Comparative effect of calcium and of the adrenergic system on calcitonin secretion in man

Characteristic changes in the concentrations of some peptide hormones, in particular those regulating serum calcium, in acute pancreatitis and myocardial infarction

In order to further investigate hormonal changes and possible metabolic consequences in acute pancreatitis, 10 cases with a mild form of the disease was studied. The influence of tissue injury per se on the hormones in question was assessed from comparison with the hormone levels in the course of myocardial infarction (MI) in 9 cases. Insulin and glucose showed no consistent changes. Glucagon was suppressed on admission, 22 +/- 10 pg . ml-1, compared with the ultimate concentration, 40 +/- 20 pg . ml-1 (p less than 0.05), and with the initial value in MI, 74 +/- 32 pg . ml-1 (p less than 0.01). Serum calcitonin (CT) was strongly elevated initially, 348 +/- 313 pg . ml-1, compared with the ultimate level, 24 +/- 7 pg . ml-1 (p less than 0.001), and with the normal initial level in MI, 43 +/- 44 pg . ml-1 (p less than 0.01). Serum CT elevations were time-related to a slight reduction in corrected serum Ca, which might reflect a biological expression of this substance. In pancreatitis, parathyroid hormone (PTH) remained normal and unchanged throughout the study, whereas patients with MI had an increased level of this hormone on admission, 0.19 +/- 0.08 microgramEq . 1(-1), compared with the ultimate concentration, 0.09 +/- 0.03 microgram/q . 1(-1) (p less than 0.02) and with the initial concentration in pancreatitis, 0.11 +/- 0.06 microgramEq . 1(-1) (p less than 0.05). Supranormal PTH levels were found in more than half of the infarction patients on days 0 and 1.

Effect of acute endurance and strength exercise on circulating calcium-regulating hormones and bone markers in young healthy males

Physical activity plays a role in the maintenance of the skeleton but the mechanical, metabolic and hormonal mechanisms involved are largely unknown. The influence of acute endurance and strength exercise on circulating levels of calcitonin, parathyroid hormone (PTH), PTH-related peptide (PTHrP), osteocalcin, carboxyterminal cross-linked telopeptide of type I collagen (ICTP) and ionized calcium (Ca2+) was therefore evaluated. Eight healthy young males performed three exercise bouts on separate occasions: endurance exercise, i.e. cycling on a cycle ergometer for 45 min at 55% of Vo2max (E55%) and 15 min at 85% of Vo2max (E85%) and strength exercise at 85% of three repetitions maximum using a leg-press device (STR). Control experiments included the same subjects with the same time schedule but without exercise. Blood samples were taken before, immediately after exercise and during the recovery period. Hormones and bone markers were measured by use of various immunoassays. There was no obvious influence on calcitonin and PTHrP levels, whereas PTH was increased after strength exercise. ICTP and osteocalcin levels correlated positively at all times and showed regular variations. In comparison with the controls, ICTP levels showed a more pronounced decrease following physical activity whereas osteocalcin followed the same pattern as the controls except for after prolonged endurance exercise when a decrease was abolished. In conclusion, an increase in PTH after strength exercise and a pronounced decrease in ICTP after all exercise together with a relative increase in osteocalcin after prolonged endurance exercise might reflect some mechanisms involved in the positive effect of physical activity on bone mass.

Hypercalcitoninemia and inappropriate calciuria in the acute trauma patient

PURPOSE

This study was undertaken to determine the role of calcium-regulatory hormones (calcitonin [CT], parathyroid hormone [PTH], and vitamin D analogs) during the first 48 hours after acute trauma.

METHODS

Eleven acutely traumatized patients admitted to the shock-trauma intensive care unit (STICU) in a tertiary care teaching hospital were enrolled. Eleven same-day elective surgery patients served as the control group. Levels of ionized calcium (Ca2+), total calcium, magnesium, phosphate, CT, PTH, vitamin D analogs, electrolyte supplementation, and renal electrolyte loss were recorded during the first 48 hours after admission to the STICU. Control-group measurements consisted of Ca2+ and CT.

