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Parathyroid hormone infusion test in children and adolescents
Insights
Children with short stature respond to parathyroid hormone (PTH) similarly to adults. These findings suggest adult reference values are applicable for evaluating pediatric hypocalcemia.
Area of Science:
- Pediatric Endocrinology
- Renal Physiology
- Hormone Action
Background:
- Short stature in children can be associated with endocrine and metabolic disorders.
- Parathyroid hormone (PTH) plays a crucial role in calcium and phosphate homeostasis.
- Understanding PTH's effects in children is vital for diagnosing and managing related conditions.
Purpose of the Study:
- To compare the physiological responses to parathyroid hormone (PTH) infusion in children with short stature versus normal adults.
- To evaluate the utility of adult reference values for interpreting PTH-induced changes in pediatric patients.
- To investigate PTH's effects in children with hypoparathyroidism and pseudohypoparathyroidism.
Main Methods:
- Administering intravenous parathyroid hormone (PTH) to 10 children with short stature.
- Comparing urinary excretion and clearance of various electrolytes (cyclic AMP, phosphate, calcium, sodium, potassium, bicarbonate) to a cohort of 28 normal adults.
- Assessing responses in 3 children with hypoparathyroidism and 1 patient with pseudohypoparathyroidism.
Main Results:
- Children with short stature exhibited higher basal serum phosphorus levels than adults.
- PTH infusion led to increased urinary excretion of cyclic AMP, sodium, potassium, bicarbonate, and phosphate clearance, along with calcium reabsorption in children, mirroring adult responses.
- Children with hypoparathyroidism showed exaggerated responses to PTH, while the patient with pseudohypoparathyroidism displayed blunted cyclic AMP, potassium, and phosphate clearance but normal sodium and bicarbonate excretion.
Conclusions:
- Physiological responses to PTH in children with short stature are comparable to those in normal adults.
- Established adult reference ranges for PTH-induced metabolic changes are applicable to pediatric populations.
- These findings support the use of adult values for evaluating hypocalcemia in childhood.
Abstract:
10 children with short stature were infused with parathyroid hormone (PTH). The results were compared to those obtained from a study of 28 normal adult volunteers. As expected, the children had higher basal serum phosphorus levels than the adults. PTH administration increased urinary excretion of cyclic AMP, sodium, potassium, bicarbonate, phosphate clearance, and reabsorption of calcium. The responses of the children were indistinguishable from those of the adults. Infusion of PTH to 3 children with hypoparathyroidism produced exaggerated cyclic AMP, phosphate, calcium, potassium, and bicarbonate responses. When given to a patient with pseudohypoparathyroidism, it did not increase urinary excretion of cyclic AMP and potassium or phosphate clearance, but did induce normal sodium and bicarbonate excretion. We conclude that the values obtained from normal adults are applicable to children and are useful in the evaluation of hypocalcemia in childhood.