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Krudy AG, Doppman JL, Miller DL, Marx SJ, Norton JA, Santora AC, Lasker RD, Downs RW, Spiegel AM, Aurbach GD. Work in progress: abnormal parathyroid glands. Comparison of nonselective arterial digital arteriography, selective parathyroid arteriography, and venous digital arteriography as methods of detection. Radiology 1983; 148:23-9. [PMID: 6134300 DOI: 10.1148/radiology.148.1.6134300] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Nonselective arterial digital arteriography (NSADA), selective parathyroid arteriography (SPA), and venous digital arteriography (VDA) were compared as methods of detecting parathyroid enlargement in 14 patients with primary hyperparathyroidism undergoing preoperative localization following unsuccessful neck surgery. All 14 had SPA and NSADA, consisting of contrast injections into the ascending aorta, innominate artery, and left subclavian artery; 7 also had VDA. Surgery was performed in 9 patients, and 2 additional glands were confirmed by fine-needle aspiration and venous sampling. Parathyroid glands could not be located in 3 patients, who were not re-explored. SPA demonstrated 11/13 abnormal glands (85%). NSADA detected 7/13 (54%), and there were 2 false positives. VDA showed 5/6 glands detected by NSADA (83%); the seventh patient did not have VDA. The overall quality of VDA was inferior to NSADA. Although NSADA and VDA are less sensitive than SPA, they are safer and easier to perform and should be the initial vascular screening procedures following unsuccessful parathyroid surgery.
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Doppman JL, Krudy AG, Marx SJ, Saxe A, Schneider P, Norton JA, Spiegel AM, Downs RW, Schaaf M, Brennan ME, Schneider AB, Aurbach GD. Aspiration of enlarged parathyroid glands for parathyroid hormone assay. Radiology 1983; 148:31-5. [PMID: 6856859 DOI: 10.1148/radiology.148.1.6856859] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Enlarged parathyroid glands were percutaneously aspirated under computed tomographic (CT) control in 7 patients, and levels of parathyroid hormone (PTH) and human thyroglobulin (HTg) were measured. All 7 patients had high levels of PTH in at least 1 specimen. It is concluded that the measurement of high concentrations of PTH in the aspirate from a cervical or mediastinal mass, with CT documentation of needle position, provides absolute localization of parathyroid masses.
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Levine MA, Downs RW, Moses AM, Breslau NA, Marx SJ, Lasker RD, Rizzoli RE, Aurbach GD, Spiegel AM. Resistance to multiple hormones in patients with pseudohypoparathyroidism. Association with deficient activity of guanine nucleotide regulatory protein. Am J Med 1983; 74:545-56. [PMID: 6301273 DOI: 10.1016/0002-9343(83)91008-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Downs RW, Levine MA, Drezner MK, Burch WM, Spiegel AM. Deficient adenylate cyclase regulatory protein in renal membranes from a patient with pseudohypoparathyroidism. J Clin Invest 1983; 71:231-5. [PMID: 6822662 PMCID: PMC436861 DOI: 10.1172/jci110763] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Recent studies have established that some patients with pseudohypoparathyroidism have a deficiency of the adenylate cyclase regulatory protein (the G unit) in plasma membranes from erythrocytes, platelets, and fibroblasts. We have directly measured the activity of the G unit in renal membranes from a patient with pseudohypoparathyroidism who, in addition to parathyroid hormone resistance, has resistance to thyrotropin and gonadotropins. Erythrocyte membrane G unit activity was 57% that of control erythrocyte membranes. Lubrol PX extracts of renal membranes had only 30% of the G unit activity of control renal membrane extracts, whether assayed with sodium fluoride or guanosine-5'-O-(3-thiotriphosphate) (GTP-gamma-S). In cholate extracts, the G unit activity was 37 and 48% of control with fluoride or GTP-gamma-S, respectively. Cholera toxin-dependent incorporation of [32P]ADP-ribose into the 42,000-Mr subunit of the G unit was decreased in renal membranes from the patient compared with control renal membranes. The data demonstrate that the membrane G unit deficiency in pseudohypoparathyroidism extends to the cells of a clinically relevant parathyroid hormone target tissue.
