• Korean Journal of Clinical Pharmacy
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• v.23 no.2
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• pp.142-150
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• 2013

Background: Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease, affecting most of those who are receiving dialysis. Cinacalcet, a novel calcimimetic, targets the calcium-sensing receptor to lower PTH levels in dialysis patients. Objective: This study aimed to assess efficacy, safety and appropriateness of use of cinacalcet in dialysis patients. Method: This retrospective study was performed on total 24 cases with identified intact parathyroid hormone (iPTH), serum calcium and phosphorus levels before and 4 weeks after cinacalcet initiation at a teaching hospital from July 1st, 2011 to October 31st, 2012. Results: Cinacalcet decreased iPTH by 19% from baseline after 4weeks treatment and it was statistically significant (p<0.001). Cinacalcet also significantly decreased iPTH levels regardless of dialysis modality (hemodialysis group versus peritoneal dialysis group) and severity of SHPT (iPTH 300-800 pg/ml group versus iPTH >800 pg/ml group). Serum calcium, phosphorus and Ca x P levels were decreased without statistical significance. Gastrointestinal events, headache and hypocalcemia were the most common side effects. Monitoring for iPTH and serum calcium was not performed appropriately. 43.7% patients initiated cinacalcet therapy at serum calcium level< 9.0 mg/dl. Conclusion: In conclusion, cinacalcet lowers parathyroid hormone levels with no serious side effects. However, it is required to avoid cinacalcet treatment in patients with low serum calcium levels and monitor iPTH and serum calcium levels during cinacalcet administration.

• Preventive Nutrition and Food Science
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• v.1 no.1
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• pp.80-86
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• 1996

Parathyroid hormone(PTH) is known to stimulate bone resorption and to inhibit bone collagen synthesis. In contrast, as the evidence of stimulation of bone formation by PTH has recently been observed, the study on the role of PTH involved in osteoporosis draws remarkable attention. This study has dealt with the role of alkaline phoshatase(AP), a marker enzyme for bone formation and osteoblast action, Animals(BALS/cmice) were divided into three dietary groups(high and medium Ca and Ca-free) and hormones including PTH, calcitonin(CT), cholecalciferol(citamin D) were i.p. injected. AP in the serum and liver was measured using Sigma 221 alkaline buffer solutions containing 9mM of p-nitrophenyl phoshate. Enzume was reacted at 37$^{\circ}C$ for 10 minutes and the reaction was stopped by 1.8ml of 0.1N NaOH and measured at 410nm. We found that serum and liver AP activity was increased by low dietary Ac. Compared to the control, and serum Ap activity was enhanced by PTH and vitamin D regardless of the dietary Ca. On the other hand, liver AP activity was inhibited by OTH and vitamin D at all levels of dietary Ca. CT inhibited the action of PTH and vitamin D in the serum. But, the inhibition of PTH and vitamin D action by CT was not observed in the liver, unlike in the case of serum.

• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.525-532
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• 1999

The parathyroid hormone related protein (PTHrP) is the most common causative peptide of humoral hypercalcemia of malignancy. In contrast, the serum level of parathyroid hormone (PTH) is low to undetectable in the majority of patients with malignancy associated hypercalcemia. Few cases exist in which the production and secretion of PTH by malignant nonparathyroid tumors have been authenticated. To our knowledge, there is very rare case in which a nonparathyroid tumor expressed simultaneously both the PTH and PTHrP. We report a case of squamous cell carcinoma of the lung with hypercalcemia which presented with simultaneous elevation of serum PTH and PTHrP. Severe hypercalcemia (serum calcium, 7.5 mEq/L) was found in a 65-year-old man who had a squamous cell carcinoma of the lung without any bony metastasis and detectable parathyroid abnormalities on isotope scintigraphy. The serum level of intact parathyroid hormone (PTH) con centration was markedly elevated as measured in two site radioimmunoreactive PTH assays (intact PTH 150 pg/mL ; normal 9~55). The serum level of a PTHrP was also increased as measured in C-terminal region specific radioimmunoassay (PTHrP 99.1 pmol/L; normal 13.8~55.3). There are no evidences of coincidental primary hyperparathyroidism in parathyroid MIBI scan and other imaging studies including neck ultrasonography and computed tomography. These results suggest that simultaneous elevation of serum PTH and PTHrP in this patient can be caused by production of both PTHrP and PTH in other nonparathyroid lesions such as squamous cell carcinoma.

