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Primary Hyperparathyroidism: Role of the Preoperative Oral Calcium Loading Test in the Differential Diagnosis Between Adenoma and Hyperplasia

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Abstract

Whereas the sensitivity of the membrane calcium receptors is decreased in parathyroid adenoma, extracellular calcium may reduce parathyroid hormone (PTH) secretion through the protein kinase C pathway in parathyroid hyperplasia. The aim of this study was to determine the role of a preoperative oral calcium loading test in the differential diagnosis between adenoma and hyperplasia. Twenty-two subjects with adenoma (group A, age ± standard error 56 ±2 years, female/male 15/7), 10 individuals with hyperplasia (group H, age 54 ±3, female/male 8/2), and 32 age and gender pair-matched controls (group C) underwent the test. Calcium and PTH were measured before and 60, 120, and 180 min after oral administration of 1 g of calcium (as gluconolactate). Product P was defined as minimal PTH concentration (pg/mL) × maximal calcium concentration (mg/dL) during the test. Ratio R was defined as relative PTH decline/relative calcium increase. The PTH decline during the test in group H was comparable to that of the controls. PTH decline <30%, Product P > 1,100, and Ratio R < 4 diagnosed adenoma with specificity of 100%, 90%, and 100%, respectively. PTH decline >60% diagnosed hyperplasia with specificity of 100%. The total accuracy of the test (65%) was comparable to that of technetium-99 m sestamibi scintigraphy (66%) and better than that of ultrasonography (58%). The test may discriminate patients with sporadic diffuse hyperplasia from individuals with solitary adenoma in cases of primary hyperparathyroidism with an indication for surgery.

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Authors and Affiliations

  1. Endocrine Institute, Assaf Harofeh Medical Center, Zerifin, 70300, Israel

    P. Hagag, E. Kummer & M. Weiss

  2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    P. Hagag, E. Kummer & M. Weiss

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  1. P. Hagag
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  2. E. Kummer
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  3. M. Weiss
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Correspondence to P. Hagag.

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Hagag, P., Kummer, E. & Weiss, M. Primary Hyperparathyroidism: Role of the Preoperative Oral Calcium Loading Test in the Differential Diagnosis Between Adenoma and Hyperplasia. Calcif Tissue Int 83, 404–413 (2008). https://doi.org/10.1007/s00223-008-9191-9

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