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Parathyroid Function in Normocalcemic Renal Transplant Recipients: Evaluation by Calcium Infusion^*

Endocrine Unit and Transplantation Service, Massachusetts General Hospital and Harvard Medial School, Boston, Massachusetts 02114

Address requests for reprints to: Dr. B. H. Mitlak, Endocrine Unit, Bulfinch 3, Massachusetts General Hospital, Boston, Massachusetts 02114.

The extent to which secondary hyperparathy-roidism may involute remains poorly defined. Renal transplantation offers a clinical situation in which metabolic stimuli for hyperparathyroidism are removed. To examine whether hyper-parathyroidism resolves after transplantation, we evaluated 11 renal transplant recipients who had been normocalcemic 6 or more months after transplantation using a sensitive 2-site immunoradiometric assay for intact serum PTH. Nine of the 11 had PTH concentrations within the normal range. Of these 9, 6 were found to have abnormal parathyroid function when challenged with an iv calcium infusion. The other 2 patients demonstrated significantly elevated basal PTH concentrations and elevated ionized calcium despite n armal total serum calcium and albumin concentrations. In both, the PTH response to infused calcium was markedly abnormal, confirming hyperparathyroid-ism. The estimated renal threshold phosphate concentration was low in 4 of 9 patients with normal basal PTH concentrations and in both with elevated basal PTH. Bone mineral density, measured at the radius by single photon absorptiometry and at the spine by dual energy x-ray absorptiometry, was normal in 8 of the 9 transplant recipients who had normal basal PTH concentrations.

^* This work was supported by USPHS Grant RR-1066 and the MGH Endocrine Gift and Bequest Fund.

Received July 9, 1990.

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