原発性副甲状腺機能充進症における副甲状腺のSuppressibilityについて:Nephrogenous Cyclic AMPを指標としたカルシウム負荷試験による検討

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概要

• 論文の詳細を見る

• The effects of calcium injection (3 mg/Kg/ 10 min) or oral calcium administration (calcium lactate 7.7g) on plasma iPTH and Nephrogenous cyclic AMP (NcAMP) were studied in 6 normal controls and 13 patients with primary hyperparathyroidism.<BR>In the control subjects, plasma iPTH determined by a predominantly carboxyl-terminal antiserum was <0.3 ng/ml before and after both calcium loads, whereas 41-98% (mean 67%) of NcAMP was rapidly and uniformly suppressed to a level lower than the normal value.<BR>In 2 patients with primary hyperparathyroidism, iPTH was clearly reduced from 8.0 to 4.6 ng/ml and 1.6 to 0.96 ng/ml, respectively, by the calcium load. However, in the other 7 patients with primary hyperparathyroidism who showed only a slight elevation of iPTH : <0.3-0.9 ng/ml, the reductions in iPTH were not detected after the calcium load : <0.3-0.7 ng/ml.<BR>In contrast, 30-54% (1.02-3.85 nmol/dl GF, ) of NcAMP, which was greater than the diurnal variation, was suppressed after calcium injection in 5 patients with primary hyperparathyroidism (2 of 4 patients with urological, and 3 of 5 patients with chemical hyperparathyroidism). But NcAMP was not suppressed in all 4 patients with skeletal hyperparathyroidism including one with proximal renal tubular dysfunction whose basal iPTH was elevated markedly but reduced clearly by the calcium load.In general, suppression of NcAMP was followed by a decrease of phosphate excretion.<BR>On the other hand, even in a patient with primary hyperparathyroidism whose NcAMP was not suppressed at all after the calcium injection, calcium infusion (15 mg/Kg/3 h) resulted in some (23%) decrease in NcAMP.<BR>Oral calcium administration resulted in responses which were almost the same as those produced by calcium injection.<BR>These results suggest that NcAMP provides a useful index in the parathyroid suppression test in patients with primary hyperparathyroidism, especially those who display a rather mild elevation of iPTH. This is not the case, however, in a few patients who show a marked elevation of iPTH and/or proximal renal tubular dysfunction.

• 日本内分泌学会の論文

著者

• 古川 洋太郎

  東北大学医学部第二内科

• 弓田 滋

  東北大学医学部第二内科

• 孫 孝義

  東北大学医学部第二内科学教室

• 海上 寛

  東北大学医学部第二内科学教室

• 三浦 良

  東北大学医学部第二内科

• 海上 寛

  東北大学医学部第二内科

• 孫 孝義

  東北大学医学部第二内科

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