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PTH -Intact (Parathyroid Hormone)

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Parathyroid Hormone (PTH) is an 84-amino acid peptide hormone secreted by the parathyroid glands

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PTH - Intact (Parathyroid Hormone) Test Guide

  • Why is it done?
    • Measures the level of intact parathyroid hormone (PTH) in the blood to assess parathyroid gland function and calcium-phosphate metabolism regulation
    • Evaluates unexplained hypercalcemia (elevated calcium) to determine if primary hyperparathyroidism is the cause
    • Investigates hypocalcemia (low calcium) to assess for hypoparathyroidism or secondary causes
    • Monitors patients with chronic kidney disease and mineral bone disorders
    • Assesses effectiveness of treatment in conditions affecting calcium and phosphate metabolism
    • Evaluates patients with symptoms of parathyroid dysfunction including weakness, bone pain, or nephrolithiasis
    • Performed when abnormal serum calcium levels are detected requiring further investigation
  • Normal Range
    • Typical Normal Range: 10-65 pg/mL (picograms per milliliter) or approximately 1.0-7.0 pmol/L (picomoles per liter)
    • Reference Range Note: Normal ranges vary by laboratory and assay method used; always consult your specific lab's reference range
    • Elevated PTH (Above Normal): Indicates increased parathyroid hormone production, suggesting primary or secondary hyperparathyroidism, or inadequate calcium regulation
    • Reduced PTH (Below Normal): Suggests hypoparathyroidism, acute illness, or suppression due to elevated serum calcium levels
    • Normal PTH with Abnormal Calcium: Requires additional investigation to identify non-parathyroid causes of calcium abnormalities
    • Units of Measurement: pg/mL (most common in US), pmol/L (international), mIU/L or ng/L in some laboratories
  • Interpretation
    • High PTH with High Calcium: Classic presentation of primary hyperparathyroidism; PTH inappropriately elevated despite high serum calcium
    • High PTH with Low Calcium: Indicates secondary hyperparathyroidism; parathyroid glands working appropriately to raise low calcium but indicate underlying metabolic disorder (vitamin D deficiency, chronic kidney disease)
    • Low PTH with High Calcium: Suggests hypercalcemia from non-parathyroid sources such as malignancy, hypervitaminosis D, or granulomatous diseases; PTH appropriately suppressed
    • Low PTH with Low Calcium: Indicates hypoparathyroidism; parathyroid glands fail to produce adequate hormone, resulting in inability to maintain calcium homeostasis
    • Factors Affecting Results: Time of day (PTH follows diurnal rhythm), vitamin D status, magnesium levels, phosphate levels, alkaline phosphatase, medications (lithium increases PTH), recent parathyroid surgery, acute or chronic illness
    • Clinical Significance of Patterns: PTH-calcium relationship is critical for interpretation; intact PTH (biologically active form) is more specific than total PTH for assessing parathyroid function; serial measurements help track disease progression or response to treatment
    • Tertiary Hyperparathyroidism: Autonomous PTH secretion with elevated calcium; typically occurs after prolonged secondary hyperparathyroidism in chronic kidney disease patients
  • Associated Organs
    • Primary Organs Involved:
      • Parathyroid glands (four small endocrine glands in neck)
      • Kidneys (regulate calcium reabsorption and vitamin D activation)
      • Small intestine (calcium absorption regulated by PTH-activated vitamin D)
      • Bones (calcium and phosphate reservoir)
    • Common Associated Conditions:
      • Primary hyperparathyroidism (single adenoma, hyperplasia, carcinoma)
      • Secondary hyperparathyroidism (vitamin D deficiency, chronic kidney disease, malabsorption)
      • Hypoparathyroidism (autoimmune, post-surgical, genetic, DiGeorge syndrome)
      • Chronic kidney disease and mineral bone disorder
      • Osteoporosis and metabolic bone disease
      • Hypercalcemia from malignancy or granulomatous diseases (sarcoidosis)
    • Complications of Abnormal PTH Levels:
      • Nephrolithiasis (kidney stones) from hypercalcemia
      • Osteoporosis and increased fracture risk
      • Tetany and seizures from hypocalcemia
      • Cardiac arrhythmias from severe electrolyte imbalances
      • Hypertension associated with primary hyperparathyroidism
      • Renal insufficiency from chronic hypercalcemia
  • Follow-up Tests
    • Recommended Concurrent/Follow-up Testing:
      • Serum calcium (total and ionized) - essential for PTH interpretation
      • Serum phosphate - works inversely with PTH and calcium
      • 25-hydroxy vitamin D (calcidiol) - critical cofactor in PTH physiology
      • 1,25-dihydroxy vitamin D (calcitriol) - active form; elevated in hyperparathyroidism
      • Serum magnesium - affects PTH secretion and action
      • Serum creatinine and estimated glomerular filtration rate (eGFR) - assess kidney function
      • Alkaline phosphatase and bone-specific alkaline phosphatase - assess bone metabolism
    • Further Investigations If Abnormal:
      • PTH-related peptide (PTHrP) - if hypercalcemia with suppressed PTH
      • Parathyroid imaging (sestamibi scan, ultrasound) - localize parathyroid adenoma
      • 24-hour urinary calcium - assess kidney stone risk and parathyroid function
      • Bone mineral density (DEXA scan) - assess osteoporosis risk
      • Markers of bone turnover (P1NP, CTX) - assess bone remodeling
      • Serum and urine protein electrophoresis - if malignancy suspected
      • Chest imaging - evaluate for sarcoidosis or malignancy
    • Monitoring Frequency:
      • Primary hyperparathyroidism (untreated): Annual PTH and calcium monitoring
      • Post-parathyroid surgery: PTH measured intraoperatively and post-operatively to confirm successful treatment
      • Chronic kidney disease: Every 3-6 months depending on stage and mineral bone disease severity
      • Hypoparathyroidism on treatment: Every 6-12 months to monitor replacement adequacy
      • After vitamin D supplementation: 6-8 weeks to reassess PTH suppression
    • Complementary Tests:
      • Calcium stimulation and suppression tests - specialized research and diagnostic tests
      • Genetic testing - for familial hypocalciuric hypercalcemia and multiple endocrine neoplasia syndromes
  • Fasting Required?
    • Fasting Requirement: No - Fasting is NOT required for PTH intact measurement
    • Timing Considerations: PTH follows a diurnal (daily) rhythm with peak levels in early morning (9 AM) and lowest levels in late afternoon; ideally draw blood in morning for consistency
    • Food and Beverage: No food or beverage restrictions; patient may eat and drink normally before blood draw
    • Medications to Avoid or Report: Lithium (increases PTH; should be reported), Thiazide diuretics (increase calcium), Vitamin D supplements (affect PTH levels), Phosphate binders, Cinacalcet (decreases PTH), Vitamin A supplements (excess can affect PTH); inform physician of all medications
    • Other Patient Preparation: Remain sitting or lying quietly for 5-10 minutes before blood draw to allow stabilization; avoid strenuous exercise immediately before test; inform lab of recent illness, hospitalization, or recent surgery as these affect PTH levels
    • Collection Details: Blood collected via venipuncture in serum separator tube; sample should be kept at room temperature and transported promptly to laboratory; PTH is stable for several hours if properly handled
    • Special Circumstances: For repeat testing or monitoring, try to have blood drawn at similar times of day; baseline calcium level should be obtained simultaneously with PTH for proper interpretation; patients on dialysis may have PTH drawn before dialysis session for consistency

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