Calcitonin, an important factor in the calcemic response to parathyroid hormone in the rat

Exploring the relationship between calcitonin, ionized calcium, and bone turnover in cats with and without naturally occurring hypercalcemia

Objectives

This case-control study aimed to evaluate calcitonin response in naturally occurring hypercalcemia in cats and assess the relationships between calcitonin and ionized calcium (iCa) and examine relationships between calcitonin, iCa and bone turnover.

Methods

Hypercalcemic cats (persistently increased iCa concentration [>1.40 mmol/l]) were identified retrospectively via a medical database search; additional hypercalcemic and normocalcemic cats were recruited prospectively. Data regarding routine biochemical and urine testing, diagnostic imaging and additional blood testing were obtained. Serum alkaline phosphatase (ALP) activity was used as a marker of bone turnover. Serum calcitonin concentration was analyzed using a previously validated immunoradiometric assay. Hypercalcemic cats with an increased calcitonin concentration (>0.9 ng/L) were termed responders. Group comparisons were performed using a Mann-Whitney test for continuous variables and a χ2 test for categorical variables. Spearman's correlation coefficient was used to examine the relationships between calcitonin, iCa and ALP.

Results

Twenty-six hypercalcemic and 25 normocalcemic cats were recruited. Only 5/26 (19.2%) of the hypercalcemic cats were identified as responders, and all were diagnosed with idiopathic hypercalcemia. There was no significant correlation between the concentrations of calcitonin and iCa (p = 0.929), calcitonin and ALP (p = 0.917) or iCa and ALP (p = 0.678) in hypercalcemic cats, however, a significant negative correlation was observed between calcitonin and ALP (p = 0.037) when normocalcemic and hypercalcemic cats with an elevated calcitonin concentration were analyzed together.

Discussion

The expected increase in calcitonin concentration was present in only a small subset of hypercalcemic cats; no correlation was found between iCa and calcitonin concentration. The inverse relationship between calcitonin and ALP in cats with increased calcitonin concentrations suggests that the ability of calcitonin to correct hypercalcemia may be related to the degree of bone turnover.

Hyporesponsiveness or resistance to the action of parathyroid hormone in chronic kidney disease

Secondary hyperparathyroidism (SHPT) is an integral component of the chronic kidney disease-mineral and bone disorder (CKD-MBD). Many factors have been associated with the development and progression of SHPT but the presence of skeletal or calcemic resistance to the action of PTH in CKD has often gone unnoticed. The term hyporesponsiveness to PTH is currently preferred and, in this chapter, we will not only review the scientific timeline but also some of the molecular mechanisms behind. Moreover, the presence of resistance to the biological action of PTH is not unique in CKD since resistance to other hormones has also been described ("uremia as a receptor disease"). This hyporesponsiveness carries out important clinical implications since it explains, at least partially, not only the progressive nature of the pathogenesis of CKD-related PTH hypersecretion and parathyroid hyperplasia but also the increasing prevalence of adynamic bone disease in the CKD population. Therefore, we underline the importance of PTH control in all CKD stages, but not aiming to completely normalize PTH levels since a certain degree of SHPT may represent an adaptive clinical response. Future studies at the molecular level, i.e. on uremia or the recent description of the calcium-sensing receptor as a phosphate sensor, may become of great value beyond their significance to explain just the hyporesponsiveness to PTH in CKD.

A feline-focused review of chronic kidney disease-mineral and bone disorders - Part 2: Pathophysiology of calcium disorder and extraosseous calcification

Derangements in mineral metabolism are one of the main entities in chronic kidney disease-mineral and bone disorder (CKD-MBD). This is the second of a two-part review of the physiology and pathophysiology of calcium homeostasis in feline CKD-MBD. While dysregulation in calcium homeostasis is known to contribute to the development of vascular calcification in CKD, evidence characterising the relationship between serum calcium concentration and nephrocalcinosis and nephrolithiasis is limited. Recently, fibroblast growth factor 23 (FGF23) and α-Klotho have gained increased research interest and been shown to be important biomarkers for the prediction of CKD progression in human patients. However, conflicting evidence exists on their role in calcium homeostasis and vascular and soft tissue calcification. This review details the pathophysiology of calcium disorders associated with CKD-MBD and its implications on vascular and soft tissue mineralisation in human and feline patients. Further prospective studies investigating the clinical consequences of calcium disturbances in cats with CKD are warranted and this may provide additional insight into the pathophysiology of feline CKD-MBD.

