Racial differences in parathyroid hormone dynamics
GE Fuleihan, CM Gundberg, R Gleason, EM Brown, ME Stromski, FD Grant and PR Conlin
Endocrine-Hypertension Division, Brigham and Women's Hospital, Boston, Massachusetts 02115.
Elevations in PTH levels have been reported in black subjects. Such
observations have not been consistent, however, and seem paradoxical in
view of the known bone-resorptive action of this hormone and the fact that
black subjects have a higher bone mineral density and fewer fractures than
their white counterparts. In this study, we used dynamic stimulation of the
calcium-PTH axis to fully characterize potential racial differences in PTH
dynamics. We, therefore, defined the inverse sigmoidal curve that describes
the relationship between serum ionized calcium concentration and intact PTH
levels in six normal white and six normal black volunteers and determined
the four parameters that characterize this relationship. An elevation in
any one of these parameters can result in hyperparathyroidism. Black
subjects had higher maximal and minimal PTH responses to hypo- and
hypercalcemia (mean intact PTH levels of 9.2 +/- 13 and 0.7 +/- 0.1 pmol/L
respectively) than white subjects (6.9 +/- 0.6 and 0.3 +/- 0.1 pmol/L,
respectively). There were no differences in the set-points or slopes of the
curves. Despite the higher baseline and stimulated endogenous PTH levels in
black subjects, their baseline and stimulated osteocalcin levels were
lower. Our dynamic studies, therefore, document mild hyperparathyroidism in
black subjects and suggest mild skeletal resistance to PTH.
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