1981 Volume 72 Issue 2 Pages 151-158
Four primary hyperparathyroid patients with 1 or more calcium-containing stones, as evidenced by surgical removal of a solitary parathyroid adenoma in every case, were examined pre- and post-operatively for serial changes in serum and urinary calcium (Ca), magnesium (Mg) and phosphorus (P) level. Immunoreactive parathyroid hormone (i-PTH) and nephrogenous adenosine 3', 5'-monophosphate (N-CAMP) level in serum were also examined. One (Y. K.) of the patients had subperiosteal resorption and markedly high serum alkaline phosphatase (Al-P) level (1180U/l). The others showed no skeletal abnormality and slightly high serum Al-P concentration. Blood samples were drawn at 9:00 A. M. in the fasting state and 24hr urine samples were collected from 6:00 A. M. to 6:00 A. M. of the next day with a glass bottle containing several ml of 6N HCl. The pre-operative data (Table 1) are the average values of 3 days during 1-3 months before operation. The post-operative day 1 signifies the 24hr period begining at 6:00 A. M. of the day immediately following the operation. The patients were administered intravenously 20-100ml/day of 2% CaCl2 when they felt numbness. They took 0.25-1μg/day of 1α-hydroxyvitamin D3 and 5-15g/day of calcium lactate from the post-operative day 3 or 4 to the end of 3 months after parathyroidectomy. Plasma i-PTH and plasma and urinary c-AMP were measured by radioimmunoassay. The i-PTH assay is specific for the carboxy terminal of the PTH molecule. Mg was measured by Xylidyl Blue method. Ca, P, creatinine and Al-P were measured by an autoanalyzer.
As shown in Table 1, Fig. 1 and 2, serum Ca, urinary P, plasma i-PTH and N-CAMP decreased significantly on the post-operative day 1. Serum and urinary Mg were slightly lowered on the post-operative day 3. Urinary Ca and serum P showed no significant change during 2 weeks after parathyroidectomy. There are 2 peculiar changes in N-CAMP. The first patient (M. Y.) showed a paradoxical increase of N-CAMP after the surgery. The others demonstrated abrupt decrease to minus values after the surgery. These two problems should be further investigated in the future.
In conclusion, after the end of the post-operative day 3 almost all of the laboratory values appear to approach the normal levels and to be within the normal limits in 2 weeks.