• Clinical and Experimental Pediatrics
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• v.46 no.10
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• pp.1032-1035
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• 2003

In pseudohypoparathyroidism as reported by Albright in 1942, the parathyroid gland can normally synthesize and secrete parathyroid hormone(PTH). Pseudohypoparathyroidism has a similar biochemical finding with hypoparathyroidisms like hypocalcemia and hyperphosphatemia due to target tissue resistance to PTH. Administered PTH does not raise the serum levels of calcium and urinary phosphate. PTH activates G-protein in peripheral tissue and adenylate cyclase through a second messenger, cAMP. Pseudohypoparathyroidism produces hyperphosphatemia and hypocalcemia because of the resistance to PTH in peripheral tissue due to a defect of G-protein, although it releases PTH normally. According to the mechanism of resistance, pseudohypoparathyroidism is classified into types : Ia, Ib, Ic and psedopseudohypoparathyroism. Type Ia is accompanied by congenital growth retardation and abnormal bony development that shows mental retardation, obesity, low height, round face, short metacarpal bone and metatarsal bone, ectopic calcification, etc. We report a case of pseudohypoparathyroidism in a premature who shows hypocalcemia, hyperphosphatemia, elevation of serum PTH and 24 hr urinary basal c-AMP in biochemical tests without Albright's hereditary osteodystrophy at physical examination, accompanied by a spontaneous fracture in the femur.

• Journal of the Korean Society of Food Science and Nutrition
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• v.28 no.3
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• pp.677-684
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• 1999

This study has dealt the effect of Ca regulating hormones and dietary Ca levels on Ca metabolism. Animals(BALB/c mice) were divided into three dietary groups(high and medium Ca and Ca free) and hormones including parathyroid hormone(PTH), calcitonin(CT), cholecalciferol(Vit D) were i.p. injected. After feeding experimental diets for five weeks, mice were anaethetized and sacrificed by heart puncture. We found that femur growth of mouse was slightly increased by high dietary Ca without showing statistical significance comparing to low dietary Ca group. The combination of PTH and CT showed the same effect when dietary Ca was high. At the same time, total mineral retention in bone was most affected by dietary Ca. In general, high Ca diet elevated Ca level in the serum. When dietary Ca was low, PTH stimulated Ca release from the bone into the serum, which was shown to be inhibited by CT treatment. Comparing to the control, PTH, Vit D and CT together tended to inhibit serum Ca level at high and medium dietary Ca. PTH and Vit D inhibited Ca reserve in the liver at all dietary levels of Ca. Both PTH and Vit D stimulated bone Ca retention when dietary Ca was low, but this effect was reversed when dietary Ca was high. When PTH, Vit D and CT were administered together, bone Ca level was greatly enhanced at low dietary Ca than at high dietary Ca, which suggests that these hormonal cooperation is needed for proper bone density maintenance especially when dietary minerals are not sufficient.

• Journal of Nutrition and Health
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• v.29 no.7
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• pp.758-771
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• 1996

This study attempted to define reference data for the distribution of vitamin d status and to explore the relationship between vitamin D status and related biochemical indices in Korean women. The vitamin D status of 179 Korean women aged from 20 to 75 years was analyzed by using HPLC(High Pressure Liquid Chromatography). Related biochemical indices such as iPTH, alkaline phosphatase, creatinine, albumin, Ca, Mg and P were also measured. The mean serum level of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were s25.8ng/ml and 89.8pg/ml, respectively. Low 25-hydroxyvitamin D (<25nmol/L) was found in 29 subjects(16.5%). There was a significantly progressive decrease in serum 25-hydroxyvitamin D with increasing age(p<0.05). After in their, there was a dramatical reduction in 25-hydroxyvitamin D(p<0.05). It was also significant in post-menopasusal women compared with pre-menopausal women(p<0.000). Serum alkaline phosphatase levels increased significantly with age(p<0.001). Whereas serum calcium and phosphorus levels remained constant with age. Serum 250-hydroxyvitamin D was invesely related to iPTH (p<0.05) and alkaline phophatase (p<0.001).

• Clinical and Experimental Pediatrics
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• v.60 no.2
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• pp.45-49
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• 2017

Purpose: Serum level of 25-hydroxyvitamin D (25-OHD) is considered as the most appropriate marker of vitamin D status. However, only a few studies have investigated the relationship between 25-OHD and parathyroid hormone (PTH) in children. To this end, this study was aimed at evaluating the lowest 25-OHD level that suppresses the production of parathyroid hormone in children. Methods: A retrospective record review was performed for children aged 0.2 to 18 years (n=193; 106 boys and 87 girls) who underwent simultaneous measurements of serum 25-OHD and PTH levels between January 2010 and June 2014. Results: The inflection point of serum 25-OHD level for maximal suppression of PTH was at 18.0 ng/mL (95% confidence interval, 14.3-21.7 ng/mL). The median PTH level of the children with 25-OHD levels of <18.0 ng/mL was higher than that of children with 25-OHD levels ${\geq}$ 18.0 ng/mL (P<0.0001). The median calcium level of children with 25-OHD levels<18.0 ng/mL was lower than that of children with 25-OHD levels${\geq}18.0ng/mL$ (P=0.0001). The frequency of hyperparathyroidism was higher in the children with 25-OHD levels<18.0 ng/mL than in the children with 25-OHD levels${\geq}18.0ng/mL$ (P<0.0001). Hypocalcemia was more prevalent in the children with 25-OHD levels<18.0 ng/mL than in the children with 25-OHD levels${\geq}18.0ng/mL$ (P<0.0001). Conclusion: These data suggest that a vitamin D level of 18.0 ng/mL could be the criterion for 25-OHD deficiency in children at the inflection point of the maximal suppression of PTH.

