Document Detail


Glomerular filtration rate and parathyroid hormone secretion in primary hyperparathyroidism.
MedLine Citation:
PMID:  19808852     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: The recent Third International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism (PHPT) set 60 ml/min as the precise level of glomerular filtration rate (GFR) below which surgery is recommended because it is considered a threshold of concern in patients with PHPT. OBJECTIVE: The aim of the study was to investigate the relationship between different stages of renal insufficiency and PTH levels in PHPT patients. DESIGN: We conducted a cross-sectional study. PATIENTS AND METHODS: We studied 294 consecutive PHPT patients. Biochemical evaluation included total and ionized serum calcium, phosphate, creatinine, immunoreactive intact PTH, and 25-hydroxyvitamin D3 levels in the fasting state. GFR was assessed with the Modification of Diet in Renal Disease Study formula. RESULTS: The mean GFR of the whole group of PHPT patients was 92.3 +/- 31.6 ml/min x 1.73 m(2). The patients were divided into four groups according to National Kidney Foundation Disease Outcomes Quality Initiative (K/DOQI) guidelines: group 1 with normal or increased GRF (>90 ml/min x 1.73 m(2); n = 153); group 2 with mild decreased GFR (60-89 ml/min x 1.73 m(2); n = 90); group 3 with moderately decreased GFR (30-59 ml/min x 1.73 m(2); n = 45); and group 4 with severely decreased GFR (<30 ml/min x 1.73 m(2); n = 6). PTH levels were comparable across groups 1-3, whereas group 4 showed significantly higher PTH levels (P < 0.0001). CONCLUSION: In our series of PHPT patients, only a severe impairment of GFR was characterized by a further PTH increase. These findings challenge the concept of a PTH elevation below the threshold of 60 ml/min of GFR.
Authors:
F Tassone; L Gianotti; I Emmolo; M Ghio; G Borretta
Publication Detail:
Type:  Journal Article     Date:  2009-10-06
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  94     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-05     Completed Date:  2010-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4458-61     Citation Subset:  AIM; IM    
Affiliation:
Division of Endocrinology and Metabolism, Santa Croce and Carle Hospital, 12100 Cuneo, Italy. francesco.tassone@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Pressure
Calcifediol / blood
Calcium / blood
Creatinine / blood
Cross-Sectional Studies
European Continental Ancestry Group
Female
Glomerular Filtration Rate*
Humans
Hyperparathyroidism, Primary / blood,  physiopathology*
Italy
Male
Middle Aged
Parathyroid Hormone / blood*,  secretion
Phosphates / blood
Chemical
Reg. No./Substance:
0/Parathyroid Hormone; 0/Phosphates; 19356-17-3/Calcifediol; 60-27-5/Creatinine; 7440-70-2/Calcium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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