著者

家城 恭彦 宮腰 久嗣 永井 幸広 番度 行弘 臼田 里香 宮本 市郎 大沢 謙三 小林 健一

出版者

一般社団法人 日本内分泌学会

雑誌

日本内分泌学会雑誌 (ISSN:00290661)

巻号頁・発行日

vol.67, no.7, pp.755-763, 1991-07-20 (Released:2012-09-24)

参考文献数

16

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It is generally accepted that acromegaly is often associated with hypercalciuria, but there are few reports on the frequency and the mechanisms of urolithiasis. Recently we consecutively experienced 2 cases of acromegaly with urolithiasis, and these experiences made us investigate the association between urolithiasis and acromegaly.Among 18 acromegalies from 1977 to March 1990 (10 males, 8 females, 24-64 years old), 13 cases (72%) fulfilled the criteria of hypercalciuria (urinary calcium (u-Ca) ?200mg/day or u-Ca/urinary creatinine (u-Ca/u-Cr)?0.15), and 7 cases (39%) suffered from urolithiasis that was diagnosed by KUB (4 cases) or X- ray computed tomography (CT)(3 cases). Especially in the last 2 years, 5 out of 7 cases (71%) were complicated with urolithiasis and all 7 cases were associated with hypercalciuria. These results suggest that hypercalciuria and urolithiasis are both much more frequent than previously reported.In 6 cases who were treated by pituitary adenomectomy from 1988-1989 (4 males, 2 females, 24-59 years old), we examined Ca metabolism before and after operation. Before operation, the levels of serum growth hormone (GH), u-Ca (mg/day), u-Ca/u-Cr (in all cases) and plasma somatomedin -C (Sm-C) (in 4 cases) were increased above the normal range. To determine the etiology of hypercalciuria, we performed the oral Ca load test under restriction of Ca (400mg/day) and P (650mg/day) intake. The results suggested that the hypercalciuria might be mainly due to the increased absorption of Ca from the intestine (so-called ”Absorptive hypercalciuria”). However, the levels of serum vitamin D (Vit. D) metabolites were all within the normal range before operation. After operation, GH and u-Ca/u-Cr (in 5 cases) and u-Ca (mg/day) (in all cases) decreased significantly compared with before operation, and the levels of Sm- C (in all cases), serum 25-(OH) D3, 1α,25-(OH)2D3 (in 4 cases) and 24,25-(OH)2D3 (in 3 cases) were also reduced after operation. Surprisingly, u-Ca and u-Ca/u-Cr normalized only in 4 cases who showed a reduction in 1α,25- (OH)2D3 levels after operation, although there were no correlations between u-Ca (mg/day) or u-Ca/u-Cr and 1α, 25-(OH)2D3. Significant correlations were found between u-Ca (mg/day) or u-Ca/u-Cr and Sm-C. The parathyroid function evaluated by the rapid Ca infusion test or nephrogenous cyclic adenosine monophosphate (NcAMP) was normal before and after operation.In conclusion, the high frequency of urolithiasis in acromegaly observed in this study may be strongly ascribed to hypercalciuria, and the facts that (1) in the general population, the frequency of urolithiasis has increased and (2) our methods of confirming urolithiasis were more sensitive than those described in previous reports. The cause of hypercalciuria might be partly due to increased Ca absorption from the intestine mediated by 1α,25-(OH)2D3. Now we emphasize that urolithiasis in acromegaly is more common than previously considered, so it is important to prevent severe complications of urolithiasis by early diagnosis and treatment.