidism With rhPTH(1-84): A Prospective, 8-Year Investigation of Efficacy and Safety

2019 ◽  
Vol 104 (11) ◽  
pp. 5601-5610 ◽  
Author(s):  
Yu-Kwang Donovan Tay ◽  
Gaia Tabacco ◽  
Natalie E Cusano ◽  
John Williams ◽  
Beatriz Omeragic ◽  
...  
Keyword(s):  
Vitamin D ◽  
Renal Function ◽  
Calcium Phosphate ◽  
Serum Calcium ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Mineral Density ◽  
Supplemental Calcium ◽  
Phosphate Product

Abstract Context Conventional treatment of hypoparathyroidism is associated with decreased renal function and increased bone mineral density (BMD). Objective To evaluate the effects of 8 years of recombinant human parathyroid hormone (1-84) [rhPTH(1-84)] therapy on key biochemical and densitometric indices. Design Prospective open-label trial. Setting Tertiary medical center. Participants Twenty-four subjects with hypoparathyroidism. Intervention Treatment with rhPTH(1-84) for 8 years. Main Outcome Measures Supplemental calcium and vitamin D requirements, serum calcium and phosphorus levels, calcium-phosphate product, urinary calcium excretion, estimated glomerular filtration rate (eGFR) and BMD. Results PTH therapy was associated with progressive reduction in supplemental calcium (57%; P < 0.01) and active vitamin D (76%; P < 0.001) requirements over 8 years. Serum calcium concentration was stable; urinary calcium excretion declined 38% (P < 0.01). eGFR remained stable and was related to baseline eGFR and serum calcium levels. Calcium-phosphate product was below the recommended limit; serum phosphorus remained within normal range. Lumbar spine and total hip BMD increased, peaking at 4 (mean ± SE, 4.6% ± 1.5%; P = 0.01) and 8 years (2.6% ± 1.1%; P = 0.02), whereas femoral neck BMD did not change and one-third radius BMD decreased (mean ± SE, −3.5% ± 1.1%; P = 0.001). BMD at all sites was higher throughout the 8 years than in the age- and sex-matched reference population. Hypercalcemia and hypocalcemia were uncommon. Conclusion rhPTH(1-84) is a safe and effective treatment for hypoparathyroidism for 8 years. Long-term reductions in supplemental requirements and biochemical improvements with stable renal function are maintained.

scholarly journals Bone and Mineral Metabolism in Patients with Primary Aldosteronism

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Luigi Petramala ◽  
Laura Zinnamosca ◽  
Amina Settevendemmie ◽  
Cristiano Marinelli ◽  
Matteo Nardi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Primary Aldosteronism ◽  
Mineral Metabolism ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Mineral Density ◽  
Lower Serum ◽  
Functional Link ◽  
The Impact

Primary aldosteronism represents major cause of secondary hypertension, strongly associated with high cardiovascular morbidity and mortality. Aldosterone excess may influence mineral homeostasis, through higher urinary calcium excretion inducing secondary increase of parathyroid hormone. Recently, in a cohort of PA patients a significant increase of primary hyperparathyroidism was found, suggesting a bidirectional functional link between the adrenal and parathyroid glands. The aim of this study was to evaluate the impact of aldosterone excess on mineral metabolism and bone mass density. In 73 PA patients we evaluated anthropometric and biochemical parameters, renin-angiotensin-aldosterone system, calcium-phosphorus metabolism, and bone mineral density; control groups were 73 essential hypertension (EH) subjects and 40 healthy subjects. Compared to HS and EH, PA subjects had significantly lower serum calcium levels and higher urinary calcium excretion. Moreover, PA patients showed higher plasma PTH, lower serum 25(OH)-vitamin D levels, higher prevalence of vitamin D deficiency (65% versus 25% and 25%;P<0.001), and higher prevalence of osteopenia/osteoporosis (38.5 and 10.5%) than EH (28% and 4%) and NS (25% and 5%), respectively. This study supports the hypothesis that bone loss and fracture risk in PA patients are potentially the result of aldosterone mediated hypercalciuria and the consecutive secondary hyperparathyroidism.

scholarly journals CALCIUM

2010 ◽  
Vol 17 (04) ◽  
pp. 698-701
Author(s):  
MUHAMMAD ISHAQ ◽  
ISRAR AHMED AKHUND ◽  
MOULA BUX LAGHARI ◽  
Muhammad Sabir
Keyword(s):  
Urinary Tract ◽  
Serum Calcium ◽  
Upper Urinary Tract ◽  
Urinary Calcium ◽  
Stone Disease ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Stone Formers ◽  
Study Results ◽  
Urinary Tract Stone