A feline-focused review of chronic kidney disease-mineral and bone disorders - Part 1: Physiology of calcium handling

Mineral derangements are a common consequence of chronic kidney disease (CKD). Despite the well-established role of phosphorus in the pathophysiology of CKD, the implications of calcium disturbances associated with CKD remain equivocal. Calcium plays an essential role in numerous physiological functions in the body and is a fundamental structural component of bone. An understanding of calcium metabolism is required to understand the potential adverse clinical implications and outcomes secondary to the (mal)adaptation of calcium-regulating hormones in CKD. The first part of this two-part review covers the physiology of calcium homeostasis (kidneys, intestines and bones) and details the intimate relationships between calcium-regulating hormones (parathyroid hormone, calcitriol, fibroblast growth factor 23, α-Klotho and calcitonin) and the role of the calcium-sensing receptor.

Hyporesponsiveness or resistance to the action of parathyroid hormone in chronic kidney disease

Secondary hyperparathyroidism (SHPT) is an integral component of the chronic kidney disease-mineral and bone disorder (CKD-MBD). Many factors have been associated with the development and progression of SHPT but the presence of skeletal or calcemic resistance to the action of PTH in CKD has often gone unnoticed. The term hyporesponsiveness to PTH is currently preferred and, in this chapter, we will not only review the scientific timeline but also some of the molecular mechanisms behind. Moreover, the presence of resistance to the biological action of PTH is not unique in CKD since resistance to other hormones has also been described ("uremia as a receptor disease"). This hyporesponsiveness carries out important clinical implications since it explains, at least partially, not only the progressive nature of the pathogenesis of CKD-related PTH hypersecretion and parathyroid hyperplasia but also the increasing prevalence of adynamic bone disease in the CKD population. Therefore, we underline the importance of PTH control in all CKD stages, but not aiming to completely normalize PTH levels since a certain degree of SHPT may represent an adaptive clinical response. Future studies at the molecular level, i.e. on uremia, or the recent description of the calcium-sensing receptor as a phosphate sensor, may become of great value beyond their significance to explain just the hyporesponsiveness to PTH in CKD.

New aspects of endocrine control of atrial fibrillation and possibilities for clinical translation

Hormones are potent endo-, para-, and autocrine endogenous regulators of the function of multiple organs, including the heart. Endocrine dysfunction promotes a number of cardiovascular diseases, including atrial fibrillation (AF). While the heart is a target for endocrine regulation, it is also an active endocrine organ itself, secreting a number of important bioactive hormones that convey significant endocrine effects, but also through para-/autocrine actions, actively participate in cardiac self-regulation. The hormones regulating heart-function work in concert to support myocardial performance. AF is a serious clinical problem associated with increased morbidity and mortality, mainly due to stroke and heart failure. Current therapies for AF remain inadequate. AF is characterized by altered atrial function and structure, including electrical and profibrotic remodelling in the atria and ventricles, which facilitates AF progression and hampers its treatment. Although features of this remodelling are well-established and its mechanisms are partly understood, important pathways pertinent to AF arrhythmogenesis are still unidentified. The discovery of these missing pathways has the potential to lead to therapeutic breakthroughs. Endocrine dysfunction is well-recognized to lead to AF. In this review, we discuss endocrine and cardiocrine signalling systems that directly, or as a consequence of an underlying cardiac pathology, contribute to AF pathogenesis. More specifically, we consider the roles of products from the hypothalamic-pituitary axis, the adrenal glands, adipose tissue, the renin–angiotensin system, atrial cardiomyocytes, and the thyroid gland in controlling atrial electrical and structural properties. The influence of endocrine/paracrine dysfunction on AF risk and mechanisms is evaluated and discussed. We focus on the most recent findings and reflect on the potential of translating them into clinical application.

