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As expected, patients with parathyroid cancer had more severe disease than patients with PHPT; the highest mean calcium, wPTH, and tPTH concentrations; and the highest total alkaline phosphatase activities.
tPTH concentrations decreased, but the wPTH:tPTH ratio did not change.
wPTH concentrations, but not tPTH concentrations, were higher at both time points in the high-ratio group.
In healthy individuals and PHPT patients, hPTH(1-84) constituted the dominant molecular form of circulating PTH, representing 90% of wPTH immunoreactivity and 79% of tPTH immunoreactivity.
We used both the wPTH assay, a 3rd-generation PTH assay that detects both hPTH(1-84) and N-PTH (2,4,5), and the tPTH assay, a 2nd-generation PTH assay that detects both hPTH(1-84) and non-(1-84) PTH fragments (2,4,5) but reacts poorly with N-PTH.
In contrast to healthy individuals and PHPT patients, in whom N-PTH represented 15% of the wPTH at most, N-PTH represented 65% of the tPTH immunoreactivity in these 2 cancer patients.
We have suggested that N-PTH can be phosphorylated on Ser17, because the different N-PTH immunoreactivities in the wPTH and tPTH assays have been associated with the 15-20 region of the PTH structure (2,4,5) and because phosphorylation of hPTH(1-84) in the 1-34 region has previously been demonstrated (10).
Cinacalcet is effective in reducing calcium concentrations in parathyroid cancer patients and causes a small decrease in tPTH concentrations, although only in patients with a low wPTH:tPTH ratio.