Clear the Fog around Parathyroid Hormone Assays

Hocher, Berthold; Zeng, Shufei

doi:10.2215/cjn.01730218

Cited by 22 publications

(20 citation statements)

References 10 publications

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“…Pregnancy affects the assessment of total vitamin D, and few authors have suggested using the free form of vitamin D for accurate diagnosis of VDD [ 25 ]. The PTH assay methods using the immunometric technique measure the oxidized PTH, which is a biologically inactive molecule, thereby falsely elevating the PTH level [ 26 , 27 ]. The measurement of total vitamin D instead of free vitamin D and the estimation of PTH by RIA assay are other methodologic limitations of our study.…”

Section: Discussionmentioning

confidence: 99%

Association of Vitamin D and Parathyroid Hormone with Insulin Sensitivity, Beta Cell Function and Gestational Diabetes in Pregnancy: A Cross-Sectional, Observational Study

et al. 2018

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IntroductionVitamin D (25OHD) and parathyroid hormone (PTH) are associated with dysglycemia, and we investigated them in gestational diabetes mellitus (GDM).MethodsIn this cross-sectional, observational study, we included 75 pregnant women between 24 and 28 weeks of gestation. A fasting venous sample was collected for plasma glucose (FPG), insulin, PTH and 25OHD. Glucose and insulin samples were collected hourly after 75 g glucose load for 2 h. Insulin sensitivity was estimated by the Matsuda index (MI) and beta cell function by the insulin secretion sensitivity index (ISSI-2). The subjects were stratified into three groups and tertiles according to the 25OHD and PTH, respectively. Appropriate statistical tests were used to compare the MI, ISSI-2 and GDM among the groups.ResultsGDM was seen in 14/75, and of these patients, 2 were 25OHD deficient, 7 insufficient and 5 had sufficient 25OHD. MI and ISSI-2, though not correlated with the 25OHD, decreased from the lower to higher PTH tertile (P < 0.001). FPG, AUCgluc (area under the curve glucose) and prevalence of GDM increased from the lower to higher PTH tertile (P < 0.001).ConclusionIncreased PTH was associated with decreased insulin sensitivity, beta cell function and GDM in pregnancy, irrespective of the underlying 25OHD level.

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Section: Discussionmentioning

confidence: 99%

Association of Vitamin D and Parathyroid Hormone with Insulin Sensitivity, Beta Cell Function and Gestational Diabetes in Pregnancy: A Cross-Sectional, Observational Study

et al. 2018

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“…The latter may be of reduced biological activity. Therefore, it could be that total PTH is elevated in CKD with most of it being oxidized with limited activity as this disease is linked to a ROS burden . In addition, reduced Klotho expression in CKD may account for the failure of increased FGF23 levels to prevent hyperparathyroidism .…”

Section: Fgf23: a Phosphaturic Hormonementioning

confidence: 99%

Regulation of fibroblast growth factor 23 (FGF23) in health and disease

et al. 2019

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Fibroblast growth factor 23 (FGF23) is mainly produced in the bone and, upon secretion, forms a complex with a FGF receptor and coreceptor αKlotho. FGF23 can exert several endocrine functions, such as inhibiting renal phosphate reabsorption and 1,25‐dihydroxyvitamin D3 production. Moreover, it has paracrine activities on several cell types, including neutrophils and hepatocytes. Klotho and Fgf23 deficiencies result in pathologies otherwise encountered in age‐associated diseases, mainly as a result of hyperphosphataemia‐dependent calcification. FGF23 levels are also perturbed in the plasma of patients with several disorders, including kidney or cardiovascular diseases. Here, we review mechanisms controlling FGF23 production and discuss how FGF23 regulation is perturbed in disease.

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“…The third-generation assays (bioactive or whole PTH assays) detect only PTH 1-84. Unlike the second generation, the detection antibodies used in the third-generation PTH assays are directed toward the first four amino acids (1)(2)(3)(4), which are the most biologically active part of the PTH molecule. This is in contrast to the second-generation assays in which the detection antibodies target more distal amino acid sequences within the amino terminal regions 35 (Figure 1).…”

Section: Third-generation Assaysmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Clinical practice guidelines in chronic kidney disease (CKD) patients recommend monitoring parathyroid hormone (PTH) levels as a key mineral bone disorder (MBD) biomarker. 1 PTH is a single-chain hormone of 84 amino acids with complex metabolism, particularly in CKD patients where retention of various PTH fragments can occur. 2,3 Over the last few decades, three generations of PTH assays have been developed that they measure different parts of the molecule resulting in substantial variation among the different manufacturers.…”

Section: Introductionmentioning

confidence: 99%

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PTH assays in dialysis patients: Practical considerations

Soliman

Hassan

Yaseen

et al. 2018

Seminars in Dialysis

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Parathyroid hormone (PTH) 1-84 is the main biologically active hormone produced by the parathyroid cells. Circulating PTH molecules include the whole PTH 1-84 along with amino (N) and carboxyl (C) terminal fragments. While PTH is the best available noninvasive biomarker to assess bone turnover in dialysis patients, the biological roles of individual circulating PTH fragments are still not completely known. The understanding that there is an enormous variation in the target specificity of currently available PTH assays for different circulating forms of PTH has led to the evolution of assays from first to second then third generation. With a reduction in kidney function, there is a preferential increase in circulating C fragments and non-PTH 1-84 forms, resulting in a decrease in the ratio of PTH 1-84/non-PTH 1-84. However, there are also substantial differences in between-assay measurements, with several fold variations in results. Targets based on multiples of the upper limit of normal (ULN) should be used rather than PTH ranges using absolute iPTH values. To date, the second-generation PTH remains the most widely used assay. Current guidelines recommend following iPTH trends rather than absolute values. Herein, we highlight problems and challenges in PTH assays/measurements and their interpretations in dialysis patients.

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Clear the Fog around Parathyroid Hormone Assays

Cited by 22 publications

References 10 publications

Association of Vitamin D and Parathyroid Hormone with Insulin Sensitivity, Beta Cell Function and Gestational Diabetes in Pregnancy: A Cross-Sectional, Observational Study

Association of Vitamin D and Parathyroid Hormone with Insulin Sensitivity, Beta Cell Function and Gestational Diabetes in Pregnancy: A Cross-Sectional, Observational Study

Regulation of fibroblast growth factor 23 (FGF23) in health and disease

PTH assays in dialysis patients: Practical considerations

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