{"id":9280,"date":"2020-04-23T04:33:31","date_gmt":"2020-04-23T01:33:31","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/pth-parathormon-intact\/"},"modified":"2026-02-19T00:18:05","modified_gmt":"2026-02-18T22:18:05","slug":"pth-parathormon-intact","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/pth-parathormon-intact\/","title":{"rendered":"\u041f\u0422\u0413 (\u0438\u043d\u0442\u0430\u043a\u0442\u043d\u044b\u0439 \u043f\u0430\u0440\u0430\u0442\u0438\u0440\u0435\u043e\u0438\u0434\u043d\u044b\u0439 \u0433\u043e\u0440\u043c\u043e\u043d)"},"content":{"rendered":"<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/em><\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Glandele paratiroide secret\u0103 un hormon cu structura polipeptidic\u0103 numit <em>parathormon <\/em>(PTH). Rolul fiziologic al paratiroidelor se exercit\u0103 prin intermediul acestui hormon, care ac\u0163ioneaz\u0103 at\u00e2t asupra oaselor, c\u00e2t \u015fi asupra rinichilor, men\u0163in\u00e2nd \u00een limite fiziologice raportul calciu\/fosfor<sup>1;6<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Molecula parathormonului intact este un polipeptid ce con\u0163ine 84 aminoacizi, av\u00e2nd o mas\u0103 molecular\u0103 de 9500Da. Biosinteza sa se realizeaz\u0103 sub forma unui pre-pro-hormon cu 115 resturi de aminoacizi. Din clivarea acestuia la nivel ribozomal rezult\u0103 pro-hormonul cu 90 aminoacizi, care este transportat \u00een aparatul Golgi \u015fi convertit\u00a0\u00een PTH propriu-zis. Secre\u0163ia PTH \u015fi eliberarea sa\u00a0\u00een circula\u0163ia sanguin\u0103 se realizeaz\u0103 prin exocitoz\u0103<sup>1;4<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Rinichiul \u015fi ficatul \u00eendep\u0103rteaz\u0103 rapid din circula\u0163ie PTH-ul intact. Metabolismul PTH este complex; produ\u015fii forma\u0163i prezint\u0103 reactivit\u0103\u0163i biologice \u015fi imunologice variate. Astfel, la nivel hepatic PTH sufer\u0103 un proces de clivare \u015fi metabolizare ce are ca rezultat generarea fragmentelor carboxil-terminale (PTH-C), amino-terminale (PTH-N) \u015fi a celor provenite din por\u0163iunea mijlocie a moleculei (PTH-M)<sup>8;9<\/sup>. Numai acele por\u0163iuni ale moleculei care con\u0163in gruparea amino-terminala (\u00eentreaga molecul\u0103 \u015fi PTH-N) sunt biologic active \u015fi au un timp de \u00eenjum\u0103t\u0103\u0163ire de 5 minute. Fragmentele PTH-C inactive, cu un timp de \u00eenjum\u0103t\u0103\u0163ire de 24-36 ore, constituie &gt;90% din PTH-ul circulant total \u015fi sunt metabolizate\u00a0\u00een principal la nivel renal. La pacien\u0163ii cu insuficien\u0163\u0103 renal\u0103 fragmentele PTH-C se pot acumula\u00a0\u00een cantit\u0103\u0163i crescute<sup>8<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Principalul factor ce regleaz\u0103 secre\u0163ia de PTH este calciul ionic din plasm\u0103. Hipocalcemia are efecte stimulatorii, iar hipercalcemia inhib\u0103 secre\u0163ia hormonului, prin ac\u0163iunea direct\u0103 a calciului asupra celulelor principale din \u0163esutul glandular paratiroidian, la nivelul unui receptor membranar cu rol de \u201esenzor\u201d pentru nivelul calciului \u2013 CASR<sup>9<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Ionii fosfat nu intervin direct asupra paratiroidei, ci prin intermediul modific\u0103rilor produse \u00een concentra\u0163ia ionilor de calciu. Cre\u015fterea nivelului de fosfa\u0163i din plasm\u0103, \u00eenso\u0163indu-se de sc\u0103derea calciului, determin\u0103 activarea secre\u0163iei de PTH \u015fi invers, cu repercursiunile respective asupra elimin\u0103rii urinare a acestora.