Calcitonin and Bone Physiology: In Vitro, In Vivo, and Clinical Investigations

Calcitonin was discovered as a peptide hormone that was known to reduce the calcium levels in the systemic circulation. This hypocalcemic effect is produced due to multiple reasons such as inhibition of bone resorption or suppression of calcium release from the bone. Thus, calcitonin was said as a primary regulator of the bone resorption process. This is the reason why calcitonin has been used widely in clinics for the treatment of bone disorders such as osteoporosis, hypercalcemia, and Paget's disease. However, presently calcitonin usage is declined due to the development of efficacious formulations of new drugs. Calcitonin gene-related peptides and several other peptides such as intermedin, amylin, and adrenomedullin (ADM) are categorized in calcitonin family. These peptides are known for the structural similarity with calcitonin. Aside from having a similar structure, these peptides have few overlapping biological activities and signal transduction action through related receptors. However, several other activities are also present that are peptide specific. In vitro and in vivo studies documented the posttreatment effects of calcitonin peptides, i.e., positive effect on bone osteoblasts and their formation and negative effect on osteoclasts and their resorption. The recent research studies carried out on genetically modified mice showed the inhibition of osteoclast activity by amylin, while astonishingly calcitonin plays its role by suppressing osteoblast and bone turnover. This article describes the review of the bone, the activity of the calcitonin family of peptides, and the link between them.

The Activity of Peptides of the Calcitonin Family in Bone

Calcitonin was discovered over 50 yr ago as a new hormone that rapidly lowers circulating calcium levels. This effect is caused by the inhibition of calcium efflux from bone, as calcitonin is a potent inhibitor of bone resorption. Calcitonin has been in clinical use for conditions of accelerated bone turnover, including Paget's disease and osteoporosis; although in recent years, with the development of drugs that are more potent inhibitors of bone resorption, its use has declined. A number of peptides that are structurally similar to calcitonin form the calcitonin family, which currently includes calcitonin gene-related peptides (αCGRP and βCGRP), amylin, adrenomedullin, and intermedin. Apart from being structurally similar, the peptides signal through related receptors and have some overlapping biological activities, although other activities are peptide specific. In bone, in vitro studies and administration of the peptides to animals generally found inhibitory effects on osteoclasts and bone resorption and positive effects on osteoblasts and bone formation. Surprisingly, studies in genetically modified mice have demonstrated that the physiological role of calcitonin appears to be the inhibition of osteoblast activity and bone turnover, whereas amylin inhibits osteoclast activity. The review article focuses on the activities of peptides of the calcitonin family in bone and the challenges in understanding the relationship between the pharmacological effects and the physiological roles of these peptides.

Calcitonin as an anticalcification treatment for implantable biological tissues

BACKGROUND AND AIM OF THE STUDY

Calcification remains the major role of failure of implantable biomedical material and in particular of bioprosthetic valves. Various treatments have been proposed to mitigate calcification of glutaraldehyde-fixed bioprosthetic valves but none have succeeded in inhibiting or mitigating efficiently the calcification process of the implantable biological tissues. Since the discovery of calcitonin (CT) and its therapeutic role in treating hypercalcemic patients, CT has never been tried as an anticalcification treatment for biomaterials. It is postulated, that tissue calcification may be efficiently minimized by forming adducts with aldehyde groups thus eliminating the places of the biological tissues onto the calcium cations could be deposited.

MATERIAL AND METHODS

Fresh porcine aortic leaflets were cut radially in three parts. Three groups of tissue were created. Group I (glutaraldehyde only), Group II (glutaraldehyde with 1% CT) and Group III (glutaraldehyde with 10% CT). All tissues were then implanted subdermally in three sets of 8 (Group I) and 9 (Group II and Group III) male Wistar rats of 12 days old. 21 days later the rats were euthanized by inhalation of CO₂. The tissues were retrieved and after rinsing with distilled water 3 times, were lyophilized at -40°C at high vacuum pressure of approximately 100mmHg for 16h. The calcium content was then measured with flat atomic absorption technique.