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Marx SJ, Spiegel AM, Levine MA, Rizzoli RE, Lasker RD, Santora AC, Downs RW, Aurbach GD. Familial hypocalciuric hypercalcemia: the relation to primary parathyroid hyperplasia. N Engl J Med 1982; 307:416-26. [PMID: 7045673 DOI: 10.1056/nejm198208123070707] [Citation(s) in RCA: 81] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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31
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Spiegel AM, Levine MA, Aurbach GD, Downs RW, Marx SJ, Lasker RD, Moses AM, Breslau NA. Deficiency of hormone receptor-adenylate cyclase coupling protein: basis for hormone resistance in pseudohypoparathyroidism. THE AMERICAN JOURNAL OF PHYSIOLOGY 1982; 243:E37-42. [PMID: 6283911 DOI: 10.1152/ajpendo.1982.243.1.e37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Pseudohypoparathyroidism is an inherited disorder associated with resistance to the action of several hormones, including parathyroid hormone, thyroid-stimulating hormone, follicle-stimulating hormone, and luteinizing hormone. The disorders described under this designation are heterogeneous in regard to the underlying genetic defects, the phenotypic manifestation, and the severity of the defects in hormone action. The majority of affected individuals who also have the characteristic skeletal changes (heredity osteodystrophy) have a defect in the guanine nucleotide regulatory protein (G protein) that is essential for coupling certain cell-surface hormone receptors to the adenylate cyclase system. This defect is probably the cause for resistance to the action of multiple hormones. In the remaining patients the cause for hormone resistance has not been identified.
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Lasker RD, Downs RW, Aurbach GD. Calcium inhibition of adenylate cyclase: studies in turkey erythrocyte and S49 CYC- cell membranes. Arch Biochem Biophys 1982; 216:345-55. [PMID: 6980630 DOI: 10.1016/0003-9861(82)90220-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Krawietz W, Downs RW, Spiegel AM, Aurbach GD. Vanadate stimulates adenylate cyclase via the guanine nucleotide regulatory protein by a mechanism differing from that of fluoride. Biochem Pharmacol 1982; 31:843-8. [PMID: 6282277 DOI: 10.1016/0006-2952(82)90472-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Vanadate stimulates adenylate cyclase activity in turkey erythrocyte membranes. The maximal stimulation is 7-fold over basal at 3 mM vanadate; higher concentrations are inhibitory. A suboptimal concentration of fluoride (1 mM) together with vanadate (3 mM) activates adenylate cyclase in a non-additive manner; cyclase activation by optimal fluoride (10 mM) is inhibited by vanadate (3 mM). There is no stimulation by vanadate of adenylate cyclase activity (measured either with Mg2+ or Mn2+) in CYC- S49 lymphoma cell membranes. Vanadate (3 mM) shows no effect on binding of Beta-adrenergic agonists or antagonists to the [3H] (-)-dihydroalprenolol binding site in turkey erythrocyte membranes. These results suggest that the effect of vanadate on Adenylate cyclase is mediated through the nucleotide regulatory protein and may act by a mechanism similar to fluoride. However, in cholera toxic-treated membranes as well as in GDP-beta-S plus isoproterenol-treated membranes, fluoride-stimulated adenylate cyclase activity is significantly reduced, but vanadate stimulation is not. Our results suggest that although the actions of vanadate and fluoride in adenylate cyclase may each involve the nucleotide regulatory unit, the exact mechanisms of activation by the two anions differ.
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Marx SJ, Attie MF, Levine MA, Spiegel AM, Downs RW, Lasker RD. The hypocalciuric or benign variant of familial hypercalcemia: clinical and biochemical features in fifteen kindreds. Medicine (Baltimore) 1981; 60:397-412. [PMID: 7311809 DOI: 10.1097/00005792-198111000-00002] [Citation(s) in RCA: 289] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Spiegel AM, Marx SJ, Brennan MF, Brown EM, Downs RW, Gardner DG, Attie MF, Aurbach GD. Parathyroid function after parathyroidectomy: evaluation by measurement of urinary cAMP. Clin Endocrinol (Oxf) 1981; 15:65-73. [PMID: 6273023 DOI: 10.1111/j.1365-2265.1981.tb02749.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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36
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Downs RW, Reen SA, Levine MA, Aurbach GD, Spiegel AM. Cholera-toxin-dependent ADP-ribosylation of the adenylate cyclase regulatory protein in turkey erythrocyte membranes. Arch Biochem Biophys 1981; 209:284-90. [PMID: 6269497 DOI: 10.1016/0003-9861(81)90282-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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37
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Stock JL, Krudy AG, Doppman JL, Jones AE, Brennan MF, Attie MF, Downs RW, Levine MA, Marx SJ, Spiegel AM, Aurbach GD. Parathyroid imaging after intraarterial injections of [75Se]selenomethionine. J Clin Endocrinol Metab 1981; 52:835-9. [PMID: 7228990 DOI: 10.1210/jcem-52-5-835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Thirteen patients with persistent hyperparathyroidism after unsuccessful neck surgery were given up to 250 microCi [75Se]selenomethionine intraarterially during parathyroid arteriography, gamma-Camera images of the neck and mediastinum localized abnormal parathyroids in four of five patients receiving complete injections, despite very small glands or unsuccessful arteriograms in some of the patients. Correctly localizing images were obtained in three patients receiving incomplete injections. However, images in five of eight of the remaining patients receiving incomplete injections showed areas of false positive uptake, and there was no way preoperatively to distinguish these from the true positive studies. We conclude that intraarterial injection of radioselenomethionine is a simple supplementary procedure in patients undergoing arteriography that may, with proper technique, be useful in identifying small foci of abnormal parathyroid tissue.
