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Calcium and Phosphorus Homeostasis in Man: Effect of Corticosteroids

Calcium and Phosphorus Homeostasis in Man: Effect of Corticosteroids Abstract Serum calcium and phosphorus levels, urinary excretion rates of calcium, phosphorus, and cyclic adenosine monophosphate (cAMP), and plasma parathyroid hormone (PTH) concentrations were determined in 11 normal subjects and in nine patients maintained on long-term prednisone therapy for chronic obstructive pulmonary disease. These same determinations were repeated in five of the prednisone-treated patients during the course of a seven-day calcium infusion. Prior to the infusion, the prednisonetreated patients demonstrated significantly elevated serum levels of PTH (P <.005) and increased rates of urinary phosphate and cAMP excretion (P <.005) when compared with normal subjects. After initiation of calcium infusion, the previous elevations in all of these determinations decreased to near normal levels. These data suggest that the effects of secondary hyperparathyroidism in patients maintained on long-term prednisone therapy may be overcome when calcium is administered intravenously. (Arch Intern Med 136:1249-1253, 1976) References 1. Harrison HE, Harrison HC: Transfer of Ca45 across intestinal wall in vitro in relation to action of vitamin D and cortisol . Am J Physiol 199:265-271, 1960. 2. Sallis JC, Holdsworth ES: Calcium metabolism in relation to vitamin D3 and adrenal function in the chick . Am J Physiol 203:506-512, 1962. 3. Kimberg DV, Schacter D, Schenker H: Active transport of calcium by intestine: Effects of dietary calcium . Am J Physiol 200:1256-1271, 1961. 4. Lukert BP, Stanbury SW, Mawer EB: Vitamin D and intestinal transport of calcium: Effects of prednisone . Endocrinology 93:718-722, 1973.Crossref 5. Gallagher JC, Aaron J, Horsman R, et al: Corticosteroid osteoporosis . J Clin Endocrinol Metab 2:355-368, 1973.Crossref 6. Dujovne CA, Azarnoff DL: Clinical complications of corticosteroid therapy: A selected review . Med Clin North Am 57:1331-1342, 1973. 7. Williams GA, Peterson WC, Bowser EN, et al: Interrelationship of parathyroid and adrenocortical function in calcium homeostasis in the rat . Endocrinology 95:707-712, 1974.Crossref 8. Storey E: The influence of adrenal cortical hormones on bone formation and resorption . Clin Orthop 30:197-216, 1963.Crossref 9. Jec WSS, Park HZ, Roberts WE, et al: Corticosteroids and bone . Am J Anat 129:477-479, 1970.Crossref 10. Arnoldsson H: Long-term ACTH and corticosteroid therapy in bronchial asthma . Acta Allergol Suppl 129:477-479, 1970. 11. Fiske CH, Subbarow Y: The colorimetric determination of phosphorus . J Biol Chem 66:375-400, 1925. 12. Alexander RL Jr: Evaluation of an automatic calcium titrator . Clin Chem 17:1171-1175, 1971. 13. Kyle LH, Schaaf M, Canary JJ: Phosphate clearance in the diagnosis of parathyroid dysfunction . Am J Med 24:240-248, 1958.Crossref 14. Mawer EB, Backhouse J, Hill LF, et al: Vitamin D metabolism and parathyroid function in man. Clin Sci Mol Med 48:349-365, 1975. 15. Pak CYC, East D, Sauzenbacker L, et al: A simple and reliable test for the diagnosis of hyperparathyroidism . Arch Intern Med 129:48-55, 1972.Crossref 16. Ackerman GL, Nolan CM: Adrenocortical responsiveness after alternate-day corticosteroid therapy . N Engl J Med 278:405-409, 1968.Crossref 17. Frost HM, Villanueva AB: Effect of cortisone on lamellar osteoblastic activity . Henry Ford Hosp Med Bull 9:97-99, 1961. 18. Jowsey J, Biggs BL: Bone formation in hypercortisonism . Acta Endocrinol 63:21-28, 1970. 19. Thompson JS, Palmieri GM, Eliel LP, et al: Effect of porcine calcitonin on osteoporosis induced by adrenal cortical steroids . J Bone Joint Surg 54:1490-1500, 1972. 20. Williams GA, Peterson WC, Bowser EN, et al: Interrelationship of parathyroid and adrenocortical function in calcium homeostasis , in Proceedings of the Fourth International Congress of Endocrinology . Excerpta Medical International Congress series 256. Washington, DC, 1972. 21. Williams GA, Bowser EN, Henderson WJ, et al: Mode of hypocalcemic action of cortisol in the rat . J Lab Clin Med 74:1023-1024, 1969. 22. Cavas FM, Bergstrom WH, Churgin SJ: Effects of the adrenal on calcium homeostasis in the rat . Metabolism 16:670-675, 1967.Crossref 23. Magaral LE, Magaral H, Budenberg MM: Effect of steroid hormones on the parathyroid hormone dose-response curve . J Pharmacol Exp Ther 169:138-141, 1969. 24. Fucik RF, Kùbreja SC, Hargis GK, et al: Effect of glucocorticoids on function of the parathyroid glands in man . J Clin Endocrinol Metab 40:152-155, 1974.Crossref 25. Sherwood LM, Mayer GP, Rainberg CF, et al: Regulation of parathyroid hormone proportional control by calcium, lack of effect of phosphate . Endocrinology 83:1043-1051, 1968.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Calcium and Phosphorus Homeostasis in Man: Effect of Corticosteroids

