Comparison of Commercially Available Parathyroid Hormone Immunoassays in the Differential Diagnosis of Hypercalcemia Due to Primary Hyperparathyroidism or Malignancy

Raisz, Lawrence G.; Yajnik, Chaitanya H.; Bockman, Richard S.; Bower, B.

doi:10.7326/0003-4819-91-5-739

Cited by 118 publications

(16 citation statements)

References 4 publications

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“…In more than 50% of the cases, lower parathyroid glands were below (up to 0.5 mm) or lateral to the lower posterior thyroid lobes (Raisz et al 1979), data that are in correspondence with ours. Between 0.5 and 1.0 mm, a 12.8% incidence was reported, very similar to the 13.2% found in this work.…”

Section: Discussionsupporting

confidence: 90%

Parathyroid gland anatomical distribution and relation to anthropometric and demographic parameters: a cadaveric study

et al. 2011

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Parathyroid glands play an important role in controlling calcium levels, which influence muscular contraction and neurotransmission. The number of variants, localization and ectopic positions make these glands tricky during surgical exploration. Detailed anatomical knowledge of these glands is fundamental to avoid postsurgical hypoparathyroidism, such as failures during thyroidectomy and parathyroid procedures. The purposes of this work were to study and report practical knowledge for surgeons in order to localize the glands. Dissections were performed on 56 cadavers. Gland identity was confirmed by histological study. Also, mediastinal tissue and the carotid sheath were treated with Carnoy's solution to identify ectopic glands. The thyroid gland was divided and sliced to identify parathyroid glands in the parenchymal and subcapsular space. Four or more parathyroid glands were found in 89.3% of the studied specimens. Mean gland weight was 33.1 mg, and its mean measurements were 6.7 × 3.9 × 2.0 mm. In more than 90% of the cases there was a correlation with the inferior laryngeal nerve and the parathyroid glands: the upper glands were located in medial positions, and the lower ones were found to be located laterally. In 42.8% of cases at least one ectopic gland was observed. The main ectopic regions were the mediastinum and thymus (19.6%), thyroid subcapsular space (12.5%) and thyroid parenchyma (5.4%). Quantity, gland characteristics and location were not influenced by anthropometric and demographic parameters. Here we show the high incidence of parathyroid glands positioned at "abnormal" locations, and as a controversial topic in endocrine surgery, this matter must be continuously studied and reported in the literature.

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Section: Discussionsupporting

confidence: 90%

Parathyroid gland anatomical distribution and relation to anthropometric and demographic parameters: a cadaveric study

et al. 2011

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“…Our observation that 50% of patients with malignancy-associated hypercalcaemia have undetectable PTH concentrations compares favourably with a comparative study of commercially-available PTH assays in the USA. 19 For those patients in whom PTH can apparently be measured in serum, the values are generally lower than in primary hyperparathyroidism, especially when related to the prevailing calcium concentration. Although biochemical tests may not often be required in practice to distinguish primary hyperparathyroidism from malignant disease, undoubtedly the need for this does arise from time to time.…”

Section: Discussionmentioning

confidence: 99%

Performance and Clinical Utility of a Commercially Available ‘C-terminal’ PTH Assay

et al. 1986

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SUMMARY. The performance and clinical utility of a 'C-terminal' parathyroid hormone (PTH) radioimmunoassay (Dac-Cel, Wellcome Diagnostics) is described. Parathyroid hormone, as measured by the Dac-Cel method, is stable in whole blood samples for at least 24 h. 84% of patients with hypercalcaemia due to primary hyperparathyroidism have values above the upper limit seen in normocalcaemic subjects (0,5 ug/L), with detectable serum PTH demonstrable in the remaining 16%. In patients with hypocalcaemia due to hypoparathyroidism serum PTH was undetectable in 73% and 'inappropriately' low in the remainder. In 50% of patients with malignancy-associated hypercalcaemia serum PTH was undetectable, but was above 0·5 ug/L in 13%. Increased PTH concentrations were invariably found in patients with renal failure.The Dac-Cel method is a reliable and robust technique for measurement of PTH and in conjunction with determination of calcium facilitates the diagnosis of primary parathyroid disorders. Caution is required in the interpretation of PTH measurements in patients with renal failure; the significance of detectable PTH in some patients with malignancy-associated hypercalcaemia is not clear.Determination of serum immunoassayable parathyroid hormone (PTH) concentrations forms an important part of the investigation of disorders of calcium metabolism. However, measurement of circulating PTH by radioimmunoassay (RIA) has been bedevilled by the heterogenous nature of circulating PTH and its peripheral metabolism. In recent years, improved understanding of the physiology of PTH secretion and its metabolism, together with the use of well-characterised antisera, has facilitated interpretation of results of PTH in serum. In this report we have evaluated the use of a recently available commercial 'C-terminal' PTH assay (Dac-Cel, Wellcome Diagnostics, Temple Hill, Dartford DA1 5AH, UK) in the investigation of patients with disorders of calcium metabolism. MethodsDac-Cel PTH RIA kits were supplied by

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“…I). The tumor itself could produce a parathormone-like substance, sel dom detected by the laboratory tests used for the normal parathormone [9]. In 1970, Knill-Jones [4] reported a hepatic gradient in the parathormone blood levels but this experiment remained unique.…”

Section: Casementioning

confidence: 99%

Hepatic Tumors and Paraneoplastic Syndromes

Morel¹,

Rohner²

1987

Dig Surg

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Paraneoplastic syndromes have been known for many years, but hepatic tumors have been incriminated only rarely in their pathogenesis. We report 3 patients with hepatic tumors and paraneoplastic syndromes. The first suffered from a hepatoma inducing dysfibrinogenemia and hypercalcemia without any bone metastases and with a normal parathormone level. The second had an isolated hepatic metastasis from a locally cured adenocarcinoma of the colon and severe sensorimotor polyneuritis culminating in tetraparesis. The third presented with hepatoma, the source of ectopic renin secretion causing severe arterial hypertension. All those paraneoplastic syndromes vanished rapidly and completely after tumor resection. Those syndromes were successfully used to monitor early recurrences of the tumors.

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Comparison of Commercially Available Parathyroid Hormone Immunoassays in the Differential Diagnosis of Hypercalcemia Due to Primary Hyperparathyroidism or Malignancy

Cited by 118 publications

References 4 publications

Parathyroid gland anatomical distribution and relation to anthropometric and demographic parameters: a cadaveric study

Parathyroid gland anatomical distribution and relation to anthropometric and demographic parameters: a cadaveric study

Performance and Clinical Utility of a Commercially Available ‘C-terminal’ PTH Assay

Hepatic Tumors and Paraneoplastic Syndromes

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