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Related Experiment Videos

Nephrogenous cyclic adenosine monophosphate as a parathyroid function test.

A E Broadus, J E Mahaffey, F C Bartter

    The Journal of Clinical Investigation
    |October 1, 1977
    PubMed
    Summary
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    Nephrogenous cyclic AMP (NcAMP) and parathyroid hormone (iPTH) levels were measured in patients with hyperparathyroidism. A new method for measuring total cyclic AMP excretion (UcAMP) based on glomerular filtration rate improved diagnostic accuracy.

    Area of Science:

    • Endocrinology
    • Nephrology
    • Clinical Chemistry

    Background:

    • Primary hyperparathyroidism (1° HPT) is characterized by elevated parathyroid hormone (PTH) levels.
    • Assessing cyclic AMP (cAMP) excretion is crucial for understanding PTH activity and diagnosing related disorders.
    • Previous methods for measuring total cAMP excretion (UcAMP) faced interpretive challenges, particularly in patients with renal impairment.

    Purpose of the Study:

    • To prospectively measure nephrogenous cyclic AMP (NcAMP), UcAMP, and plasma immunoreactive parathyroid hormone (iPTH) in control subjects and patients with 1° HPT and chronic hypoparathyroidism.
    • To develop and validate a novel parametric expression for UcAMP that accounts for renal function, improving diagnostic utility.
    • To evaluate the diagnostic performance of NcAMP and the new UcAMP expression in identifying hyperparathyroidism, including in subgroups with varying degrees of renal insufficiency.

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    Main Methods:

    • Prospective measurement of NcAMP, UcAMP, and plasma iPTH in 55 controls, 57 patients with 1° HPT, and 10 with hypoparathyroidism.
    • Analysis of NcAMP and plasma iPTH levels using established immunoassay techniques.
    • Development and application of a new parametric expression for UcAMP, normalizing excretion to glomerular filtration rate (GFR), to overcome limitations of previous methods (e.g., normalization to creatinine excretion).

    Main Results:

    • Elevated NcAMP was observed in 91% of patients with 1° HPT, including those with mild or intermittent hypercalcemia and varying degrees of renal insufficiency.
    • Plasma iPTH was elevated in 73% of patients with 1° HPT.
    • The novel UcAMP expression, normalized to GFR, demonstrated elevated values in 89% of 1° HPT patients, outperforming normalization to creatinine excretion (81% elevated) and absolute excretion rates, especially in patients with renal impairment.

    Conclusions:

    • NcAMP measurements are highly sensitive for detecting hyperparathyroidism.
    • A novel parametric expression for UcAMP, normalized to GFR, significantly enhances the diagnostic accuracy of cAMP excretion measurements in hyperparathyroidism, even in the presence of renal insufficiency.
    • The validated measurements and expressions provide reliable tools for assessing cAMP metabolism and diagnosing parathyroid disorders.