Phenytoin inhibition of parathyroid hormone induced bone resorption in vitro

1 A study is reported of the effects of phenytoin and phenobarbitone on bone calcium mobilization by parathyroid hormone in vitro.2 In a therapeutic concentration (15 mug/ml), phenytoin significantly inhibited parathyroid hormone-induced calcium release from bone.3 The inhibitory effect of phenytoin on bone calcium mobilization could play a role in the maintenance of hypocalcaemia in epileptic patients on long-term anticonvulsant drug therapy.

Evolution of bone disease over 10 years in 135 patients with terminal renal failure

An objective radiographic study of erosions, fractures, and periarticular and vascular calcification was made in a series of 135 patients over 10 years of maintenance haemodialysis therapy. The four lesions progressed at different rates, consistent with variation in the response of tissues to a changing biochemical milieu and deficiency in vitamin D metabolites. The half time for development of individual radiographic signs was 3.4 years for vascular calcification, 9 years for fractures, 16 years for periarticular calcification, and 22.9 years for erosions. Calcification of the dorsalis pedis artery seen as a developing ring or tube was an early and valuable sign of disturbed calcium metabolism. In these patients renal osteodystrophy is a chronic condition with a prolonged time course.

Plasma calcium fractions and the protein-binding of calcium in normal subjects and in patients with hypercalcaemia and hypocalcaemia

A study is reported of the estimation of plasma calcium fractions and the calcium-binding affinity of plasma proteins in a total sample of 59 people, which included 29 normal subjects and 30 patients with either hypercalcaemia or hypocalcaemia. It was demonstrated that when the sample was considered as a whole there was a significant correlation between the total plasma calcium concentration and the ultrafiltrable, ionized, and protein-bound calcium fractions and between the ultrafiltrable and ionized fractions. We have also demonstrated that in patients with either hypercalcaemia or hypocalcaemia, including acidotic uraemics, the calcium-binding affinity of the plasma proteins did not differ significantly from that in normal subjects. A significant correlation was also found between the total plasma calcium concentration and the ultrafiltrable, ionized and protein-bound calcium fractions when the normal subjects and the groups of patients with hypercalcaemia and hypocalcaemia due to chronic renal failure were considered as separate groups. The group of patients with hypercalcaemia included patients both with hyperparathyroidism and with hypercalcaemia due to other causes.

Value of plasma chloride concentration and acid-base status in the differential diagnosis of hyperparathyroidism from other causes of hypercalcaemia

A study is reported of the estimation of plasma chloride concentration and acid-base status in the differentiation of primary hyperparathyroidism from all other causes of hypercalcaemia. In the two groups of patients studied, all of whom had hypercalcaemia, there was complete separation between the two groups on the basis of plasma chloride concentration and acid-base status. In 16 patients with primary hyperparathyroidism the increase in plasma chloride concentration and associated metabolic acidosis could have been accounted for by the known renal tubular effects of parathyroid hormone. In 13 patients with hypercalcaemia due to various other causes the decrease in plasma chloride concentration and associated metabolic alkalosis could be accounted for either by the known effects of an excess of calcium-ion on the renal tubules, or perhaps by suppression of endogenous parathyroid hormone secretion. In patients with hypercalcaemia and hypophosphataemia of ;pseudohyperparathyroidism' associated with non-endocrine tumours it is postulated that the low plasma chloride concentrations and metabolic alkalosis found in these patients were due either to a differing biological activity of the parathyroid-hormone-like polypeptide secreted by the tumour cells, or possibly to simultaneous secretion by these cells of an ACTH-like polypeptide.

The effect of diurnal variation on total plasma calcium concentration in normal subjects

In 12 normal subjects plasma calcium and phosphorus concentrations were estimated during a normal working day. In the individual subjects fluctuations from the fasting values occurred during the period of study, but at no time during that period did the mean values differ significantly from the fasting plasma calcium or phosphorus concentrations. In three of the subjects the study was repeated while fasting during a normal working day. In these subjects the fluctuations in both plasma calcium and phosphorus concentrations were less than during a normal day while taking meals, and there was evidence of a diurnal variation in the plasma phosphorus concentration.

