IONIZED, ULTRAFILTRABLE AND TOTAL CALCIUM IN SERUM IN HYPERPARATHYROIDISM

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Abstract
The present study has been performed in order to evaluate whether analysis of the ionized and ultrafiltrable fractions of calcium in the serum (Ca++ and UFCa) is superior or not to the analysis of total calcium (TOCa) in demonstrating the presence of hypercalcaemia. For this evaluation determinations have been carried out in 60 patients with hyperparathyroidism. The material has been divided into one group of 47 patients with definite hypercalcaemia (average TOCa > mean control + 2.6 sd) and another of 14 patients with borderline hypercalcaemia (mean control + 2.6 sd ≧ TOCa ≧ mean control + sd; average Ca++ ≧ mean control + 2.6 sd). In the group with definite hypercalcaemia the average concentrations of TOCa, UFCa and Ca++ are all greater than the mean control + 2.6 sd, but the UFCa and Ca++ provide a greater distinction between the control group and the patients than that indicated by the concentration of TOCa. In the group with borderline hypercalcaemia large parathyroid glands were removed in all patients. Histological classification characterized 8 as adenomas and 6 as normal. Identity between these two subgroups as far as the preoperative level of TOCa, UFCa and Ca++ and the postoperative fall in this level is concerned makes it probable that the parathyroid tissue which was removed in both groups had the same secretory capacity irrespective of the histological classification. It is concluded that the UFCa and Ca++ which were clearly elevated in 9 and 14 patients, respectively, were both superior to the TOCa in demonstrating hypercalcaemia, not only in the 8 patients with definite histological evidence of hyperparathyroidism but also in the group as a whole. When the total of 147 preoperative determinations of Ca++, UFCa and TOCa is estimated, it is found that 3%, 15% and 31%, respectively, of the determinations fall within the mean control level + 2.6 sd and 1%, 9% and 25% within the mean control level + 2 sd. Accordingly, it is suggested that UFCa and/or Ca++ should be determined in all patients with borderline hypercalcaemia.

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