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Acute effects of removal of parathyroid adenoma on plasma and urinary hydroxyproline levels

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Abstract

This study was carried out to investigate early effects of parathyroidectomy (PTx) on bone matrix collagen metabolism. Eleven patients suffering from primary hyperparathyroidism were studied by measuring urinary excretion of hydroxyproline (OHPr) and cAMP in samples collected before PTx and, on the day of surgery, at intervals of 1–3 h for the first 10 h and then at longer intervals. In six patients nondialyzable urinary OHPr and free plasma aminoacid levels were also assayed. We found that the average period required for OHPr/Cr ratio and plasma OHPr to reach normal values was longer than the mean time required for cAMP/Cr ratio to reach normal limits. In all patients the total amount of nondialyzable OHPr decreased in the first 24 h after PTx but thereafter a daily increase in the urinary excretion of nondialyzable component was seen, so that the fractional amount of nondialyzable OHPr in the fourth postoperative day (26.8 ±5.2 SE) was significantly higher than that of preoperative one (6.1 ± 1.0; p < 0.02). Our results confirm that PTx induces a reduction in the rate of bone collagen resorption and indicate that changes of OHPr/Cr ratio and free plasma OHPr values may be considered useful indices of successful parathyroid surgery, even though they lag behind those of cAMP. The different behavior of total and nondialyzable OHPr after surgery indicates that acute deficiency of parathyroid hormone induces a positive uncoupling of the two processes of bone remodeling, thus supporting the view that the acute direct effect of the hormone on bone formation is an inhibition of this process.

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References

  1. Parfitt A.M. The actions of parathyroid hormone on bone. Relation to bone remodeling and turnover, calcium homeostasis and metabolic bone disease. III. PTH and osteoblasts, the relationship between bone turnover and bone loss, and the state of the bones in primary hyperparathyroidism. Metabolism 25: 1033, 1976.

    Article  PubMed  CAS  Google Scholar 

  2. Mallette L.E., Bilezikian J.P., Heath D.A, Aurbach G.D. Primary hyperparathyroidism: clinical and biochemical features. Medicine 53: 127, 1974.

    Article  PubMed  CAS  Google Scholar 

  3. Mazzuoli G.F., D’Erasmo E., Scarda A., S., Mancini D., Malaguti Aliberti L. Significance of early increase in stable and radioactive plasma calcium after parathyroidectomy in primary hyperparathyroidism. Calcif. Tissue Int. 29: 185, 1979.

    Article  PubMed  CAS  Google Scholar 

  4. Mazzuoli G.F., D’Erasmo E., Scarda A., Mancini D., Minisola S., Malaguti Aliberti L. Further studies on the significance of the early increase in serum calcium following parathyroidectomy in primary hyperparathyroidism. In: Mac Intyre I., Szelke M. (Eds.), Molecular endocrinology. Elsevier, North-Holland Biomedical Press, Amsterdam 1979, p. 327.

    Google Scholar 

  5. Muls E., Bouillon R., De Moor P. Hormonal and biochemical changes in patients successfully operated for primary hyperparathyroidism. Acta Endocrinol. (Kbh.) 83: 549, 1976.

    CAS  Google Scholar 

  6. Onishi T., Tsuji M., Morimoto S., Okada Y., Arima M., Itatani H., Kinoshita K., Sonoda T., Kumahara Y. Changes of urinary cyclic AMP excretion and plasma parathyroid hormone levels before and after parathyroidectomy in patients with primary hyperparathyroidism. Clin. Endocrinol. (Oxf.) 11: 307, 1979.

    Article  CAS  Google Scholar 

  7. Spiegel A.M., Marx S.J., Brennan M.F., Brown E.M., Koehler J.O., Aurbach G.D. Urinary cAMP excretion during surgery: an index of successful parathyroidectomy in patients with primary hyperparathyroidism. J. Clin. Endocrinol. Metab. 47: 537, 1978.

    Article  PubMed  CAS  Google Scholar 

  8. Spiegel A.M., Eastman S.T., Attie M.F., Downs R.W. Jr., Levine M.A., Marx S.J., Stock J.L., Saxe A.W., Brennan M.F., Aurbach G.D. Intraoperative measurements of urinary cyclic AMP to guide surgery for primary hyperparathyroidism. N. Engl. J. Med. 303: 1457; 1980.

    Article  PubMed  CAS  Google Scholar 

  9. Kalima T., Kivirikko K.I., Lattinen O., Uitto J. Urinary free and total hydroxyproline in hyperparathyroidism and the effect of removal of parathyroid adenoma. Clin. Chim. Acta 19: 443, 1968.

    Article  PubMed  CAS  Google Scholar 

  10. Smith R. Dissociation between changes in urinary total hydroxy-proline and plasma alkaline phosphatase after removal of parathyroid tumor. Clin. Chim. Acta 23: 421, 1969.

    Article  PubMed  CAS  Google Scholar 

  11. Haddad J.G. Jr., Couranz S., Avioli L.V. Non dialyzable urinary hydroxyproline as an index of bone collagen formation. J. Clin. Endocrinol. Metab. 30: 282, 1970.

    Article  PubMed  CAS  Google Scholar 

  12. Peacock M., Pierides A.M., Nordin B.E.C. Biochemical changes following parathyroidectomy. In: Endocrinology 1971. Proceedings of the third international Symposium. William Heinemann Medical Books Ltd, London, 1972, p. 350.

    Google Scholar 

  13. Parfitt A.M. The actions of parathyroid hormone on bone. Relation to bone remodeling and turnover, calcium homeostasis and metabolic bone disease. II. PTH and bone cells: bone turnover and plasma calcium regulation. Metabolism 25: 909, 1976.