RESULTS

The preimplantation values of Ca concentration as expressed in mg Ca/g of tissue were 1.79±0.14 in Group I, 4.78±0.0079 in Group II and 2.88±0.17 in Group III (p=ns). 21 days later the values of Ca concentration were 126.95±12.97 for Group I, 24.69±2.71 for Group II (p<0.05) and 27.16±2.95 for Group III (p<0.05). There was not significance difference between Groups II and III, even if Group II showed a less accumulation of Ca concentration (×5.16) than Group III (×9.43).

CONCLUSION

An anticalcification treatment based on calcitonin as an additive to buffered glutaraldehyde, mitigates the calcification process of the implantable biological tissues, as compared to glutaraldehyde treatment only.

Calcitonin, the forgotten hormone: does it deserve to be forgotten?

Calcitonin is a 32 amino acid hormone secreted by the C-cells of the thyroid gland. Calcitonin has been preserved during the transition from ocean-based life to land dwellers and is phylogenetically older than parathyroid hormone. Calcitonin secretion is stimulated by increases in the serum calcium concentration and calcitonin protects against the development of hypercalcemia. Calcitonin is also stimulated by gastrointestinal hormones such as gastrin. This has led to the unproven hypothesis that postprandial calcitonin stimulation could play a role in the deposition of calcium and phosphate in bone after feeding. However, no bone or other abnormalities have been described in states of calcitonin deficiency or excess except for diarrhea in a few patients with medullary thyroid carcinoma. Calcitonin is known to stimulate renal 1,25 (OH)2 vitamin D (1,25D) production at a site in the proximal tubule different from parathyroid hormone and hypophosphatemia. During pregnancy and lactation, both calcitonin and 1,25D are increased. The increases in calcitonin and 1,25D may be important in the transfer of maternal calcium to the fetus/infant and in the prevention and recovery of maternal bone loss. Calcitonin has an immediate effect on decreasing osteoclast activity and has been used for treatment of hypercalcemia. Recent studies in the calcitonin gene knockout mouse have shown increases in bone mass and bone formation. This last result together with the presence of calcitonin receptors on the osteocyte suggests that calcitonin could possibly affect osteocyte products which affect bone formation. In summary, a precise role for calcitonin remains elusive more than 50 years after its discovery.

Metabolic acidosis-induced hypercalcemia in an azotemic patient with primary hyperparathyroidism

A 58-year-old man with Stage 3b chronic kidney disease and primary hyperparathyroidism treated with cinacalcet was admitted for acute cholecystitis. A cholecystostomy tube was placed, estimated glomerular filtration rate decreased, metabolic acidosis developed and ionized calcium increased from 1.33 to 1.76 mM despite cinacalcet administration. A sodium bicarbonate infusion corrected the metabolic acidosis restoring ionized calcium to normal despite no improvement in renal function. The correlation between the increase in serum bicarbonate and decrease in ionized calcium was r = −0.93, P < 0.001. In summary, severe hypercalcemia was attributable to metabolic acidosis increasing calcium efflux from bone while renal failure decreased the capacity to excrete calcium.

New insights in regulation of calcium homeostasis

PURPOSE OF REVIEW

Regulation of calcium homeostasis during a lifetime is a complex process reflecting a balance among intestinal calcium absorption, bone calcium influx and efflux, and renal calcium excretion. Perturbations can result in hypocalcemia or hypercalcemia and adaptations in calcium handling must occur during growth and aging.

RECENT FINDINGS

Study of the calcium sensing receptor in the thick ascending limb of Henle and TRPV5 in the distal tubule continues to provide insights into regulation of renal calcium excretion. Hypercalcemia-induced secretion of calcitonin via activation of the calcium-sensing receptor may protect against the development of hypercalcemia. A calcilytic was shown to increase serum calcium by decreasing renal calcium excretion. Ezrin, a cross-linking protein important for renal phosphate handling, is also involved in the regulation of intestinal calcium absorption. Increased 1,25-hydroxyvitamin D (1,25D) values were shown to protect against the development of hypocalcemia by increasing calcium efflux and decreasing calcium influx in bone. Finally, fibroblast growth factor 23 stimulation, which should result in suppression of 1,25D, was shown to be prevented in a model of vitamin D deficiency in which maintenance of 1,25D is important in minimizing hypocalcemia.

