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July 1960

Reevaluation of Phosphate Excretion Tests in the Diagnosis of Hyperparathyroidism

Author Affiliations

Los Angeles

From the Los Angeles County Hospital and the Department of Medicine, University of Southern California School of Medicine.

Arch Intern Med. 1960;106(1):48-56. doi:10.1001/archinte.1960.03820010050009

In recent years revived interest in the diagnosis of hyperparathyroidism has centered around the newer tests of inorganic phosphate metabolism. The demonstration of a phosphaturic effect of parathyroid hormone can be credited to Albright, Bauer, Ropes and Aub1 and Greenwald and Gross.2 It has been claimed that the phosphaturia is entirely the result of a rise in glomerular filtration rate,3 but more detailed studies have demonstrated a definite additional effect of parathormone on tubular phosphate reabsorption.4-6

In 1953, Sirota demonstrated decreased tubular reabsorption of phosphate (TRP) in two patients with hyperparathyroidism.7 After removal of the adenoma TRP rose in both patients. Schaaf and Kyle reported similar findings in three hyperparathyroid patients.8 In two publications in 19569 and 1957,10 Chambers, Gordan, Goldman and Reifenstein reported extensive studies of phosphate (P) metabolism in 23 patients with parathyroid adenomas. A number of these patients had normal serum P levels, but in 21 out of 22