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Parathyroid hormone and calcitonin response during the calcium infusion test in patients with primary hyperparathyroidism

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Abstract

Objective

While activation of the calcium (Ca) sensing receptor (CaSR) suppresses parathyroid hormone (PTH) secretion, calcitonin (CT) secretion is stimulated via CaSR. The aim of this study was to evaluate PTH and CT responses during a calcium infusion test (CIT) in patients with primary hyperparathyroidism (PHPT).

Methods

This pivotal prospective study included 64 patients (44 PHPT patients vs. 20 healthy controls [HCs], median age 57 [25–79] vs. 56 [39–74] years). All PHPT patients underwent parathyroidectomy (PTX). A week before and 1 month after PTX, the CIT was performed (bolus infusion of Ca gluconate 0.2 ml/kg body weight), followed by plasma sampling for Ca2+, PTH, and CT at 0, 1, 2, 3, 5, 8, and 10 min.

Results

PTH suppression was lower in PHPT patients compared to HCs (49.82 vs. 64.06%, p = 0.006), but after PTX suppression, it was higher (76.3%, p < 0.001). PHPT patients had attenuated CT response vs. HCs during the CIT (3.1- vs. 8.0-fold increase, p < 0.001), but after PTX, it improved (5.8-fold increase). The PTHmin > 19.3 ng/l and CTmax ≤ 27.5 ng/l cut-off values predict diagnosis of PHPT (sensitivity 90.9%, 97.7%, and specificity 100%, 75%, respectively). Patients with adenoma had lower basal CT levels vs. hyperplasia both before and after PTX (4.5 vs. 6.8 and 5.4 vs. 7.9 ng/l, respectively, p = 0.008, p = 0.018).

Conclusion

PTH and CT responses during the CIT in PHPT patients may be an additional diagnostic tool. The CIT could play a role in both the diagnosis of PHPT and in the differential diagnosis between adenoma and hyperplasia.

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Data availability

The data are available to “Hormones” upon request.

Abbreviations

AUC:

Area under the curve

BW:

Body weight

Ca:

Calcium

CaSR:

Calcium-sensing receptor

Ca2 + :

Ionized calcium

CI:

Confidence interval

CIT:

Calcium infusion test

CT:

Calcitonin

CTmax:

Maximum CT level

CTsi:

Stimulated calcitonin increase

HC:

Healthy control

HCT:

Hypercalcitoninemia

ICMA:

Immunochemiluminometric assay

IRMA:

Immunoradiometric assay

MEN:

Multiple endocrine neoplasia

Phos:

Phosphate

PHPT:

Primary hyperparathyroidism

PTH:

Parathyroid hormone

PTHmin:

Minimum PTH level

PTHsup[%]:

Percent of parathyroid hormone suppression

PTG:

Parathyroid gland

PTX:

Parathyroidectomy

ROC:

Receiver operating characteristic

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Acknowledgements

We gratefully acknowledge the nurses of the Internal Medicine Department/Endocrinology section of the Clinical Centre of Montenegro for their diligent work in performing tests and collecting data.

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Authors and Affiliations

  1. Department of Internal Medicine, Endocrinology Section, Clinical Center of Montenegro, Kruševac bb, Podgorica, 81000, Montenegro

    Emir Muzurović & Snežana Vujošević

  2. Faculty of Medicine, University of Montenegro, Podgorica, 81000, Montenegro

    Emir Muzurović & Snežana Vujošević

  3. Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia

    Karin Zibar Tomšić

  4. Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Beograd, Serbia

    Milan Petakov

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  1. Emir Muzurović
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  4. Milan Petakov
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Contributions

Study conception and design: EM and KZT; acquisition of data: EM and KZT; statistical analysis: KZT; analysis and interpretation of data: EM, KZT, SV, and MP; drafting of manuscript: EM and KZT; critical revision: MP. All authors approved the final version of the article, including the authorship list.

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Correspondence to Emir Muzurović.

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The study was approved by the Scientific Committee of the University of Montenegro (Faculty of Medicine/Clinical Center of Montenegro).

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Muzurović, E., Tomšić, K.Z., Vujošević, S. et al. Parathyroid hormone and calcitonin response during the calcium infusion test in patients with primary hyperparathyroidism. Hormones 21, 261–270 (2022). https://doi.org/10.1007/s42000-022-00353-2

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