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Related Experiment Videos

Practical considerations in PTH testing.

Jean-Claude Souberbielle1, Gérard Friedlander, Catherine Cormier

  • 1Laboratoire d'Explorations Fonctionnelles, hôpital Necker-Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France. jean-claude.souberbielle@nck.ap-hop-paris.fr

Clinica Chimica Acta; International Journal of Clinical Chemistry
|November 29, 2005
PubMed
Summary

New parathyroid hormone (PTH) assays offer improved specificity but haven't yet surpassed older methods in clinical practice. Establishing PTH reference values in vitamin D-sufficient individuals enhances hyperparathyroidism diagnosis.

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Area of Science:

  • Biochemistry
  • Endocrinology
  • Clinical Chemistry

Background:

  • Recent advancements in parathyroid hormone (PTH) biology have led to the development of new assay methodologies.
  • The "intact" PTH assays measure both full-length PTH (1-84) and non-1-84 fragments, prompting the creation of newer assays.

Purpose of the Study:

  • To address the confusion arising from various PTH assay nomenclatures by proposing a simplified classification.
  • To evaluate the clinical utility of third-generation PTH assays compared to second-generation assays.
  • To investigate the impact of vitamin D status on PTH reference values and diagnostic sensitivity.

Main Methods:

  • Comparison of second-generation ("intact" PTH) and third-generation (Whole, CAP, BioIntact) PTH assays.
  • Analysis of clinical data to assess the superiority of third-generation assays.

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  • Proposal for establishing PTH reference ranges in subjects with normal vitamin D status (25OHD measurement).

    • Main Results:

    • Third-generation PTH assays recognize "amino-PTH" in addition to 1-84 PTH.
    • Currently, third-generation assays have not demonstrated superiority over second-generation assays in clinical practice.
    • Establishing PTH reference values in vitamin D-sufficient individuals decreased the upper limit of normal by 25-35%, improving diagnostic sensitivity for hyperparathyroidism.

    Conclusions:

    • A simplified nomenclature is needed, classifying older assays as second-generation and newer ones as third-generation.
    • No current recommendation exists to switch to third-generation PTH assays or use ratios from combined measurements.
    • Further bone biopsy studies in dialyzed patients are required to reach a consensus on assay utility. Establishing vitamin D-corrected PTH reference values enhances hyperparathyroidism diagnosis.