Parathyroid Hormone Regulation of Secretion and Laboratory Determination

Jonas Rastad, MD, PhD ■ Peter Ridefelt, MD, PhD ■ Wen T. Shen, MD

The parathyroid gland is exceptional among human tissues because its principal secretory product, parathyroid hormone (PTH), is involved in a direct feedback loop, which tightly regulates the serum calcium concentration. This secretion is potently inhibited by calcium through calcium sensors on the parathyroid cell surface, and PTH exerts its effects through a specific receptor in the peripheral target tissues. In the past, disturbances in this system were difficult to recognize clinically because of inadequate assays for PTH and calcitriol. Despite the improvements in these assays, however, management of patients with the broad spectrum of metabolic calcium disturbances is still complicated by limitations in knowledge. This chapter provides a background for subsequent chapters on hyperparathyroidism by outlining the normal physiologic regulation of PTH secretion, describing the derangements in PTH and calcium regulation in primary and secondary hyperparathyroidism (HPT), and defining the current methods for determining serum PTH values.

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