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Vitamina D<sub>3 <\/sub>exercit\u0103 efecte inhibitorii asupra secre\u0163iei de PTH, prin reac\u0163ii de feed-back negativ realizate de excesul de calciu seric. In general, reac\u0163iile de reglare a secre\u0163iei de PTH sunt cuplate cu ale calcitoninei, mai ales la copii \u015fi tineri<sup>4;7<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Principala func\u0163ie a PTH-ului este men\u0163inerea concentra\u0163iei calciului ionic \u00een lichidul extracelular; aceasta se realizeaz\u0103 prin urm\u0103toarele mecanisme:<\/span><\/p>\n<ul>\n<li style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">stimularea resorb\u0163iei osoase, cu eliberarea calciului \u015fi fosforului din oase; PTH-ul nu exercit\u0103 un efect direct asupra osteoclastelor mature, ci mediaz\u0103 diferen\u0163erea celulelor preosteosclatice \u00een osteoclaste active;<\/span><\/li>\n<li style=\"text-align: justify;\">stimularea reabsorb\u0163iei calciului \u015fi inhibarea reabsorb\u0163iei fosforului la nivelul tubilor renali;<\/li>\n<li style=\"text-align: justify;\">stimularea sintezei de 1 alfa-hidroxilaza renal\u0103 cu cre\u015fterea consecutiv\u0103 a produc\u0163iei de 1,25-(OH) vitamina D, care la r\u00e2ndul s\u0103u va cre\u015fte absorb\u0163ia intestinal\u0103 de calciu \u015fi fosfor.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Por\u0163iunea amino-terminal\u0103 a PTH-ului se leag\u0103 de un receptor specific la nivelul organelor-\u0163int\u0103 care moduleaz\u0103 adelat ciclaza \u015fi fosfolipaza C. Muta\u0163iile activatoare ale acestui receptor cauzeaz\u0103\u00a0 condrodisplazia Jansen cu hipercalcemie \u015fi modific\u0103ri ale metafizelor osoase<sup>9<\/sup>. In cazuri rare de sindroame mo\u015ftenite asociate cu rezisten\u0163a sau lipsa de r\u0103spuns la PTH, precum \u015fi \u00een insuficien\u0163a renal\u0103 eliberarea PTH nu are ca rezultat cre\u015fterea calcemiei<sup>8<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Efectul net al PTH la nivel renal, osos \u015fi, indirect, intestinal este reprezentat de cre\u015fterea concentra\u0163iei de calciu seric \u015fi ionic \u015fi sc\u0103derea concentra\u0163iei de fosfor seric<sup>9<\/sup>. \u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">In afara ac\u0163iunii cuplate asupra balan\u0163ei fosfo-calcice, PTH cre\u015fte reabsorb\u0163ia ionilor de magneziu \u015fi hidrogen, \u00een timp ce o scade pe cea a sodiului, potasiului, aminoacizilor. PTH inhib\u0103 de asemenea reabsorb\u0163ia bicarbonatului\u00a0\u00een tubul proximal, \u00eentr-un mod asem\u0103n\u0103tor aceleia a fosfatului<sup>7<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Hiperparatiroidismul determin\u0103 hipercalcemie, hipofosfatemie, hipercalciurie \u015fi hiperfosfaturie. Consecin\u0163ele pe termen lung sunt: deshidratare, litiaza renal\u0103, hipertensiune, tulbur\u0103ri gastrointestinale, osteoporoz\u0103 \u015fi uneori tulbur\u0103ri neuropsihice. Cel mai frecvent hiperparatiroidismul este primar fiind cauzat de adenoame paratiroidiene. Hiperparatiroidismul secundar se dezvolt\u0103 ca r\u0103spuns la hipocalcemie \u015fi hiperfosfatemie; cauza cea mai frecvent\u0103 este insuficien\u0163a renal\u0103 cronic\u0103. Un hiperparatiroidism secundar vechi se poate complica cu un hiperparatiroidism ter\u0163iar, care const\u0103 \u00een dezvoltarea unei hipersecre\u0163ii paratiroidiene autonome. Cazuri rare de hiperparatiroidism benign sunt consecin\u0163a unor muta\u0163ii inactivatoare ale CASR.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Hipoparatiroidismul este cel mai adesea consecin\u0163a interven\u0163iilor chirurgicale pe tiroid\u0103, dar se poate produce de asemenea \u015fi printr-un mecanism autoimun sau ca urmare a unor muta\u0163ii activatoare CASR. Se manifest\u0103 prin hipocalcemie, cu tetanie \u015fi posibil atrofie de nerv optic<sup>8<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Recomand\u0103ri pentru determinarea PTH\u00ad <\/em><\/strong><em>- <\/em>diagnosticul afec\u0163iunilor parotidiene (tumori, hiperplazii); diagnosticul altor afec\u0163iuni care altereaz\u0103 balan\u0163a fosfo-calcic\u0103; monitorizarea pacien\u0163ilor cu dializ\u0103 renal\u0103<sup>6<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Preg\u0103tire pacient <\/em><\/strong><em>- <\/em>obligatoriu \u00e0 jeun;<\/span><\/p>\n<ul>\n<li style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">exist\u0103 o varia\u0163ie diurn\u0103 a nivelului de PTH \u00een s\u00e2nge; recoltarea pentru determinarea PTH se face diminea\u0163a, c\u00e2nd nivelul s\u0103u este minim;<\/span><\/li>\n<li style=\"text-align: justify;\">se recomand\u0103 determinarea simultan\u0103 de calciu total, calciu ionic, fosfor, magneziu; este util\u0103 \u015fi determinarea creatininei sanguine<sup>5<\/sup><span style=\"font-size: 12pt;\">.