Aims & Objectives: To evaluate the effects of Serum Calcium and Urinary Calcium excretion on upper urinary tract stone diseases in the Peshawar (a high stone incidence belt). Subjects & Methods: One hundred patients (age 20-60years) who were suffering severely from upper urinary tract stone disease were selected from LRH and Hayatabad Medical Complex Hospitals of Peshawar, same numbers of healthy controls from the same region were also selected for the study. Results: When results were summed up and testParameters were compared, it was seen that mean Serum Calcium in stone formers was greater than that of non-stone formers (P<0.001). Same pattern was also observed (P< 0.001) in both groups regarding mean urinary calcium excretion. Conclusions: We concluded that calcium is a definitive risk factor in upper urinary tract stone disease. However we suggest further work and research on wide scale population inorder to evaluate this relation. 

scholarly journals SAT-377 Case Series of Ectopic Parathyroid Gland

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Subashini Rajoo ◽  
Yueh Chien Kuan ◽  
Chin Voon Tong
Keyword(s):  
Parathyroid Adenoma ◽  
Parathyroid Gland ◽  
Serum Calcium ◽  
Urinary Calcium ◽  
Urinary Calcium Excretion ◽  
Calcium Excretion ◽  
Excretion Ratio ◽  
Ectopic Parathyroid Adenoma ◽  
Sestamibi Scan ◽  
Ectopic Parathyroid

Abstract The prevalence of mediastinal parathyroid adenoma is unknown. Embryological origin and more extensive aberrant migration of the parathyroid glands result in ectopic glands found in the mediastinum. We report herein 4 cases of ectopic parathyroid adenoma causing primary hyperparathyroidism from three public hospitals in MalaysiaCase 1.A 70 year old lady with underlying diabetes mellitus, hypertension, chronic immune thrombocytopenic purpura and liver cirrhosis presented with incidental asymptomatic hypercalcemia during an admission for pneumonia. Her blood results revealed high corrected calcium of 2.93 mmol/L (2.02-2.60) and a low phosphate of 0.66 (0.81-1.45) mmol/L with an unsuppressed intact parathyroid hormone (iPTH) of 14.56 pmol/L (1.6-6.9). She had an equivocal urinary calcium excretion ratio of 0.01. Her bone mineral density confirmed severe osteoporosis at distal radius and neck of femur with a Tscore of -3.6 and -3.1 respectively. A hyperfunctioning ectopic parathyroid gland was seen in the Technetium Sestamibi scan which corelates with a mediastinal lymphadenopathy on CECT. The largest node measured 1.6 x 1.2 cm. Parathyroid gland was confirmed on HPE of the video-assisted-thoracoscopic surgical (VATS) excision of the mediastinal mass. Intraoperative iPTH (ioPTH) serially reduced from 8.87 to 1.94 to 1.03 pmol/L and she maintained a serum calcium levels of 2.4 mmol/L post surgery. She did not require any calcium or vitamin D supplementation. Case 2. A 36 year old male presented with generalized body weakness secondary to hypokalemia. His calcium was 3.07 mmol/l, phosphate 0.64 mmol/l and iPTH 11.53 pmol/L. Increase Technetium uptake seen at mediastinum. Post operatively, calcium normalized and remained stable 1 year later. Case 3.47 year old female presented with acute gallstone pancreatitis complicated with a pancreatic pseudocyst. She was found to have hypercalcemia of 2.77 mmol/L, phosphate 0.70 mmol/l and iPTH 21.87 pmol/L. Sestamibi scan revealed hyperfunctiong parathyroid tissue posterior to the left thyroid lobe and in the mediastinum. She is awaiting surgery. Case 4.Another asymptomatic 47 year old male who has history of post Radioactive-iodine hypothyroidism had an incidental finding of serum calcium of 2.69-2.84 mmol/L, phosphate 0.71-0.91 mmol/L and iPTH 9.89 pmol/L with urinary calcium excretion ratio of 0.019. His Sestamibi scan showed uptake at the superior mediastinum. Ectopic parathyroid gland is rarely encountered. With the advent of Technetium-Sestamibi scintigraphy, ectopic parathyroid adenoma can be localized easily. However, surgery poses a challenge due the location of the adenoma which may occasionally be near large vascular structures in the mediastinum. The availability of intraoperative PTH aids the decision for surgical exploration and completion.

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