SUMMARY

Recent information has provided new insights on how intestinal, bone and renal mechanisms are regulated to maintain calcium homeostasis.

Down-regulation of human osteoblast PTH/PTHrP receptor mRNA in end-stage renal failure

BACKGROUND

Resistance to the action of parathyroid hormone (PTH) has been demonstrated in end-stage renal failure and is considered to be important in the pathogenesis of secondary hyperparathyroidism. The mechanism of resistance is unknown. However, altered regulation of cellular PTH/PTH-related protein (PTH/PTHrP) receptor (PTH1R) has been assumed to be important.

METHODS

We have used in situ hybridization to examine PTH1R mRNA expression by osteoblasts in human bone and have compared the expression in high- and low-turnover renal bone disease, high-turnover nonrenal bone disease (healing fracture callus and Pagetic bone), and normal bone. Bone biopsies were formalin fixed, ethylenediaminetetraacetic acid decalcified, and paraffin wax embedded. A 1.8 kb PTH1R cDNA probe, labeled with 35S, was used, and the hybridization signal was revealed by autoradiography. The density of signal over osteoblasts was quantitated using a semiautomated Leica image analysis software package.

RESULTS

The mean density of PTH1R mRNA signal over osteoblasts in renal high-turnover bone was only 36% of that found in nonrenal high-turnover bone (P < 0.05) and 51% of that found in normal bone (P < 0.05). Osteoblast PTH1R mRNA signal in adynamic bone from individuals with diabetes mellitus was 28% of normal bone (P < 0.05) and 54% of that found in renal high-turnover bone (P < 0.05).

CONCLUSIONS

These results demonstrate a down-regulation of osteoblast PTH1R mRNA in end-stage renal failure in comparison to normal and high-turnover bone from otherwise healthy individuals, and provide an insight into the mechanisms of "skeletal resistance" to the actions of PTH.

Biological potency and radioimmunoassay of canine calcitonin

Calcitonin (CT) is a major calcitropic hormone. Because of low cross reactivity of canine CT (cCT) in radioimmunoassays (RIA) developed for other species, a homologous RIA is needed. Synthesis of cCT allowed study of its biologic potency using a rat bioassay and its plasma half-life in dogs. The availability of cCT also made possible the development of a homologous RIA for measurement of basal and stimulated plasma CT concentrations in dogs. The biologic potency of the synthesized cCT in rats is 24 IU/mg of peptide, which is low in comparison with the 4,000 IU/mg of the salmon CT standard. In the dog, an even lower potency of 4.4 IU/mg of cCT was found. Measurement of the disappearance of iv-injected radioiodinated or nonradioiodinated cCT revealed a short biologic half-life of less than 3 min, followed by a long half-life of 20 min. A polyclonal antiserum against synthetic cCT was raised in a goat. Using a final antiserum dilution of 1:12,000 and 125I-labeled synthetic cCT, the RIA had a detection limit of 6.5 ng/l. The antibody did not crossreact with standard human CT and had <0.1% cross reactivity with porcine CT. For measurement of plasma cCT concentrations, an extraction procedure was developed using ethanol. Dilutions of synthetic cCT and canine plasma extracts revealed parallelism over a wide range of concentrations. Size exclusion chromatography of canine plasma extracts on Biogel P-10 revealed a single cCT peak at the same position as [125I]-cCT, showing that there was little interference by other proteins or cCT prohormone. Basal plasma CT concentrations were 12-80 ng/l, and there was an 8- and 20-fold increase after calcium (1 and 2.5 mg/kg body weight) bolus infusion.

Parathyroid hormone is not a key hormone in the rapid minute-to-minute regulation of plasma Ca2+ homeostasis in rats

BACKGROUND

The role of parathyroid hormone (PTH) in the rapid minute-to-minute regulation of plasma Ca2+ (p-Ca2+) was studied in vivo in rats.

