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Unexpected Serum Parathyroid Hormone Profiles in Some Patients with Primary Hyperparathyroidism

(Departments of¹ Hormonal Biology and ² Endocrine Surgery, Hôpital Saint-Louis, Paris, France;³ Department of Rhumatologie, Hôpital Cochin, Paris, France;⁴ Physiology Laboratory, Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Paris, France;⁵ INSERM U 671, Paris, France;

^aaddress correspondence to this author at: Department of Hormonal Biology, Saint-Louis University Hospital and INSERM U 671, 1 avenue Claude Vellefaux, 75475 Paris cedex 10, France; fax 33-1-42-49-42-80, e-mail philippe.boudou{at}sls.aphp.fr)

Abstract

Background: Third-generation parathyroid hormone (PTH) assays have been reported to measure only intact PTH(1–84), in contrast to second-generation assays, which also detect PTH(7–84) fragments. Higher PTH measurements were observed with third- than with second-generation PTH assays in a few patients with either severe primary hyperparathyroidism or parathyroid carcinoma.

Methods: We analyzed biological data [second- and third-generation PTH assays, 25-hydroxyvitamin D (25-OHD), calcium, and phosphate concentrations] obtained before and after surgery for 2 groups of patients selected from a large series of consecutive patients with primary hyperparathyroidism (PHPT): 7 female patients with surgically and histologically confirmed PHPT (group 1) and a matched group (group 2).

Results: For group 1 but not group 2, PTH concentrations measured by third-generation PTH assays before surgery were higher than those measured by the second-generation assays. Circulating 25-OHD, calcium, and phosphate concentrations were similar in both groups. In addition, PTH values measured with the third-generation PTH assays in group 1 decreased after surgery.

Conclusions: Our results confirm that third-generation PTH assays do not measure only PTH(1–84). The frequency of this unexpected finding of markedly lower PTH concentrations than previously reported was 5% in patients with PHPT without malignancy. We do not know whether the presence of this unexpected profile is predictive of malignancy.

The following articles in journals at HighWire Press have cited this article:

				M. R. Rubin, S. J. Silverberg, P. D'Amour, J.-H. Brossard, L. Rousseau, J. Sliney Jr, T. Cantor, and J. P. Bilezikian An N-Terminal Molecular Form of Parathyroid Hormone (PTH) Distinct from hPTH(1 84) Is Overproduced in Parathyroid Carcinoma Clin. Chem., August 1, 2007; 53(8): 1470 - 1476. [Abstract] [Full Text] [PDF]