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NDT Plus 2008 1(Supplement 3):iii54-iii58; doi:10.1093/ndtplus/sfn088
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

This article appears in the following NDT Plus issue: Parathyroid Intervention - Current themes and future perspectives [View the issue table of contents]

Reversed whole PTH/intact PTH ratio as an indicator of marked parathyroid enlargement: five case studies and a literature review

Hirotaka Komaba1, Yoko Takeda1, Jeongsoo Shin2, Reika Tanaka3, Takatoshi Kakuta3, Yoshihiro Tominaga4 and Masafumi Fukagawa1

1 Division of Nephrology and Kidney Center, Kobe University School of Medicine, Kobe 650-0017
2 Motomachi HD Clinic, Kobe, 650-0012
3 Department of Internal Medicine, Tokai University School of Medicine, Isehara, 259-1193
4 Department of Transplant and Endocrine Surgery, Nagoya Second Red Cross Hospital, Nagoya, 466-8650, Japan

Correspondence: Masafumi Fukagawa, Division of Nephrology and Kidney Center, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. Tel: +81-78-382-6500; Fax: +81-78-382-6509; E-mail: fukagawa{at}med.kobe-u.ac.jp


  Abstract

Parathyroid hormone (PTH) levels detected by intact PTH assays are generally higher than those detected by the whole PTH assay because the latter does not detect non-(1–84) PTH fragments, mainly PTH (7–84). Rare exceptions to this rule have been reported in patients with severe primary or secondary hyperparathyroidism and parathyroid carcinoma. Overproduction of an N-form of PTH other than PTH (1–84) has been observed in the sera of these patients. We report five additional cases with the reversed whole PTH/intact PTH ratio associated with severe hyperparathyroidism in haemodialysis patients. Three patients demonstrated enlargement of a single hypervascular gland, whereas the other two had undergone surgical parathyroidectomy and later showed recurrent hyperparathyroidism due to progressive autograft hyperplasia. In the case of a single enlarged gland, the pathological pattern and heterogeneous expression of parathyroid adenomatosis 1/cyclin D1 suggested it to be a single nodule of uraemic hyperparathyroidism rather than sporadic primary adenoma. These cases suggested that the reversed whole PTH/intact PTH ratio could be an indicator of marked parathyroid enlargement. Further studies are required to elucidate the clinical significance of the reversed whole PTH/intact PTH ratio in haemodialysis patients.

Key Words: intact PTH • N-PTH • secondary hyperparathyroidism • single nodule • whole PTH

Received for publication February 5, 2008. Accepted for publication February 29, 2008.


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