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Published on: March 14, 2017
Parathyroid responsiveness to hypocalcemic and hypercalcemic stimuli in adult growth hormone deficiency after growth
Aftab M Ahmad1, Marion T Hopkins, Joegi Thomas
1Department of Diabetes & Endocrinology, Royal Liverpool University Hospital, Liverpool L7 8XP, UK. DRAAHMAD@Yahoo.com
Abstract:
Adult growth hormone deficiency (AGHD) is associated with osteoporosis. Previous reports have suggested that alterations in parathyroid gland responsiveness to changes in calcium concentration may play a role in the genesis of osteoporosis in untreated AGHD patients. We investigated the endogenous parathyroid hormone [PTH-(1-84)] response to hypocalcemic and hypercalcemic stimuli induced by sodium EDTA and calcium gluconate infusion, respectively, and to PTH-(1-34) infusion in AGHD patients before and during GH replacement (GHR). We have demonstrated that the maximum PTH-(1-84) stimulation and suppression occurred at significantly higher calcium concentrations and in response to smaller changes in calcium concentrations after GHR. The calcemic response to the effects of PTH-(1-34) infusion significantly increased after GHR. The calcium set point (the calcium concentration at which the rate of PTH secretion is one-half of its maximal value) significantly increased in all groups after 3 mo on GHR, and it increased further at 12 mo. Our results suggest increased parathyroid gland sensitivity to smaller changes in serum calcium and increased end-organ sensitivity to the effects of PTH in AGHD patients after GHR. These findings may help us to understand the mechanisms underlying the genesis of osteoporosis in AGHD patients.
Insights
Growth hormone replacement therapy improves parathyroid gland function in adults with growth hormone deficiency (AGHD). This enhances calcium regulation and may help prevent osteoporosis in AGHD patients.
Area of Science:
- Endocrinology
- Bone Metabolism
Background:
- Adult growth hormone deficiency (AGHD) is linked to osteoporosis.
- Altered parathyroid gland function may contribute to osteoporosis in AGHD.
Purpose of the Study:
- To investigate parathyroid hormone (PTH) response to calcium challenges in AGHD patients.
- To assess the effects of growth hormone replacement (GHR) on parathyroid gland function and calcium homeostasis.
Main Methods:
- Measured endogenous PTH-(1-84) response to induced hypocalcemia and hypercalcemia.
- Administered PTH-(1-34) infusion to assess calcemic response.
- Evaluated patients before and during GHR.
Main Results:
- GHR increased PTH-(1-84) stimulation and suppression at higher calcium levels.
- GHR enhanced calcemic response to PTH-(1-34) infusion.
- Calcium set point significantly increased after GHR, indicating improved calcium regulation.
Conclusions:
- GHR enhances parathyroid gland sensitivity to calcium fluctuations.
- GHR increases end-organ sensitivity to PTH effects.
- These improvements may elucidate mechanisms of osteoporosis in AGHD.
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