Demonstration of a diurnal variation in serum parathyroid hormone in primary and secondary hyperparathyroidism

It had been reported previously that there is a diurnal variation in serum parathyroid hormone (PTH) in normal subjects but not in patients with primary hyperparathyroidism. Studies were performed to determine whether there is a diurnal variation in serum PTH in primary or secondary hyperparathyroidism and whether the nocturnal increase in serum PTH, if present, could be prevented by induced hypercalcemia. Serum PTH and calcium were measured in five normal subjects, two patients with pseudohypoparathyroidism, and fourteen patients with primary hyperparathyroidism, twelve of whom were subsequently found to have parathyroid adenomas. In the normals, there was a mean decline in serum PTH of 0.07 ng/ml before noon and a mean increase of 0.04 ng/ml after 8 PM. In primary hyperparathyroidism there was a mean decline in serum PTH before noon of 0.11 ng/ml and a mean increase of 0.11 ng/ml after 8 PM. In both groups, the lowest mean serum calcium values were noted between midnight and 6:00 AM. Patients with pseudohypoparathyroidism showed a nocturnal increase in serum PTH. In each of two normal subjects, two patients with primary hyperparathyroidism, and two patients with pseudohypoparathyroidism, calcium, 4 mg/kg body weight per hour for 4 hours (8:00 PM to 12 midnight), produced hypercalcemia and prevented the nocturnal increase in serum PTH. We have concluded that a diurnal variation in serum PTH often occurs in both normal subjects and in patients with primary or secondary hyperparathyroidism and that nocturnal increases in serum PTH can be prevented by induced hypercalcemia.