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Spiegel AM, Downs RW, Levine MA, Singer MJ, Krawietz W, Marx SJ, Woodard CJ, Reen SA, Aurbach GD. The role of guanine nucleotides in regulation of adenylate cyclase activity. RECENT PROGRESS IN HORMONE RESEARCH 1981; 37:635-65. [PMID: 7280358 DOI: 10.1016/b978-0-12-571137-1.50018-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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39
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Spiegel AM, Downs RW. Guanine nucleotides: key regulators of hormone receptor-adenylate cyclase interaction. Endocr Rev 1981; 2:275-305. [PMID: 6115747 DOI: 10.1210/edrv-2-3-275] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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40
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Spiegel AM, Eastman ST, Attie MF, Downs RW, Levine MA, Marx SJ, Stock JL, Saxe AW, Brennan MF, Aurbach GD. Intraoperative measurements of urinary cyclic AMP to guide surgery for primary hyperparathyroidism. N Engl J Med 1980; 303:1457-60. [PMID: 6253789 DOI: 10.1056/nejm198012183032505] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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41
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Nielsen TB, Downs RW, Spiegel AM. Restoration of guanine nucleotide- and fluoride-stimulated activity to an adenylate cyclase-deficient cell line with affinity-purified guanine nucleotide regulatory protein. Biochem J 1980; 190:439-43. [PMID: 6258568 PMCID: PMC1162109 DOI: 10.1042/bj1900439] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A guanine nucleotide-binding protein purified from turkey erythrocytes by affinity chromatography confers both F-- and guanine nucleotide-stimulation of adenylate cyclase to membranes from CYC- cells, a mutant cell line deficient in these responses. Interaction of turkey erythrocyte membranes with beta-adrenergic agonists before affinity chromatography, which is essential for binding of the guanine nucleotide regulatory protein to the affinity matrix, was also required for recovery of F--stimulation restoring activity in the affinity eluate.
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Levine MA, Downs RW, Singer M, Marx SJ, Aurbach GD, Spiegel AM. Deficient activity of guanine nucleotide regulatory protein in erythrocytes from patients with pseudohypoparathyroidism. Biochem Biophys Res Commun 1980; 94:1319-24. [PMID: 6249307 DOI: 10.1016/0006-291x(80)90563-x] [Citation(s) in RCA: 180] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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43
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Marx SJ, Spiegel AM, Sharp ME, Brown EM, Gardner DG, Downs RW, Attie MF, Stock JL. Adenosine 3',5'-monophosphate response to parathyroid hormone: familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism. J Clin Endocrinol Metab 1980; 50:546-8. [PMID: 6244324 DOI: 10.1210/jcem-50-3-546] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We investigated cAMP metabolism during and after a 15-min infusion of parathyroid hormone (PTH) in 7 normals, 13 patients with typical primary hyperparathyroidism (1HPT), and 6 patients with familial hypocalciuric hypercalcemia (FHH). Nephrogenous urinary cAMP excretion rate reached a peak during the first or second 30 min urine collection interval after the start of the PTH infusion in all subjects. cAMP concentration in plasma reached a peak within 5--20 min of the start of the infusion and then decreased with an initial half-time of 15 min. The peak value of nephrogenous urinary cAMP excretion rate was lower in the group with 1HPT than in the group with FHH or in normals (119 vs, 275 vs. 204 nmol/100 ml glomerular filtrate; P less than 0.0 5 for both comparisons). Similarly, the peak value of plasma cAMP concentration was less in 1HPT subjects than in FHH patients or in normals (11.1 vs. 17.1 vs. 16.6 nmol/100 ml, respectively; P less than 0.05 for both comparisons). For purposes of diagnostic classification, the two hypercalcemia groups could be more completely separated by the values of either the renal calcium to creatinine clearance ratio or the plasma PTH concentration than by the values of inidices of cAMP response to PTH. The differences in cAMP response to PTH between FHH and 1HPT patients could be secondary to differences in circulating PTH concentrations (these are lower in subjects with FHH) or could reflect a renal lesion more closely related to the underlying etiology of FHH.