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Specimen recoltat <\/em><\/strong><em>- <\/em>\u0432\u0435\u043d\u043e\u0437\u043d\u0430\u044f \u043a\u0440\u043e\u0432\u044c<sup>5<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Recipient de recoltare <\/em><\/strong><em>- <\/em>vacutainer f\u0103r\u0103 anticoagulant, cu\/f\u0103r\u0103 gel separator<sup>5<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Cauze de respingere<\/em><\/strong> <strong><em>a probei <\/em><\/strong>\u2013 specimen intens hemolizat<sup>5<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Prelucrare necesar\u0103 dupa recoltare <\/em><\/strong><em>- <\/em>se separ\u0103 c\u00e2t mai repede serul prin centrifugare<sup>5<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Volum prob\u0103<\/em><\/strong> \u2013 minim 0.5 mL ser<sup>5<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Stabilitate prob\u0103 <\/em><\/strong><em>- <\/em>serul separat este stabil <em>6 ore<\/em> temperatura camerei, <em>24 ore<\/em> la 2-8\u00b0C \u015fi\u00a0 <em>timp \u00eendelungat<\/em> la <\/span><span style=\"font-size: 12pt;\">-20\u00b0C sau la -70\u00b0C; nu decongela\u0163i\/recongela\u0163i<sup>5<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Metod\u0103 <\/em><\/strong>- <span style=\"text-decoration: underline;\">imunochimic\u0103 cu detec\u0163ie prin electrochemiluminiscen\u0163\u0103 (ECLIA)<\/span>; se determin\u0103 <em>PTH intact \u015f<\/em>i se elimin\u0103 astfel interferen\u0163a exercitat\u0103 de metaboli\u0163i; cei 2 anticorpi monoclonali utiliza\u0163i reac\u0163ioneaz\u0103 cu epitopi corespunz\u0103tori regiunilor de aminoacizi 26-32 \u015fi 37-42 din molecula PTH<sup>5<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Valori de referin\u0163\u0103 <\/em><\/strong><em>- <\/em>15-65 pg\/mL<sup>5<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Limita de detec\u0163ie <\/em><\/strong>\u2013 1.20 pg\/mL<sup>5<\/sup>. <strong><em>\u00a0<\/em><\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Interpretarea rezultatelor<\/em><\/strong><\/span><\/p>\n<p style=\"text-align: justify; padding-left: 30px;\"><span style=\"font-size: 12pt;\"><strong><span style=\"text-decoration: underline;\">Cre\u015fteri<\/span>:<\/strong> hiperparatiroidism primar, hiperparatiroidism secundar, sindrom Zollinger-Ellison, formele ereditare de rahitism dependent de vitamina D, leziuni ale m\u0103duvei spin\u0103rii.<\/span><\/p>\n<p style=\"text-align: justify; padding-left: 30px;\"><span style=\"font-size: 12pt;\"><strong><span style=\"text-decoration: underline;\">Sc\u0103deri<\/span>:<\/strong> hipoparatiroidism prin mecanism autoimun sau indus chirurgical, hipercalcemie de cauz\u0103 non-paratiroidian\u0103, deficit de magneziu, sarcoidoz\u0103, hipertiroidism, sindrom DiGeorge<sup>2;6<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">In tabelul de mai jos sunt prezentate nivelele \u00eenregistrate de PTH \u015fi calciu seric\u00a0\u00een diverse afec\u0163iuni<sup>6<\/sup>:<\/span><\/p>\n<table class=\"wp-block-table w-100\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\"><strong><em>PTH intact (pg\/mL)<\/em><\/strong><\/span><\/p>\n<\/td>\n<td width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\"><strong><em>Calciu seric (mg\/dL)<\/em><\/strong><\/span><\/p>\n<\/td>\n<td