TY - JOUR
T1 - Serum erythropoietin and erythropoiesis in primary and secondary hyperparathyroidism
T2 - Effect of parathyroidectomy
AU - Urena, P.
AU - Eckardt, K. U.
AU - Sarfati, E.
AU - Zingraff, J.
AU - Zins, B.
AU - Roullet, J. B.
AU - Roland, E.
AU - Drueke, T.
AU - Kurtz, A.
PY - 1991
Y1 - 1991
N2 - Primary as well as secondary hyperparathyroidism may be associated with anemia, and parathyroidectomy (PTx) may improve or even heal it. The precise link between the two conditions is still matter of discussion. The purpose of the present study was to investigate possible effects of PTx on serum immunoreactive erythropoietin (iEPO) in secondary (group I, n = 23), and primary (group II, n = 16) hyperparathyroidism patients, and in 3 patients undergoing cervicotomy for thyroid mass removal (group III). In group I patients, circulating iEPO levels rose from 23.1 ± 4.8 mU/ml before PTx to 28.2 ± 5.0 and 245 ± 125 mU/ml (mean ± SEM) at day 7 (p = NS) and 14 after PTx (p < 0.003), respectively. Reticulocyte count increased 2 weeks after PTx: from 61,000 ± 13,317 to 86,533 ± 13,462/mm3 (p < 0.05, n = 23). In 4 of these patients serum iEPO levels could be measured again 12-24 months after PTx. They were slightly higher than those determined before PTx: 37.0 ± 8.4 versus 31.8 ± 13.5 mU/ml. Their hematocrits were also higher than before PTx: 12.8 ± 0.9 versus 11.0 ± 0.9 g/dl. In group II patients, serum iEPO levels remained unchanged after PTx : 17.5 ± 2.0 mU/ml before PTx and 20.0 ± 3.0 mU/ml 14 days after PTx. The reticulocyte count, however, increased significantly 2 weeks after PTx: from 25,103 ± 3,000 to 40,827 ± 4,080/mm3 (p < 0.01). In group III patients, serum iEPO, reticulocyte count, and hemoglobin remained stable after surgery. Since all group I patients had received vitamin D supplementation after PTx, we studied an additional group of 14 chronic dialysis patients (group IV) who received either calcitriol (1 μg/day, n = 7) or placebo (n = 7) during 14 days. The patients on calcitriol treatment, but not those on placebo, had a significant decrease of serum iEPO: 18.6 ± 4.9 versus 16.0 ± 4.2 mU/ml (p < 0.03). In conclusion, PTx led to a striking increase of serum iEPO and blood reticulocytes in uremic patients with secondary hyperparathyroidism, and an increase of reticulocyte count, but not of iEPO, in patients with primary hyperparathyroidism. Marked changes of circulating PTH, extra- or intracellular calcium and phosphorus concentrations as well as of tissue sensitivity to EPO after PTx could all be responsible. In contrast, the surgical procedure and the therapeutic increase in plasma calcitriol do not appear to be involved.
AB - Primary as well as secondary hyperparathyroidism may be associated with anemia, and parathyroidectomy (PTx) may improve or even heal it. The precise link between the two conditions is still matter of discussion. The purpose of the present study was to investigate possible effects of PTx on serum immunoreactive erythropoietin (iEPO) in secondary (group I, n = 23), and primary (group II, n = 16) hyperparathyroidism patients, and in 3 patients undergoing cervicotomy for thyroid mass removal (group III). In group I patients, circulating iEPO levels rose from 23.1 ± 4.8 mU/ml before PTx to 28.2 ± 5.0 and 245 ± 125 mU/ml (mean ± SEM) at day 7 (p = NS) and 14 after PTx (p < 0.003), respectively. Reticulocyte count increased 2 weeks after PTx: from 61,000 ± 13,317 to 86,533 ± 13,462/mm3 (p < 0.05, n = 23). In 4 of these patients serum iEPO levels could be measured again 12-24 months after PTx. They were slightly higher than those determined before PTx: 37.0 ± 8.4 versus 31.8 ± 13.5 mU/ml. Their hematocrits were also higher than before PTx: 12.8 ± 0.9 versus 11.0 ± 0.9 g/dl. In group II patients, serum iEPO levels remained unchanged after PTx : 17.5 ± 2.0 mU/ml before PTx and 20.0 ± 3.0 mU/ml 14 days after PTx. The reticulocyte count, however, increased significantly 2 weeks after PTx: from 25,103 ± 3,000 to 40,827 ± 4,080/mm3 (p < 0.01). In group III patients, serum iEPO, reticulocyte count, and hemoglobin remained stable after surgery. Since all group I patients had received vitamin D supplementation after PTx, we studied an additional group of 14 chronic dialysis patients (group IV) who received either calcitriol (1 μg/day, n = 7) or placebo (n = 7) during 14 days. The patients on calcitriol treatment, but not those on placebo, had a significant decrease of serum iEPO: 18.6 ± 4.9 versus 16.0 ± 4.2 mU/ml (p < 0.03). In conclusion, PTx led to a striking increase of serum iEPO and blood reticulocytes in uremic patients with secondary hyperparathyroidism, and an increase of reticulocyte count, but not of iEPO, in patients with primary hyperparathyroidism. Marked changes of circulating PTH, extra- or intracellular calcium and phosphorus concentrations as well as of tissue sensitivity to EPO after PTx could all be responsible. In contrast, the surgical procedure and the therapeutic increase in plasma calcitriol do not appear to be involved.
KW - anemia
KW - calcitriol
KW - erythropoietin
KW - hemodialysis
KW - hyperparathyroidism
KW - parathyr oidectomy
KW - uremia
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U2 - 10.1159/000186596
DO - 10.1159/000186596
M3 - Article
C2 - 1758526
AN - SCOPUS:0026055358
SN - 0028-2766
VL - 59
SP - 384
EP - 393
JO - Nephron
JF - Nephron
IS - 3
ER -