• Journal of Nutrition and Health
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• v.29 no.9
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• pp.1013-1020
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• 1996

The purpose of this study was to investigate nutrient intake and bone status in rural postmenopausal women in Korea. Ten postmenopausal women in An-Sung area participated in this study and they were divided into two groups ; women in group I had been postmenopausal for 4 years or less and those in group II had been postmenopausal for 5 years or more before the present study began. Their environmental factors and dietary intakes were surveyed through the personal interviews. Serum levels of calcium, phosphorus, parathyroid hormone(PTH), estradiol and urinary Ca, P, creatinine, hydroxyproline levels were measured from December 4 to December 27 in 1993. The reults of this study are summarized as follows : Average ages of group I and II were 54.8 and 57.2 years. Average menopausal ages of group I and II were 50.8 and 47.3 years. The nutrient intakes of subjects were higher than recommended dietary allowances(RDA) except calorie, protein, calcium, and vitamin A. The nutrient status did not show any significant difference between group I and II. Serum levels of Ca, P, PTH, estradiol and urinary P, creatinine excretion did not show any significant difference between group I and II, and all levels were in normal range. Urinary Ca excretion(p<0.05) and hydroxyproline excretion(p<0.01) were significantly lower in group I than in group II. Urinary Ca/creatinine(Ca/cr) and hydroxyproline/creatinine(Hpr/cr) rations were significantly higher in group II than in group I(p<0.01. And Hpr/cr levels of group I were in normal range, but most of subjects in group II were higher than 0.017 indicating sign of osteoporosis. Correlations between parameters showed that serum PTH adn urinary Ca, Ca/cr levels were positive related (p<0.01), and the years of the after menopausal year and urinary Hpr/cr was also positive related(p<0.05). The present results suggests that it is difficult to protect postmenopausal women's bone destruction having Korean usual diets. Therefore, to prevent osteoporosis with aging, minimizing the hormonal changes in postmenopausal women is needed as well as Ca supplementation and proper exercise before menopause begins.

• Korean Journal of Radiology
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• v.21 no.12
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• pp.1383-1392
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• 2020

Objective: This study aimed to evaluate the efficacy and safety of ultrasound (US)-guided minimally invasive treatment in patients with parathyroid lesions. Materials and Methods: This study included 27 patients who had undergone US-guided radiofrequency ablation (RFA) or ethanol ablation (EA) for parathyroid lesions between January 2010 and 2018. RFA was performed in 19 patients with primary hyperparathyroidism (PHPT, n = 11) or secondary hyperparathyroidism (SHPT, n = 8), and EA was performed in eight patients with symptomatic nonfunctioning parathyroid cysts (SNPCs). Nodule size, volume, serum parathyroid hormone (PTH) and calcium levels were recorded before and after treatment. Complications were evaluated during and after treatment. Results: In patients with PHPT, significant reductions in size and volume were noted after RFA at 6- and 12-month follow-up (all, p < 0.05). Seven nodules nearly completely disappeared (residual volume < 0.1 mL); serum PTH and calcium levels were reduced to normal ranges (7/11, 63.6%). Four patients experienced partial reductions of serum PTH and calcium levels (4/11, 36.4%). In patients with SHPT, three experienced therapeutic response of serum PTH (3/8, 37.5%), while five showed persistent hyperparathyroidism (5/8, 62.5%) within 6 months after RFA. In patients with SNPCs, EA resulted in significant reductions in cyst size and volume (all, p < 0.05) at the last follow-up. A total of four complications (two transient hypocalcemia [RFA], one permanent [RFA], and one transient [EA] hoarseness) were observed. Conclusion: Minimally invasive treatments, such as RFA and EA, may serve as therapeutic alternatives for patients with PHPT or SNPCs; they may have limited usefulness in patients with SHPT.

• Preventive Nutrition and Food Science
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• v.2 no.1
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• pp.55-60
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• 1997

A lysosomal and matrix degrading enzyme $\beta$-glucuronidase activity was measured in BALS/c mice fed high and low Ca in combination with the i.p. adminstration of calcium-regulating hormones including parathyoid hormone(PTH), calcitonin(CT) and cholecalciferol(Vit D). After feeding experimental diets for five weeks, mice were sacrificed by cervical dislocation and the enzyme was fluometrically measured at 440nm. $\beta$-Glucuronidase activity was inhibited by high calcium in the diet. in addition, vitamin D also inhibited the enzyme activity in the serum regardless of the level of dietary calcium. In contrast, PTH has shown to stimulate the enzyme at all the levels of dietary calcium. Calcitonin, and inhibitor of PTH action for bone resorption, revealed to curb PTH effect in this enzyme, whereas CT stimulated the action of vitamin D in the serum. The above results led us to conclude that osteoclastic bone resorption and senile osteoporosis may be reduced by adequate dietary calcium and vitamin D.