RESULTS

At admission, 91% of the patients had ionized hypocalcemia (1.04 +/- 0.10 mmol/L). Ca2+ levels increased significantly over time (1.13 +/- 0.08 at 24 hours; 1.16 +/- 0.07 at 48 hours) but remained below the control-group value (1.28 +/- 0.05; P < .05) despite supplementation. Ninety-one percent of the patients had increased CT values at admission, 91% at 24 hours, and 78% at 48 hours. Median CT values in the trauma patients were higher throughout the study than in the control group (P < .05). Urinary calcium loss in the trauma patients was within the normal range. PTH and vitamin D analog values were within the normal range throughout the study. Multiple regression analysis did not show any significant correlation between electrolytes and hormone or protein concentrations.

CONCLUSIONS

Acute trauma patients have ionized hypocalcemia associated with inappropriate urinary calcium loss, increased CT levels, and normal PTH and vitamin D analog values. We believe the degree of calciuria we observed was inappropriate in the context of ionized hypocalcemia. The cause of these increased CT levels is unclear. Our results suggest that Ca(2+)-regulatory mechanisms may be disrupted in the acute trauma patient.

Aspirin idiosyncrasy in systemic mast cell disease: a new look at mediator release during aspirin desensitization

OBJECTIVE

To report the clinical responses and mediator-release profiles of an aspirin-sensitive man with systemic mast cell disease during aspirin desensitization.

MATERIAL AND METHODS

We quantified the release of six mediators during aspirin desensitization.

RESULTS

Although aspirin was administered cautiously with an initial dose of 20 mg, successful aspirin desensitization necessitated complete monitoring and resuscitation capabilities of a medical intensive-care unit for 4.5 days because of frequent, severe anaphylactoid responses. To our knowledge, this is the first report of a pronounced increase in plasma levels of the vasodilator peptide calcitonin gene-related peptide during episodes of aspirin-induced hypotension. Increases in plasma levels of calcitonin and serum levels of tryptase paralleled those of calcitonin gene-related peptide, but plasma levels of calcitonin remained increased for up to 18 hours. Urinary excretion of histamine and 1-methyl-4-imidazoleacetic acid also showed precipitous, although delayed, increases. Excretion of the prostaglandin D2 metabolite 11 beta-prostaglandin F2 alpha followed a bimodal pattern during aspirin desensitization; after severe hypotensive responses, the maximal value was more than 490,000 pg/mL, but the level decreased to less than 100 pg/mL after therapeutic serum levels of salicylate were attained.

CONCLUSION

These data suggest that the hypotensive responses to aspirin in some patients with systemic mast cell disease may result from the combined effects of several mediators.

Calcium homeostasis in the first days of life in relation to feeding

Determinations of serum calcium (Ca), phosphorus (P), magnesium (Mg), calcitonin (CT) and parathyroid hormone (PTH) were carried out in full term newborn infants during the first 168 h of life. The infants were randomly assigned to two different diets: glucose and breast feeding (BF) only or early formula feeding (F). The Ca serum levels decreased from birth to the 24th h; after that time they increased until the 72nd h. The values of serum Ca at the 48th and 72nd h were significantly lower in the F than in the BF group. In contrast, the P serum levels increased from birth to the 48th h and then they decreased; the values of serum P at the 48th h were significantly higher in F than in the BF group. The CT serum levels increased from birth to the 24th h and then they decreased. No difference between the F and BF groups was found during the first 48 h, while at the 72nd h the F group demonstrated significantly higher values of serum CT. PTH serum levels also increased from birth to the 24th h with significantly higher values at the 72nd h in the F group. The results of this investigation demonstrate that the difference in feeding in the first hours of life affects the calcium homeostasis and the secretion of hormones involved in the regulation of serum Ca levels.

