How to Differentiate Hyperparathyroid Patients Among Intermittent Hypercalcemic Urinary Stone Formers: A Combined Use of Immunoreactive Parathyroid Hormone and Nephrogenous Adenosine 3’,5’-Monophosphate

Abstract

The levels of plasma immunoreactive parathyroid hormone and nephrogenous adenosine 3’,5’-monophosphate were measured in 5 normal controls and 12 intermittent hypercalcemic patients with calcium-containing nephrolithiasis before and during calcium infusion to differentiate hyperparathyroid patients among those with intermittent hypercalcemic urinary stones.Six patients with simultaneous elevation of plasma immunoreactive parathyroid hormone and nephrogenous adenosine 3’,5’-monophosphate in the basal levels (group 1) were operated on and a single parathyroid adenoma was removed from each patient, resulting in normocalcemia. Six other patients did not have an operation. Of the 6 patients 3 had normal basal levels of immunoreactive parathyroid hormone and nephrogenous adenosine 3’5’-monophosphate (group 3), showed adequate suppressibility during calcium infusion and were considered to have normal parathyroid function. However, the remaining 3 patients had slightly elevated nephrogenous adenosine 3’5’-monophosphate and normal plasma immunoreactive parathyroid hormone in basal levels (group 2). During calcium infusion the 3 patients revealed slightly abnormal suppressibility in either plasma immunoreactive parathyroid hormone or nephrogenous adenosine 3’5’-monophosphate responses and were considered as an intermediate type between normal and primary hyperparathyroidism. They are now being followed.We have concluded that 1) simultaneous elevation of plasma immunoreactive parathyroid hormone and nephrogenous adenosine 3’5’-monophosphate in the basal levels strongly suggests primary hyperparathyroidism, 2) the measurement of nephrogenous adenosine 3’,5’-monophosphate in the patients with parathyroid adenoma showed 3 types of response to calcium infusion from autonomous to non-autonomous and 3) there are various types of patients with intermittent hypercalcemic urinary stones, ranging from normal to those with primary hyperparathyroidism in parathyroid function.