MATERIALS AND METHODS

The rapid calcaemic response to exogenous rat PTH1-34 (16 microg) was examined in normal rats, and the long-term calcaemic response was examined in parathyroidectomized (PTX) rats receiving PTH1-34 for 24 h at 0.2, 0. 4 and 0.8 microg h-1. Acute hypocalcaemia was induced by EGTA for 30 min, and then the rapid recovery of p-Ca2+ was studied for 130 min in normal rats, 24 h after PTX and in PTX rats infused with exogenous rat PTH1-34. The dynamics of the rapid recovery of p-Ca2+ was studied at two additional doses of EGTA.

RESULTS

No rapid calcaemic response was observed in the first 60 min after administration of PTH and no hypocalcaemia was seen for 2 h after acute PTX. This slow effect of PTH suggests that PTH might not be responsible for maintaining the stable p-Ca2+ on a rapid minute-to-minute basis. EGTA induced acute hypocalcaemia in both normal and PTX rats (P < 0.01). In both groups a rapid and similar increase in p-Ca2+ took place 10 min after discontinuing EGTA (P < 0. 05). Within 60 min, p-Ca2+ increased further, independently of the presence of PTH. Infusion of PTH to PTX rats did not affect the rapid recovery of p-Ca2+ (P < 0.05) from EGTA induced hypocalcaemia.

CONCLUSION

PTH is not a key hormone in the rapid recovery of p-Ca2+ after induction of hypocalcaemia, but might, however, set the long-term levels of p-Ca2+ maintained by mammalian organisms. The involvement of an as yet unknown factor in the rapid regulation of p-Ca2+ is suggested.

Secondary hyperparathyroidism in renal failure: the trade-off hypothesis revisited

Our understanding of the mechanism responsible for secondary hyperparathyroidism (HPTH) has advanced significantly since the "trade-off" hypothesis was formulated. It appears that in early renal failure a deficit of calcitriol synthesis is an important factor. However, additional factors, such as a defect of the vitamin D receptor or the newly cloned calcium sensor receptor (BoPCaR1), may be present in the parathyroid cells. As renal failure progresses, the lack of calcitriol becomes more pronounced, inducing HPTH. With advanced chronic renal failure, hyperphosphatemia is an additional important factor in worsening HPTH. In addition, resistance of the parathyroids to calcitriol due to a reduced density of calcitriol receptors also may contribute to HPTH. Finally, uremia per se not only may cause a receptor abnormality in the parathyroid but at the level of the bone it may aggravate the impaired calcemic response to PTH. In conclusion, after reviewing the "trade-off" hypothesis, although some of the original concepts may have been simplistic, most of the factors postulated 30 years ago are still operative in the pathogenesis of secondary HPTH in renal failure.

Direct in vivo assessment of parathyroid hormone-calcium relationship curve in renal patients

Secondary hyperparathyroidism (SHP) is a well documented finding even in the early stages of chronic renal failure (CRF). A sigmoidal relationship, fitting a four parameter model, links PTH secretion rate and calcium concentration changes. To our knowledge, PTH secretory parameters have only been studied in uremic patients who are in dialysis treatment. As a result of these studies, a possible role for derangement in setpoint values (that is, the serum calcium concentration corresponding to the mid-range value on the sigmoidal curve) has been suggested in the pathogenesis of SHP in CRF. Our study was undertaken to gain insight into the calcium-PTH relationship curve in the first course of CRF and to assess whether a change in any of the secretory parameters is related to the beginning of SHP. We studied 27 male renal patients with a variable degree of renal function (creatinine clearance 12 to 164 ml/min) and 9 control subjects. In all patients and controls the following parameters were evaluated: (1) basal 1,25(OH)2 vitamin D, 25(OH)vitamin D, calcitonin (CT), intact PTH; (2) GFR by Cr51EDTA clearance; (3) the sigmoidal PTH-ionized calcium relation curve, by means of a hypocalcemic stimulating test (Na2-EDTA 37 mg/kg body weight/2 hr) and a hypercalcemic test (Ca gluconate giving 8 mg/kg of body weight/2 hr of Ca element), performed on two consecutive days.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between serum calcitonin and calcium in the hemodialysis patient

