Abstract
Ten patients with primary hyperparathyroidism caused by enlargement of a single parathyroid gland were studied preoperatively. An intravenous bolus of 4 g magnesium sulphate followed by a continuous infusion of 2 g per hour for 3 hours increased serum magnesium from 0.76 to 2.12 mmol/l (median values,p <0.005). Serum C-terminal parathyroid hormone (PTH) decreased from 94 to 78 pmol/l (p <0.005), and serum intact PTH from 7.0 to 4.8 pmol/l (p <0.008). The PTH changes preceded decreases in serum total calcium from 2.79 to 2.55 mmol/1 (p <0.01), and serum ionized calcium from 1.52 to 1.45 mol/1 (p <0.007). Urinary calcium excretion increased and urinary phosphate excretion decreased. Serum phosphorus, pH, albumin, creatinine, alkaline phosphatase, and urinary cyclic AMP showed no significant changes. The study showed that an intravenous magnesium sulphate infusion which at least doubled the normal serum magnesium concentration significantly suppressed PTH secretion in patients with primary hyperparathyroidism and subsequently reduced the serum calcium concentration.
Résumé
Dix patients présentant un hyperparathyroïdisme dû à l'hypertrophie d'une seule glande parathyroïdienne ont été étudiés avant d'être opérés. Une injection intraveineuse de sulfate de magnésie, 4 g, en bolus, suivie d'une infusion continue de 2 g/h pendant 3 heures a augmenté la concentration sérique en magnésie de 0.76 à 2.12 mmol/l (valeurs médianes,p < 0.005). La concentration en parathormone sérique (PTH), dosée par la méthode immunologique C-terminale a baissé de 94 à 78 pmol/l (p < 0.005) alors que celle de la PTH intacte a baissé de 7.0 à 4.8 pmol/l (p < 0.008). Ces changements en concentration de PTH ont précédé des diminutions en calcium total de 2.79 à 2.55 mmol/l (p < 0.01), et de calcium ionisé de 1.52 à 1.45 mmol/l (p < 0.007). Le taux d'excrétion urinaire de calcium a augmenté alors que l'excrétion en phosphates a diminué. Il n'y avait pas de modifications significatives dans les valeurs de la phosphorémie, le pH, l'albuminémie, la créatinine ou les phosphatases alcalines dans le sérum; de même, le taux d'AMP cyclique urinaire n'a pas changé. Cette étude montre qu'une perfusion intraveineuse de sulfate de magnésie, augmentant la concentration sérique en magnésie d'au moins le double, déprime de façon significative la sécrétion en PTH chez les patients présentant un hyperparathyroîdisme primitif et par conséquent a réduit l'hypercalcémie.
Resumen
Diez pacientes con hiperparatiroidismo primario causado por una glándula única aumentada de tamaño fueron estudiados preoperatoriamente. Un bolo intravenoso de 4 g de sulfato de magnesio seguido de una infusión continua a razon de 2 g por hora por 3 horas, produjo un aumento en el magnesio sérico de 0.76 a 2.12 mmol/l (valores promedio,p < 0.005). El nivel sérico de la fracíon C-terminal de la hormona paratiroidea (PTH) descendió de 94 a 78 pmol/l (p < 0.005), y el nivel de la PTH intacta de 7.0 a 4.8 pmol/l (p < 0.008). Los cambios en la PTH precedieron a la disminución en la concentracíon del calcio sérico de 2.79 a 2.55 mmol/l (p < 0.01), y del calcio ionizado sérico de 1.52 a 1.45 mmol/l (p < 0.007). La excreción de calcio urinario aumentó y la excreción de fosfato urinario disminuyó. El fósforo sérico, pH, albúmina, creatinina, fosfatasa alcalina, y AMP cíclica urinaria no mostraron cambios significativos. El estudio demostró que una infusión intravenosa de sulfato de magnesio que logre por lo menos doblar la concentracíon normal de magnesio sérico suprime en forma significativa la secrecíon de PTH en pacientes con hiperparatiroidismo primario y consecuentemente reduce la concentracíon sérica de calcio.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Buckle, R.M., Care, A.D., Cooper, C.W., Gitelman, H.J.: The influence of plasma magnesium concentration on parathyroid hormone secretion. J. Endocrinol.42:529, 1968
Targovnik, J.H., Rodman, J.S., Sherwood, L.M.: Regulation of parathyroid secretion in vitro: Quantitative aspects of calcium and magnesium ion control. Endocrinology88:1477, 1971
Habener, J.F., Potts, Jr., J.T.: Relative effectiveness of magnesium and calcium on the secretion and biosynthesis of parathyroid hormone in vitro. Endocrinology98:197, 1976
Morrissey, J.J., Cohn, D.V.: The effects of calcium and magnesium on the secretion of parathormone and parathyroid secretory protein by isolated porcine parathyroid cells. Endocrinology103:2081, 1978
Mayer, G.P., Hurst, J.G.: Comparison of the effect of calcium and magnesium on parathyroid hormone secretion rate in calves. Endocrinology102:1803, 1978