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Marx SJ, Stock JL, Attie MF, Downs RW, Gardner DG, Brown EM, Spiegel AM, Doppman JL, Brennan MF. Familial hypocalciuric hypercalcemia: recognition among patients referred after unsuccessful parathyroid exploration. Ann Intern Med 1980; 92:351-6. [PMID: 7356229 DOI: 10.7326/0003-4819-92-3-351] [Citation(s) in RCA: 104] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Of 67 patients referred after unsuccessful surgery for presumed primary hyperparathyroidism, six were shown to be members of kindreds with familial hypocalciuric hypercalcemia. This diagnosis had not been recognized in any of the six previosuly. Most of the remaining 61 cases had proven or probable typical primary hyperparathyroidism, and a subgroup of four had hypercalcemia with suppression of the parathyroid glands. Urine calcium excretion expressed as the calcium:creatinine clearance ratio provided an easily measurable and effective index to separate the groups with familial hypocalciuric hypercalcemia, typical primary hyperparathyroidism, and suppressed parathyroids. Thus, at least 9% of patients referred after unsuccessful parathyroidectomy had familial hypocalciuric hypercalcemia. The assessment of urine calcium excretion by indices such as the calcium:creatinine clearance ratio should facilitate recognition of this condition, which responds poorly to standard subtotal parathyroidectomy.
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Downs RW, Spiegel AM, Singer M, Reen S, Aurbach GD. Fluoride stimulation of adenylate cyclase is dependent on the guanine nucleotide regulatory protein. J Biol Chem 1980; 255:949-54. [PMID: 6243302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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46
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Brown EM, Gardner DG, Brennan MF, Marx SJ, Spiegel AM, Attie MF, Downs RW, Doppman JL, Aurbach CD. Calcium-regulated parathyroid hormone release in primary hyperparathyroidism: studies in vitro with dispersed parathyroid cells. Am J Med 1979; 66:923-31. [PMID: 453225 DOI: 10.1016/0002-9343(79)90446-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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47
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Brown EM, Brennan MF, Broadus AE, Marx SJ, Gardner DG, Spiegel AM, Downs RW, Attie MF, Aurbach GD. Human parathyroid autografts: comparison of function in vivo and in vitro. J Clin Endocrinol Metab 1979; 48:648-54. [PMID: 219003 DOI: 10.1210/jcem-48-4-648] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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48
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Brown EM, Broadus AE, Brennan MF, Gardner DG, Marx SJ, Spiegel AM, Downs RW, Attie M, Aurbach GD. Direct comparison in vivo and in vitro of suppressibility of parathyroid function by calcium in primary hyperparathyroidism. J Clin Endocrinol Metab 1979; 48:604-10. [PMID: 429506 DOI: 10.1210/jcem-48-4-604] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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49
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Spiegel AM, Doppman JL, Marx SJ, Brennan MF, Brown EM, Downs RW, Gardner DG, Attie M, Aurbach GD. Preoperative localization of abnormal parathyroid: neck massage versus arteriography and selective venous sampling. Ann Intern Med 1978; 89:935-6. [PMID: 214001 DOI: 10.7326/0003-4819-89-6-935] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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50
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Marx SJ, Spiegel AM, Brown EM, Gardner DG, Downs RW, Attie M, Hamstra AJ, DeLuca HF. A familial syndrome of decrease in sensitivity to 1,25-dihydroxyvitamin D. J Clin Endocrinol Metab 1978; 47:1303-10. [PMID: 233695 DOI: 10.1210/jcem-47-6-1303] [Citation(s) in RCA: 114] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Typical features of hereditary vitamin D-dependent (pseudovitamin D-deficient) rickets were observed beginning at ages 20 and 5 months in a brother and sister. Both had calcium malabsorption correctable with high doses of 25-hydroxyvitamin D. During periods of hypocalcemia they both manifested secondary hyperparathyroidism with hypophosphatemia and high serum concentrations of endogenously produced 1,25-dihydroxyvitamin D. In each, normalization of serum calcium concentration and resolution of osteomalacia were obtained with continuous administration of high doses of ergocalciferol or high doses of 1,25-dihydroxycholecalciferol. Chemical features of vitamin D deficiency were corrected in the presence of high circulating concentrations of 1,25-dihydroxyvitamin D2, produced endogenously, or of 1,25-dihydroxyvitamin D3, administered by mouth. Serum concentrations of 25-hydroxyvitamin D2, 25-hydroxyvitamin D3, 24,25-dihydroxyvitamin D, and 1,25-dihydroxyvitamin D were normal in five first degree relatives. We conclude that in these five first degree relatives. We conclude that in these siblings, rickets and osteomalacia resulted from a hereditary decreased sensitivity to 1,25-dihydroxyvitamin D at the intestine and perhaps other vitamin D target tissues.
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