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References (22)

Publisher
American Medical Association
Copyright
Copyright © 1976 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1976.03630110025009
Publisher site
See Article on Publisher Site

Abstract

Abstract Serum calcium and phosphorus levels, urinary excretion rates of calcium, phosphorus, and cyclic adenosine monophosphate (cAMP), and plasma parathyroid hormone (PTH) concentrations were determined in 11 normal subjects and in nine patients maintained on long-term prednisone therapy for chronic obstructive pulmonary disease. These same determinations were repeated in five of the prednisone-treated patients during the course of a seven-day calcium infusion. Prior to the infusion, the prednisonetreated patients demonstrated significantly elevated serum levels of PTH (P <.005) and increased rates of urinary phosphate and cAMP excretion (P <.005) when compared with normal subjects. After initiation of calcium infusion, the previous elevations in all of these determinations decreased to near normal levels. These data suggest that the effects of secondary hyperparathyroidism in patients maintained on long-term prednisone therapy may be overcome when calcium is administered intravenously. (Arch Intern Med 136:1249-1253, 1976) References 1. Harrison HE, Harrison HC: Transfer of Ca45 across intestinal wall in vitro in relation to action of vitamin D and cortisol . Am J Physiol 199:265-271, 1960. 2. Sallis JC, Holdsworth ES: Calcium metabolism in relation to vitamin D3 and adrenal function in the chick . Am J Physiol 203:506-512, 1962. 3. Kimberg DV, Schacter D, Schenker H: Active transport of calcium by intestine: Effects of dietary calcium . Am J Physiol 200:1256-1271, 1961. 4. Lukert BP, Stanbury SW, Mawer EB: Vitamin D and intestinal transport of calcium: Effects of prednisone . Endocrinology 93:718-722, 1973.Crossref 5. Gallagher JC, Aaron J, Horsman R, et al: Corticosteroid osteoporosis . J Clin Endocrinol Metab 2:355-368, 1973.Crossref 6. Dujovne CA, Azarnoff DL: Clinical complications of corticosteroid therapy: A selected review . Med Clin North Am 57:1331-1342, 1973. 7. Williams GA, Peterson WC, Bowser EN, et al: Interrelationship of parathyroid and adrenocortical function in calcium homeostasis in the rat . Endocrinology 95:707-712, 1974.Crossref 8. Storey E: The influence of adrenal cortical hormones on bone formation and resorption . Clin Orthop 30:197-216, 1963.Crossref 9. Jec WSS, Park HZ, Roberts WE, et al: Corticosteroids and bone . Am J Anat 129:477-479, 1970.Crossref 10. Arnoldsson H: Long-term ACTH and corticosteroid therapy in bronchial asthma . Acta Allergol Suppl 129:477-479, 1970. 11. Fiske CH, Subbarow Y: The colorimetric determination of phosphorus . J Biol Chem 66:375-400, 1925. 12. Alexander RL Jr: Evaluation of an automatic calcium titrator . Clin Chem 17:1171-1175, 1971. 13. Kyle LH, Schaaf M, Canary JJ: Phosphate clearance in the diagnosis of parathyroid dysfunction . Am J Med 24:240-248, 1958.Crossref 14. Mawer EB, Backhouse J, Hill LF, et al: Vitamin D metabolism and parathyroid function in man. Clin Sci Mol Med 48:349-365, 1975. 15. Pak CYC, East D, Sauzenbacker L, et al: A simple and reliable test for the diagnosis of hyperparathyroidism . Arch Intern Med 129:48-55, 1972.Crossref 16. Ackerman GL, Nolan CM: Adrenocortical responsiveness after alternate-day corticosteroid therapy . N Engl J Med 278:405-409, 1968.Crossref 17. Frost HM, Villanueva AB: Effect of cortisone on lamellar osteoblastic activity . Henry Ford Hosp Med Bull 9:97-99, 1961. 18. Jowsey J, Biggs BL: Bone formation in hypercortisonism . Acta Endocrinol 63:21-28, 1970. 19. Thompson JS, Palmieri GM, Eliel LP, et al: Effect of porcine calcitonin on osteoporosis induced by adrenal cortical steroids . J Bone Joint Surg 54:1490-1500, 1972. 20. Williams GA, Peterson WC, Bowser EN, et al: Interrelationship of parathyroid and adrenocortical function in calcium homeostasis , in Proceedings of the Fourth International Congress of Endocrinology . Excerpta Medical International Congress series 256. Washington, DC, 1972. 21. Williams GA, Bowser EN, Henderson WJ, et al: Mode of hypocalcemic action of cortisol in the rat . J Lab Clin Med 74:1023-1024, 1969. 22. Cavas FM, Bergstrom WH, Churgin SJ: Effects of the adrenal on calcium homeostasis in the rat . Metabolism 16:670-675, 1967.Crossref 23. Magaral LE, Magaral H, Budenberg MM: Effect of steroid hormones on the parathyroid hormone dose-response curve . J Pharmacol Exp Ther 169:138-141, 1969. 24. Fucik RF, Kùbreja SC, Hargis GK, et al: Effect of glucocorticoids on function of the parathyroid glands in man . J Clin Endocrinol Metab 40:152-155, 1974.Crossref 25. Sherwood LM, Mayer GP, Rainberg CF, et al: Regulation of parathyroid hormone proportional control by calcium, lack of effect of phosphate . Endocrinology 83:1043-1051, 1968.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1976

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