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Increased Gastrin and Calcitonin Secretion after Oral Calcium or Peptones Administration in Patients with Hypercalciuria: A Clue to an Alteration in Calcium-Sensing Receptor Activity

Endocrinology and Diabetes Unit (M.Be., V.R., V.V., T.V., G.B.) and Lorenz Research Center (R.T., M.Ba.), Department of Medicine (O.S., G.B.-P.), Luigi Sacco Hospital (Vialba), University of Milan, 21057 Milan, Italy; and Geriatric Unit (L.J.D.), Department of Internal Medicine and Geriatrics, University of Palermo, Italy

Address all correspondence and requests for reprints to: Maurizio Bevilacqua, Servizio di Endocrinologia e Diabetologia, Ospedale L. Sacco, Via GB Grassi 74, 20157 Milan, Italy. E-mail: mauriziobevilacqua{at}fastwebnet.it.

The calcium-sensing receptor (CaSR) has been detected in human antral gastrin-secreting cells, where, upon calcium and/or amino acid allosteric activation, it stimulates gastrin secretion. Patients with absorptive hypercalciuria (AH) display an enhanced gastric acid output; therefore, we evaluated the secretion of gastrin in subjects with AH (30 subjects vs. 30 healthy female controls, all postmenopausal) after oral calcium administration (1 g calcium gluconate) and, on a separate occasion, after peptone loading test (protein hydrolyzed, 10 g). Gastrin and monomeric calcitonin responses were higher in AH after both oral calcium administration (P < 0.01) and peptone loading (P < 0.01). Because the activation of CaSR by oral calcium and peptones directly induces gastrin release, the higher gastrin responses to these stimuli suggest an increased sensitivity of gastrin-secreting cells CaSR in patients with AH. A similar alteration in thyroid C cells might explain the enhanced calcitonin responses to both calcium and peptones. If the same alterations should in addition be present in the distal tubule (where CaSR is expressed as well), then a possible explanation for amino acid-induced hypercalciuria in AH would have been identified.

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