    Article  PubMed  CAS  Google Scholar 

  14. Halse J., Gordeladze J.O. Urinary excretion of calcium, hydroxyproline and 3’, 5’-cyclic adenosine monophosphate in primary hyperparathyroidism. Acta Endocrinol. (Kbh.) 92: 138, 1979.

    CAS  Google Scholar 

  15. Hodgkinson A., Knowles C.F. Laboratory methods. In: Nordin B.E.C. (Ed.), Calcium phosphate and magnesium metabolism. Churchill Livingstone, London, 1976, p. 525.

    Google Scholar 

  16. Husdan H., Leung M., Oreopoulos D., Rapoport A. Measurement of free and free-plus peptide hydroxyproline fractions in plasma. Clin. Chem. 24: 204, 1978.

    PubMed  CAS  Google Scholar 

  17. Krane S.M., Munoz A.J., Harris E.D. Urinary polypeptides related to collagen synthesis. J. Clin. Invest. 49: 716, 1970.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  18. Broadus A.E., Mahaffey J.E., Bartter F.C., Neer R.M. Nephrogenous cyclic adenosine monophosphate as a parathyroid function test. J. Clin. Invest. 60: 771, 1977.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  19. Delmas P.D., Stenner D., Wahner H.W., Mann K.G., Riggs B.L Serum bone GLA protein increases with ageing in normal women: implications for age-related bone loss. 4th Annual Scientific Meeting of the American Society for Bone and Mineral Research, 1982 (Abstract).

    Google Scholar 

  20. Mazzuoli G.F., D’Erasmo E., Scarda A., Minisola S., Mancini D., Valtorta C, Tabolli S. Studies on parathyroid function in some pathophysiological conditions. In: Albertini A., Ekins R. (Eds.), Monoclonal antibodies and developments in immunoassay. Elsevier, North Holland Biomedical Press, Amsterdam, 1981, p. 231.

    Google Scholar 

  21. Lloyd H.M. Primary hyperparathyroidism: analysis of the role of the parathyroid tumor. Medicine 47: 53, 1968.

    Article  PubMed  CAS  Google Scholar 

  22. Parfitt A.M. Equilibrium and disequilibrium hypercalcemia. New light on an old concept. Metab. Bone Dis. Rel. Res. 1: 279, 1979.

    Article  Google Scholar 

  23. Parthemore J.G., Deftos L.J. Calcitonin secretion in primary hyperparathyroidism. J. Clin. Endocrinol. Metab. 49: 223, 1979.

    Article  PubMed  CAS  Google Scholar 

  24. Mazzuoli G.F., D’Erasmo E., Scarda A., Mancini D., Mini-sola S., Malaguti Aliberti L., Valtorta C. Calcitonin secretion and bone disease severity in hypercalcaemic hyperparathyroidism. Clin. Endocrinol. (Oxf.) 75: 81, 1981.

    Article  Google Scholar 

  25. Stanbury S.W. Vitamin D and hyperparathyroidism. J. Res. Coll. Phys. Lond. 15: 205, 1981.

    CAS  Google Scholar 

  26. Lumb G.A, Stanbury S.W. Parathyroid function in human vitamin D deficiency and vitamin D deficiency in primary hyperparathyroidism. Am. J. Med. 56: 833, 1974.

    Article  PubMed  CAS  Google Scholar 

  27. Albright G., Reifenstein E.C., Jr. The parathyroid glands and metabolic bone disease. Williams and Wilkins, Baltimore, 1948, p. 104.

    Google Scholar 

  28. Krane S.M., Munoz A.S., Harris E.D. Collagen-like fragments: excretion in urine of patients with Paget’s disease of bone. Science 157: 713, 1967.

    Article  PubMed  Google Scholar 

  29. Kalu D.N. Evaluation of a new technique for measuring bone formation. Med. Lab. Technol. 32: 98, 1973.

    Google Scholar 

  30. Laitinen O. Clinical applications of urinary hydroxyproline determination. Acta Med. Scand. (Suppl.) 577: 26, 1974.

    Google Scholar 

  31. Laitinen O. Bone, calcium, and hydroxyproline metabolism in hyperparathyroidism and after removal of parathyroid adenoma. Acta Med. Scand. 202: 39, 1972.

    Article  Google Scholar 

  32. Caniggia A., Gennari C., Guideri R., Cesari L. Comparison between the results of radiocalcium studies and histological findings in a case of primary hyperparathyroidism (osteitis fibrosa cystica generalisata of von Recklinghausen) before and after removal of parathyroid adenoma. J. Clin. Endocrinol. Metab. 26: 867, 1966.

    Article  PubMed  CAS  Google Scholar 

  33. Chesnut C.H. III, Ivey J.L., Nelp W.B., Baylink D.J. Assessment of anabolic steroids and calcitonin in the treatment of osteoporosis. In: Barzel U.S. (Ed.), Osteoporosis II. Grune & Stratton, New York, 1979, p. 135.

    Google Scholar 

  34. Baylink D., Farley J., Howar G., Drivdhal R., Puzas E., Masuda T., Ivey J., Gruber H. In: Massry S.G., Letteri J.M., Ritz F. (Eds.), Regulation of phosphate and mineral metabolism. Plenum Press, New York, 1981, p. 409.

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This work was supported by a grant from the Consiglio Nazionale delle Ricerche. The results of this study have been partly presented at the XIV Acta Endocrinologica Congress, June 1983, Stockholm, Sweden.

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Minisola, S., Medori, C., Antonelli, R. et al. Acute effects of removal of parathyroid adenoma on plasma and urinary hydroxyproline levels. J Endocrinol Invest 7, 563–568 (1984). https://doi.org/10.1007/BF03349487

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