The tubular reabsorption of calcium, expressed in percentage of the filtered load of calcium (TRCa %), and the phosphate excretion index were examined in 31 hypercalcemic patients to evaluate their relative value in the differential diagnosis of hypercalcemia. The phosphate excretion index proved to be of no value.
High TRCa% values were found in primary hyperparathyroidism (15 pat.), in hyperparathyroidism and sarcoidosis (1 pat.) and in hypercalcemia attributed to metabolic alkalosis (2 pat.). The elevated TRCa % values in the lastânamed condition are probably explained by a specific effect of the metabolic disturbance on the renal tubule. It is inferred that an increased tubular reabsorption of calcium may contribute to the development and maintenance of the hypercalcemia in the milkâalkali syndrome.
Low TRCa % values were found in poststrumectomy hypoparathyroidism overdosed with vitamin D (3 pat.), ordinary hypercalcemic sarcoidosis (5 pat.), idiopathic intestinal hyperabsorption hypercalcemia (1 pat.), Hodgkin's paragranuloma (1 pat.), myelomatosis (1 pat.) and, surprisingly, in hyperparathyroidism associated with sarcoidosis (1 pat.) and with idiopathic hypercalcuria (1 pat.).
It is concluded that TRCa%âwith only a few exceptionsâreflects the functional state of the parathyroid glands in hypercalcemia, being elevated in the presence of hypersecretion of parathyroid hormone and depressed in nonâparathyroid hypercalcemia, in which functional hypoparathyroidism is assumed to be present.