Novel peptides from the calcitonin gene: expression, receptors and biological function

Calcitonin gene products include calcitonin and its carboxyl-terminal flanking peptide (in man PDN-21), and calcitonin gene-related peptide (CGRP). Alternative splicing of the initial gene transcripts results in the production of two distinct messenger RNA encoding precursors of CGRP and of calcitonin. CGRP messenger RNA is the predominant transcription product of the calcitonin gene in neural tissues, but it is also present in the pituitary and the C-cells of normal thyroid glands and in medullary thyroid carcinoma. Immunoreactive CGRP has, moreover, been recognized around blood vessels of the heart. Calcitonin and PDN-21 are cosecreted from thyroid C-cells, but they are also found in the brain and pituitary. CGRP receptors are present in the brain and the heart, and calcitonin receptors in bone and kidney cells and in the hypothalamus. Calcitonin administered peripherally and in vitro inhibits bone resorption and stimulates renal 1.25-dihydroxycholecalciferol production. CGRP used in the same manner has potent cardiovascular effects (vasodilation, hypotension, positive chronotropic and inotropic action in the heart). Intracerebroventricular administration of CGRP raises the blood pressure, and both CGRP and calcitonin inhibit gastric acid secretion and food intake. The distinct but overlapping effects of calcitonin and CGRP raise important regulatory and functional issues.

Calcitonin and parathyroid hormone in newborn infants with fracture of the clavicle

Determinations of serum calcium (Ca), phosphorus (P), calcitonin (CT), and parathyroid hormone (PTH) were carried out in 36 full-term newborn infants with fracture of the clavicle (CF) and in 46 normal neonates (N). At the 6th hour of life the CF neonates demonstrated lower serum Ca and higher serum CT in comparison with normal infants. In the hours following, no significant differences between the two groups for the Ca levels were found, whereas serum CT remained significantly higher in the CF newborns at the 24th, 48th, and 72nd hour of life. Significant differences between normal and CF infants in the PTH serum levels were detected only at the 48th hour, when PTH was lower in the CF newborns. The results of this investigation indicate that the fracture of the clavicle is a significant and peculiar factor in stimulating CT secretion. Serum Ca level appeared to be controlled by CT rather than auto-regulating the secretion of the hormone.

Lack of influence of isoproterenol, propranolol, and dopamine on immunoreactive parathyroid hormone and calcitonin in normal man

Available evidence in vitro and in vivo suggests that pharmacologic doses of isoproterenol stimulate the secretion of parathyroid hormone (PTH) and calcitonin (CT) and propranolol inhibits secretion. However, the findings in man are either quite modest or inconsistent. In view of this controversy, we examined the effects of isoproterenol, 0.15 micrograms intradermally (i.d.), dopamine, 5 micrograms/kg body weight over 60 min intravenously (i.v.), and propranolol, 1 mg over 5 min followed by 60 micrograms per min for 2 i.v. in normal human subjects. It was found that these agents did not alter serum calcium, serum immunoreactive PTH, or plasma immunoreactive CT. The findings do not support a physiologic role for biogenic amines in the control and regulation of PTH or CT secretion in normal man.

Increase in plasma calcitonin following femoral fracture in rats

The secretion of calcitonin (CT) has been studied in male rats following a standardized, left femoral fracture after administration of subcutaneous fluanisone and fentanyl citrate anaesthesia. Twenty-five minutes after the fracture, the plasma concentrations of CT were increased by about 20 per cent in young and by about 60 per cent in adult rats compared to prefracture levels of the hormone. Three weeks later, plasma CT had decreased and was not significantly different from prefracture levels. Anaesthesia combined with femoral fracture did not influence plasma calcium significantly, whereas the plasma concentrations of calcium increased in young control rats during 35 minutes of anaesthesia alone. Plasma CT, however, remained unchanged in these control rats in the same period. In rats with a transplanted, CT-secreting, medullary thyroid carcinoma, femoral fracture did not alter the already high plasma concentrations of CT. It is suggested that increase in CT secretion is part of a general response to trauma.