Ethinyl Estradiol and Norethindrone in the Treatment of Primary Hyperparathyroidism in Postmenopausal Women

Peter L. Selby, Munro Peacock

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Abstract

Treatment with ethinyl estradiol or norethindrone reduces the bone-turnover rate and plasma calcium levels in normal postmenopausal women, without affecting the secretion of calcium-regulating hormones. To assess the effect of these sex steroids in patients with primary hyperparathyroidism, we treated postmenopausal women who had hyperparathyroidism with either ethinyl estradiol (n = 6) or norethindrone (n = 11). After three weeks of treatment, the bone-turnover rate declined and plasma calcium fell from a mean (±1 SE) of 2.77±0.07 mmol per liter (11.1±0.3 mg per deciliter) to 2.58+0.05 mmol per liter (10.3±0.2 mg per deciliter; P<0.01) in the group treated with ethinyl estradiol, and from 2.93±0.08 mmol per liter (11.7±0.3 mg per deciliter) to 2.84±0.08 mmol per liter (11.4±0.3 per deciliter; P<0.05) in the patients who received norethindrone. No significant changes in the plasma levels of parathyroid hormone, calcitonin, or calcitriol were observed after the estrogen-induced increases in vitamin D–binding protein had been taken into account. Since the decline in plasma calcium levels did not stimulate secretion of parathyroid hormone, we conclude that treatment with either sex steroid resets the threshold for secretion of parathyroid hormone. Thus, although the reductions in plasma calcium levels were moderate, sex-hormone therapy may be useful in the treatment of mild hyperparathyroidism in postmenopausal women. (N Engl J Med 1986;314:1481–5.), WE have previously shown that administration of estrogen to normal postmenopausal women reduces both the plasma calcium concentration and the urinary calcium excretion within three weeks.1 These effects result from a decrease in the rate of bone resorption, and they do not appear to be associated with changes in the plasma concentration of the calcium-regulating hormones (parathyroid hormone, calcitonin, and calcitriol) after estrogen-induced changes in the plasma concentration of vitamin D–binding protein have been taken into account.1 This correction is necessary because most calcitriol in plasma is bound to vitamin D-binding protein, which, like other binding proteins, is increased by…

Original languageEnglish (US)
Pages (from-to)1481-1485
Number of pages5
JournalNew England Journal of Medicine
Volume314
Issue number23
DOIs
StatePublished - Jun 5 1986

ASJC Scopus subject areas

  • Medicine(all)

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