width=\"276\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\"><strong><em>Interpretare<\/em><\/strong><\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">15-65<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">8.6-10.2<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"276\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">Normal<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">&gt;65<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">&gt;10.2<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"276\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">Hiperparatiroidism primar<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">&gt;65<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">&lt;10.2<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"276\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">Hiperparatiroidism secundar<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">&lt;65<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">&gt;10.2<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"276\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">Hipercalcemie de cauz\u0103 non-paratiroidian\u0103<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">&lt;15<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">&lt;8.6<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"276\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">Hipoparatiroidism<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">15-65<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"144\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">&lt;8.6<\/span><\/p>\n<\/td>\n<td valign=\"top\" width=\"276\">\n<p style=\"text-align: center;\"><span style=\"font-size: 10pt;\">Hipocalcemie de cauz\u0103 non-paratiroidian\u0103<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Aproximativ 90% dintre pacien\u0163ii cu hiperparatirodism primar au niveluri crescute de PTH; restul pacien\u0163ilor prezint\u0103 niveluri normale de PTH, dar inadecvate fa\u0163\u0103 de valoarea calcemiei. La ~40% dintre pacien\u0163ii cu hiperparatiroidism primar nivelul fosforului seric este &lt;2.5 mg\/dL \u015fi la ~80% nivelul fosforului este &lt;3 mg\/dL.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Un nivel sc\u0103zut (adecvat) de PTH \u00eenso\u0163it de un nivel crescut al fosforului la un pacient hipercalcemic indic\u0103 faptul c\u0103 hipercalcemia nu este cauzat\u0103 de PTH sau de molecule asem\u0103n\u0103toare acestuia.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Un nivel sc\u0103zut (adecvat) \u00eenso\u0163it de un nivel sc\u0103zut al fosforului la un pacient hipercalcemic este sugestiv pentru diagnosticul de hipercalcemie paraneoplazic\u0103 determinat\u0103 de PTHRP (parathyroid-related peptide). Aceast\u0103 molecul\u0103 prezint\u0103 omologie amino-terminal\u0103 cu PTH \u015fi poate transactiva receptorul PTH. Poate fi produs\u0103 de multe tipuri de tumori.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">O valoare sc\u0103zut\u0103 sau normal\u0103 a PTH la un pacient cu hipocalcemie sugereaz\u0103 hipoparatiroidism cu condi\u0163ia ca nivelul magneziului s\u0103 fie normal. Hipomagneziemia inhib\u0103 eliberarea \u015fi exercitarea ac\u0163iunilor PTH putand astfel mima hipoparatiroidismul.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Hipocalcemia asociat\u0103 cu valori crescute PTH la un pacient cu func\u0163ie renal\u0103 normal\u0103 sugereaz\u0103 rezisten\u0163a la ac\u0163iunile PTH (pseudohipoparatiroidism tip 1a, 1b, 1c sau 2) sau, foarte rar, un PTH cu activitate biologic\u0103 ineficient\u0103.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Un num\u0103r limitat de fragmente PTH-C care se acumuleaz\u0103 \u00een insuficien\u0163a renal\u0103, \u00een principal PTH 7-84, reac\u0163ioneaz\u0103 \u00eencruci\u015fat \u00een acest test. PTH intact \u00eenregistreaz\u0103 de asemenea valori crescute \u00een insuficien\u0163a renal\u0103, cre\u015fterile u\u015foare fiind considerate benefice (compenseaz\u0103 rezisten\u0163a la PTH a organelor \u0163int\u0103). In consecin\u0163\u0103, concentra\u0163iile de 1.5-3 ori mai mari fa\u0163\u0103 de limita superioar\u0103 a valorilor de referin\u0163\u0103 sunt optime \u00een cazul pacien\u0163ilor afla\u0163i \u00een faza terminal\u0103 a insuficien\u0163ei renale. La aceast\u0103 categorie de pacien\u0163i concentra\u0163iile mai sc\u0103zute de PTH pot fi asociate cu afectare osoas\u0103 adinamic\u0103, \u00een timp ce valorile mai mari sugereaz\u0103 un posibil hiperparatiroidism secundar sau ter\u0163iar ce poate conduce la osteodistrofie renal\u0103 cu turn-over osos crescut.