副甲状腺疾患における尿中及び血中c-nucleotides主として副甲状腺ホルモン, カルシウム及びカルシトニン負荷による変化

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Basal plasma levels and urinary excretion of adenosine 3', 5'-monophosphate and guanosine 3', 5'-monophosphate were determined in patients with primary hyperparathyroidism, idiopathic, surgical and pseudohypoparathyroidism and in normal controls in order to elucidate whether or not they provide good indices of parathyroid activity. The effects of the parathyroid hormone (PTH), calcium and calcitonin (CT) on plasma and urinary c-AMP and c-GMP were studied in patients with hyperparathyroidism and hypoparathyroidism and in normal controls. I) C-AMP and c-GMP were measured in urine collected from 8 : 00 a.m. to 10 : 00 a.m. and in plasma obtained at 9 : 00 a.m. in 9 patients with primary hyperparathyroidism, in 24 patients with hypoparathyroidism and in 9 normal controls. II) 200 units of bovine PTH (Eli-Lilly) were injected intravenously with saline at 10 : 00 a.m. Urine was collected at 30, 60,120 and 180 min., and blood was obtained at 30, 60 and 120 min. after the PTH administration. III) Calcium (Ca 15 mg/kg) was infused intravenously with 500 ml of saline for 4 hours (9 : 00 a.m. to 1 : 00 p.m.). Urine was collected, and blood was obtained at every 1 hour until 1 : 00 p.m. IV) 40 MRCU. of calcitonin was injected intramuscularly, urine was collected and blood was obtained every 1 hour until 1 : 00 p.m Urine and plasma c-AMP and c-GMP were measured by radioimmunoassay using YAMASA c-AMP and c-GMP assay kits. Serum PTH was measured by radioimmunoassay using an antibody to bovine PTH. The results were as follows : 1) The basal excretion of urinary c-AMP was significantly higher in 9 patients with primary hyperparathyroidism and significantly lower in 24 patients with hypoparathyroidism than it was in the normal controls. There were positive correlations between these basal excretions and serum Ca or PTH levels. The plasma c-AMP levels were higher in patients with primary hyperparathyroidism than they were in the normal controls, but those with hypoparathyroidism were not so different from the normal controls. On the other hand, plasma and urinary c-GMP did not show any significant differences between the normal controls and patients with hyper or hypoparathyroidism. 2) The responsiveness of urinary c-AMP to PTH was higher in the patients with hypoparathyroidism and lower in the patients with primary hyperparathyroidism than it was in the normal controls. In the patients with pseudohypoparathyroidism, however, only a small increase was observed. The responsiveness of plasma c-AMP showed the same tendency though much less than urinary c-AMP. Urinary c-GMP showed about a 50% increase in the urine collected the first 1 hour after the PTH administration, but there was no apparent difference between the normal controls and the patients with hyper- or hypoparathyroidism. 3) The urinary excretion of c-AMP decreased by calcium infusion for 4 hours in patients with primary hyperparathyroidism because of the suppression of endogenous PTH secretion. On the other hand, urinary c-GMP increased in 5 out of 7 patients. In a case of pseudohypoparathyroidism, c-AMP excretion increased markedly after the calcium infusion. 4) Urinary c-AMP excretion increased 55% in 3 normal controls and 39% in 5 patients with primary hyperparathyroidism by 40U of CT. This increase may have resulted from the direct effect of calcitonin. 5) The urinary excretion of c-AMP decreased immediately after parathyroidectomy in patients with primary hyperparathyroidism. From these findings, it is suggested that c-AMP in plasma and urine provides a good index of parathyroid activity, but c-GMP does not.
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副甲状腺疾患における尿中及び血中c-nucleotides主として副甲状腺ホルモン, カルシウム及びカルシトニン負荷による変化

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