合成ヒトPTH-(1-34)によるEllsworth-Howard試験

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  • Urinary Phosphate and Cyclic Adenosine Monophosphate Response to Intravenous Administration of Synthetic Human Parathyroid Hormone- (1-34) in Idiopathic Hypoparathyroidism, Pseudohypoparathyroidism, Pseudopseudohypoparathyroidism and Normal Subjects

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The response to exogenous parathyroid hormone (PTH) with urinary excretion of phosphate and cyclic adenosine monophosphate (cAMP) was tested by the use of synthetic human parathyroid hormone (1-34) [hPTH-(1-34)] on 59 patients with hypocalcemia and normal or high serum inorganic phosphorus and normal renal function without a history of parathyroidectomy for differentiation between idiopathic hypoparathyroidism (IHP), pseudohypoparathyroidism (PHP) and related diseases along with 18 normal subjects.<BR>A positive phosphaturic response to exogenous PTH was defined as the increment of 2 hours phosphate excretion (ΔP) of more than 35 mg. A positive urinary cAMP response to exogenous PTH was defined as the increment by more than 1 μmole per one hour (ΔcAMP) and the increase of 1 hour excretion by more than 10 times.<BR>Increments of 2 hours urinary phosphate excretion in response to hPTH-(1-34) 100 units were 60.5±7.7 mg (mean±SEM) in 27 patients with IHP, 23.5±5.9 mg in 21 patients with PHP type I and 24.9±4.0 mg in 17 normal subjects. Increments of 1 hour urinary cAMP excretion in response to (1-34) 100 units were 12.0±1.5 μmole in 27 patients with IHP, 0.33±0.10 μmole in patients with PHP type I and 23.6±5.8 μmole in 15 normal subjects. Ratios of 1 hour urinary cAMP excretion were 97±10 in 27 patients with IHP, 3.6±0.5 in 21 patients with PHP type I and 54±14 in 15 normal subjects.<BR>Positive phosphaturic and negative urinary cAMP response was encountered in 3 out of 21 patients with PHP type I in response to hPTH-(1-34). This exaggerated phosphaturic response should be considered as due to the influence of treatment with Ca or vitamin D derivatives.

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