An increase in the serum calcium level is known to stimulate calcitonin secretion, but whether calcitonin contributes to calcium regulation in the dialysis patient is not known. Because we recently observed in the rat that (1) a sigmoidal calcitonin-calcium curve was present, and (2) calcitonin stimulation decreased the calcemic response to parathyroid hormone (PTH), the relationship between serum calcitonin and calcium was studied in six hemodialysis patients. To evaluate both the calcitonin-calcium and PTH-calcium relationships, hemodialysis with a low-calcium dialysate (2 mg/dL) was performed and followed 1 week later by hemodialysis with a high-calcium dialysate (8 mg/dL). The calcitonin-calcium relationship was best represented as a sigmoidal curve that was opposite in direction to the PTH-calcium curve. The range of the calcitonin-calcium curve was less than the PTH-calcium curve; as a percent of maximal, the minimal calcitonin was higher than the minimal PTH, 61% +/- 5% versus 26% +/- 4% (P < 0.001). As opposed to the PTH-calcium curve in which the basal PTH value was intermediate between the minimal and maximal PTH, the basal calcitonin value was close to the minimal calcitonin. Despite a wide range of ionized serum calcium concentrations (3.5 to 5.3 mg/dL), maximal stimulation was greater than maximal inhibition of calcitonin, 60% +/- 13% versus 3% +/- 2% (P = 0.01). Finally, a significant correlation was observed between basal and maximal calcitonin (r = 0.99, P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Interrelationship between parathyroid hormone and insulin: effects on DNA synthesis in UMR-106-01 cells

UMR-106-01 osteoblast-like cells respond to high concentrations of parathyroid hormone (PTH) in vitro by decreasing thymidine incorporation, a marker of DNA synthesis and cell proliferation. This response is different from in vivo conditions, such as primary and secondary hyperparathyroidism, in which high PTH levels are associated with an increased number of osteoblasts. When the response of UMR-106-01 cells to PTH is evaluated in vitro, however, these cells are exposed to only a single hormone. The present study was designed to evaluate the combined effects of two hormones, PTH and insulin, on the DNA synthesis of UMR-106-01 cells. PTH is known to decrease and insulin to increase thymidine incorporation by UMR-106-01 cells. To examine the interaction of these hormones, acute studies, defined as a 24 h exposure to hormone, and chronic studies, defined as a 7 day exposure to hormone, were performed. Both acute and chronic exposure to 10(-9) M PTH decreased thymidine incorporation by UMR-106-01 cells, with suppression ranging from 27 to 81% (P < 0.05). Both acute and chronic exposure to 10(-8) M insulin (INS) increased thymidine incorporation by UMR-106-01 cells; this ranged from 26 to 58% (P < 0.05). However, chronic exposure to 10(-9) M PTH followed by an acute exposure to 10(-8) M INS resulted in a 710% increase in thymidine incorporation (P < 0.01). Reversing the sequence by chronically exposing UMR-106-01 cells to 10(-8) M INS followed by acute exposure to 10(-9) M PTH resulted in a 53% decrease in thymidine incorporation (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Correction of severe secondary hyperparathyroidism in two dialysis patients: surgical removal versus percutaneous ethanol injection

Two chronic hemodialysis patients had recurrent, severe secondary hyperparathyroidism. The first had no sonographically visible parathyroid gland in the neck. Computed tomography (CT) scan indicated the existence of a parathyroid mass in the upper mediastinum, which was removed surgically. The second patient had two intracervical, hyperplastic parathyroid glands visible on ultrasound examination. He volunteered for nonsurgical removal via sonographically guided percutaneous injection of ethanol. In both patients, serum total calcium concentration decreased dramatically to values near 1.5 mmol/L 24 hours after treatment. In patient 1, serum immunoreactive parathyroid hormone (iPTH) (1-84) decreased from 1,582 pg/mL before surgery to 34 pg/mL after 24 hours (normal range, 10 to 65 pg/mL). In contrast, serum iPTH (1-84) decreased only progressively in patient 2, from 1,680 pg/mL before ethanol injection to 865 pg/mL after 24 hours and to 378 pg/mL after 72 hours to reach 30 pg/mL after 14 days. Thus, patient 2 had a striking decrease of plasma calcium immediately after parathyroid gland destruction, even though circulating iPTH was still very high. The reason for such a discrepancy remains unexplained at present, and further study will be necessary to solve this issue.