Massry, S.C., Coburn, J.W., Kleeman, C.R.: Evidence for suppression of parathyroid gland activity by hypermagnesemia. J. Clin. Invest.49:1619, 1910
Slatopolsky, E., Mercado, A., Morrison, A., Yates, J., Klahr, S.: Inhibitory effects of hypermagnesemia on the renal action of parathyroid hormone. J. Clin. Invest.58:1273, 1976
Carney, S.L., Wong, N.L.M., Quamme, G.A., Dirks, J.H.: Effect of magnesium deficiency on renal magnesium and calcium transport in the rat. J. Clin. Invest.65:180, 1980
Freitag, J.J., Martin, K.J., Conrades, M.B., Bellorin-Font, E., Teitelbaum, S., Klahr, S., Slatopolsky, E.: Evidence for skeletal resistance to parathyroid hormone in magnesium deficiency: Studies in isolated perfused bone. J. Clin. Invest.64:1238, 1979
Chase, L.R., Slatopolsky, E.: Secretion and metabolic efficacy of parathyroid hormone in patients with severe hypomagnesaemia. J. Clin. Endocrinol. Metab.38:363, 1974
Suh, S.M., Tashjian, A.H., Matsuo, N., Parkinson, D.K., Fraser, D.: Pathogenesis of hypocalcemia in primary hypomagnesaemia: Normal end-organ responsiveness to parathyroid hormone, impaired parathyroid gland function. J. Clin. Invest.52:153, 1973
Spisso, K.R., Harbert, G.M., Thiagarajah, S.: The use of magnesium sulphate as the primary tocolytic agent to prevent premature delivery. Am. J. Obstet. Gynecol.142:840, 1982
Elliot, J.P.: Magnesium sulphate as a tocolytic agent. Am. J. Obstet. Gynecol.147:277, 1983
Donovan, E.F., Tsang, R.C., Steichen, J.J., Strub, R.J., Chen, I.W., Chen, M.: Neonatal hypermagnesemia: Effect on parathyroid hormone and calcium homeostasis. J. Pediatr.96:305, 1980
Cholst, I.N., Steinberg, S.F., Tropper, P.J., Fox, H.E., Segre, G.V., Bilezikian, J.P.: The influence of hypermagnesemia on serum calcium and parathyroid hormone levels in human subjects. N. Engl. J. Med.310:1221, 1984
Cruikshank, D.P., Pitkin, R.M., Donnelly, E., Reynolds, W.A.: Urinary magnesium, calcium and phosphate excretion during magnesium sulphate infusion. Obstet. Gynecol.58:430, 1981
Cruikshank, D.W., Pitkin, R.M., Reynolds, W.A., Williams, G.A., Hargis, G.K.: Effects of magnesium sulphate treatment on perinatal calcium metabolism. 1. Maternal and fetal responses. Am. J. Obstet. Gynecol.134:243, 1979
Mountokalakis, T.H., Tsiotras, S., Skopelitis, P., Alivisatos, J.: Hypocalcemia following magnesium sulphate therapy. J.A.M.A.221:195, 1972
Ferment, O., Gamier, P.E., Touitou, Y.: Comparison of the feedback effect of magnesium and calcium on parathyroid hormone secretion in man. J. Endocrinology113:117, 1987
Rude, R.K., Oldham, S.B., Sharp, C.F., Singer, F.R.: Parathyroid hormone secretion in magnesium deficiency. J. Clin. Endocrinol. Metab.47:800, 1978
Gillman, A.G.: A protein binding assay for adenosine 3′∶5′ cyclic monophosphate. Proc. Nat. Acad. Sci. USA67:305, 1910
Broadus, A.E.: Nephrogenous cyclic AMP as a parathyroid function test. Nephron23:136, 1979
Dietel, M., Holzel, F.: Influence on parathyroid hormone storage in normal and adenomatous parathyroid tissue by stimulation and inhibition in vitro. J. Histochem. Cytochem.31:275, 1983
Brown, E.M.: Four-parameter model of the sigmoid relationship between parathyroid hormone release and extracellular calcium concentration in normal and abnormal parathyroid tissue. J. Clin. Endocrinol. Metab.56:572, 1983
LeBoff, M.S., Shoback, D., Brown, E.M., Thatcher, J., Leombruno, R., Beaudoin, D., Henry, M., Wilson, R., Pallotta, J., Marynick, S., Stock, J., Leight, G.: Regulation of parathyroid hormone release and cytosolic calcium by extracellular calcium in dispersed and cultured bovine and pathological human parathyroid cells. J. Clin. Invest.75:49, 1985
Shoback, D., Thatcher, J., Leombruno, R., Brown, E.: Effects of extracellular calcium and magnesium on cytosolic calcium and PTH release in dispersed bovine parathyroid cells. Endocrinology113:424, 1983
Russell, J., Lettier, D., Sherwood, L.M.: Suppression by 1, 25 (OH)2D3 of transcription of the pre-proparathyroid hormone gene. Endocrinology119:2864, 1986
Silver, J., Naveh-Many, T., Mayer, H., Schmelzer, H.J., Popovtzer, M.M.: Regulation by vitamin D metabolites of parathyroid hormone gene transcription in vivo in the rat. J. Clin. Invest.78:1296, 1986
Gilman, A.G., Goodman, L.S., Gilman, A., editors: Goodman and Gilman's The Pharmacological Basis of Therapeutics, sixth edition, New York, MacMillan, 1980, pp. 879–882
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gough, I.R., Balderson, G.A., Lloyd, H.M. et al. The effect of intravenous magnesium sulphate on parathyroid function in primary hyperparathyroidism. World J. Surg. 12, 463–468 (1988). https://doi.org/10.1007/BF01655421
Issue Date:
DOI: https://doi.org/10.1007/BF01655421