The role of parathyroid hormone in the gastro-intestinal absorption of calcium

1. Gastrointestinal calcium absorption was studied in six normal subjects and in one patient with idiopathic hypoparathyroidism during a control period and during treatment with parathyroid extract.

2. In all subjects there was a small increase in the gastro-intestinal absorption of calcium during the administration of parathyroid extract.

The measurement of intestinal calcium absorption by external radioisotope counting: application to study of nephrolithiasis

1. Gastro-intestinal absorption of calcium was studied in man by the measurement of forearm radioactivity in a large-volume liquid scintillation counter following separate oral and intravenous doses of 47CaCl2. From the ratio of the percentages of total radioactivity appearing in the forearm following these separate determinations the fractional absorption of calcium was estimated.

2. Changes of forearm radioactivity with time following the administration of this isotope were studied; evidence is presented that the radioactivity in the forearm at 4 h after administration of the isotope gives a valid assessment of fractional calcium absorption.

3. Fractional calcium absorption determined by this technique correlated well with the net calcium absorption as determined from stool radioactivity after oral administration of isotope.

4. In normal subjects it was shown that fractional calcium absorption measured by this technique varies inversely with the stable calcium load and that the absolute amount of calcium absorbed from given loads increases with the size of the load in the range 20–1000 mg calcium.

5. Gastro-intestinal calcium absorption was measured at various oral calcium loads in a group of fifteen patients with recurrent calcium-containing renal stones. All the patients were normocalcaemic; some had hypercalciuria. In the patients with hypercalciuria, calcium absorption, fractional and absolute, was significantly increased at all calcium loads as compared to that of patients with normal urinary calcium.

6. It is concluded that hyperabsorption of calcium from the gastro-intestinal tract plays a crucial role in the aetiology of hypercalciuria, probably by causing an increase in the renal filtered calcium load.

Plasma "cortisol" levels in right and left ventricular failure

Plasma ;cortisol' values are reported in 36 patients during or following right ventricular failure, and 12 during or following left ventricular failure. In patients with right ventricular failure the normal circadian rhythm was abolished with elevation of midnight values. Disturbance of rhythm was less marked in left ventricular failure, although midnight values were usually raised. Dexamethasone suppression of plasma ;cortisol' levels was abolished or reduced in right ventricular failure. These results confirm our earlier findings and further support our contention that the disturbance of circadian rhythm is not due to a simple stress mechanism. The results are of importance in the differential diagnosis of Cushing's syndrome based on plasma ;cortisol' values, if there is concomitant right ventricular failure.

The urinary calcium-creatinine ratio as a measure of urinary calcium excretion

Urine specimens were collected from 26 normal subjects, 10 patients with proven primary hyperparathyroidism, and eight patients with hypercalcaemia due to other causes. After overnight urine concentration, an oral water load was given to induce a diuresis and provide urine specimens with a relatively wide range of creatinine concentration for each subject. In normal subjects the urinary calcium/creatinine ratio was found to be independent of urine concentration. In eight out of 10 patients with primary hyperparathyroidism and in two out of eight patients with hyper-calcaemia due to other causes, the urinary calcium/creatinine ratio was found to be high when the creatinine concentration was low, but usually normal when the creatinine concentration was high. The results suggest that if the urinary calcium/creatinine ratio of random urine specimens is used as a ;screening' procedure to detect hypercalciuria the latter cannot be excluded if the urinary creatinine concentration is more than 40 mg per 100 ml.

Ultramicrofluorimetric determination of calcium in plasma

A precise and reproducible method is described for the ultramicro fluorimetric determination of calcium in plasma, based upon the formation of a fluorescent complex between calcium and calcein at a strongly alkaline pH. In a group of normal subjects, the mean concentration of plasma calcium was 9.66 mg/100 ml with a normal range of 8.9 to 10.4 mg/100 ml.