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Diagnosis and Treatment |

Synthetic Human Parathyroid Hormone 1-34 Fragment for Diagnostic Testing

Lawrence E. Mallette, MD, PhD
[+] Article and Author Information

Grant Support: Supported in part by the Veterans Administration.

Requests for Reprints: Lawrence E. Mallette, Medical Service, 111E, VAMC, 2002 Holcombe Blvd., Houston, TX 77030.

Current Author Address: Dr. Mallette: Medical Service, 111E, VAMC, 2002 Holcombe Blvd., Houston, TX 77030.


© 1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;109(10):800-804. doi:10.7326/0003-4819-109-10-800
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Since bovine parathyroid extract became unavailable for stimulatory testing, the differentiation between hypoparathyroidism and pseudohypoparathyroidism has been made from the measurement of serum parathyroid hormone (PTH) values alone. Responsiveness to PTH can once again be tested with teriparatide acetate, the newly available, biologically active 1-34 fragment of human PTH. The PTH infusion test can be used to confirm a preliminary diagnosis based on serum immunoreactive PTH values, to differentiate between type 1 and type 2 pseudohypoparathyroidism, or to detect a subtle abnormality of calcium metabolism in normocalcemic patients with features suggesting pseudohypoparathyroidism. Of several variables used to express changes in renal metabolism of cyclic adenosine 3′,5′-monophosphate (cAMP) or phosphate, the 30-minute change in cAMP excretion per unit of glomerular filtration and the 60-minute percentage fall in the tubular maximum for phosphate reabsorption provide the best discrimination. Teriparatide has a low incidence of adverse reactions and provides an effective diagnostic tool.

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