CALCIUM INFUSION IN THE DETECTION OF BONE DISEASE IN PARATHYROID DISORDERS

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Abstract
The retention of an infused load of calcium was determined under standard conditions in 25 patients with various parathyroid disorders, in 12 normal control subjects, and in 3 patients with idiopathic hypercalciuria. A normal range of 40–60 per cent calcium-retention was found, and there was some support to the thesis that hypercalciuria per se may lower the retention of calcium. Patients with primary hyperparathyroidism showed a wide range of calcium retention reflecting on one side probably hypercalciuria (low calcium retention) and on the other osteitis fibrosa generalisata (high calcium retention). In detecting early bone involvement in parathyroid hyperfunction, the calcium retention test was of equal or greater value than alkaline phosphatase determination in the serum. In secondary hyperparathyroidism due to severe renal insufficiency, a high calcium retention was seen pointing either to delayed calcium excretion (low GFR) or increased avidity of the skeleton for calcium as a consequence of an admixture of osteomalacia and osteitis fibrosa. All hypoparathyroid patients retained large quantities of calcium. In three of these cases, an elevated alkaline phosphatase level indicated osteomalacia, possibly following inadequate calcium absorption from the gut, while in two patients a low filtered load of calcium accounted for the apparent high calcium retention.

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