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Unii pacien\u0163i cu hipercalcemie moderat\u0103 \u015fi niveluri de fosfor variabile, care au fie un PTH u\u015for crescut, fie normal (inadecvat) pot suferi de hipercalcemie hipocalciurica idiopatic\u0103 cauzat\u0103 de o muta\u0163ie inactivatoare CASR<sup>8<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\"><strong><em>Limite \u015fi interferen\u0163e<\/em><\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Deficien\u0163a de vitamina D induce cre\u015fterea nivelului de PTH. Sindromul lapte-alcaline (Burnett) poate determina o fals\u0103 sc\u0103dere a nivelurilor de PTH<sup>1;2;7<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Fragmentul PTH-C 7-84, care se acumuleaz\u0103 \u00een insuficien\u0163a renal\u0103, prezint\u0103 o reactivitate \u00eencruci\u015fat\u0103 semnificativ\u0103\u00a0\u00een cadrul acestui test. Din acest motiv, la pacien\u0163ii cu insuficien\u0163\u0103 renal\u0103 nu se vor aplica valorile de referin\u0163\u0103 pentru popula\u0163ia s\u0103n\u0103toas\u0103<sup>8<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">\u2022 Medicamente<\/span><\/p>\n<p style=\"text-align: justify; padding-left: 30px;\"><span style=\"font-size: 12pt;\"><strong><span style=\"text-decoration: underline;\">Cre\u015fteri<\/span>:<\/strong> ciclosporina, fenitoin, foscarnet, hormon uman de cre\u015ftere, hidrocortizon, izoniazida, ketoconazol, litiu, nifedipina, pamidronat, prednison, tamoxifen, terapie estro-progestativ\u0103, verapamil<sup>3<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify; padding-left: 30px;\"><span style=\"font-size: 12pt;\"><strong><span style=\"text-decoration: underline;\">Sc\u0103deri<\/span>:<\/strong> calcitriol, cimetidina, contraceptive orale, diltiazem, famotidina, gentamicina, hidroxid de aluminiu, pindolol, prednison, sulfat de magneziu, tiazide, vitamina D<sup>3<\/sup>.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">\u2022 Interferen\u0163e analitice<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 12pt;\">Pot produce interferen\u0163e cu unele componente ale kit-ului \u015fi conduce la rezultate neconcludente urm\u0103toarele:<\/span><\/p>\n<div style=\"text-align: justify; padding-left: 30px;\"><span style=\"font-size: 12pt;\">\u2013 tratamentul cu biotin\u0103 \u00een doze mari (&gt;5 mg\/zi); de aceea se recomand\u0103 ca recoltarea de s\u00e2nge s\u0103 se fac\u0103 dup\u0103 minimum 8 ore de la ultima administrare;<\/span><\/div>\n<div style=\"text-align: justify; padding-left: 30px;\"><span style=\"font-size: 12pt;\">\u2013 titrurile foarte crescute de anticorpi anti-streptavidina \u015fi anti-ruteniu<sup>5<\/sup>.<\/span><\/div>\n<p style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt;\">\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n<div><span style=\"font-size: 12pt;\">1. <span style=\"font-size: 10pt;\">D.C.Cojocaru, Doina-Irina Cojocaru, Elena Ciornea. Biochimia hormonilor. CORSON, Romania, Ed. 1999, 76-80.<\/span><\/span><\/div>\n<div><span style=\"font-size: 10pt;\">2. Frances Fischbach. Overview of Chemistry Studies. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams &amp; Wilkins, USA, 8 Ed., 2009, 396-398.<\/span><\/div>\n<div><span style=\"font-size: 10pt;\">3. Frances Fischbach. Effects of the Most Commonly Used Drugs on Frequently Ordered Laboratory Tests. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams &amp; Wilkins, USA, 7 Ed., 2004, 1188-1238.<\/span><\/div>\n<div><span style=\"font-size: 10pt;\">4. Ion Haulica. Fiziologia uman\u0103, 2002, 823-832.<\/span><\/div>\n<div><span style=\"font-size: 10pt;\">5. Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate. 2010. Ref Type: Catalog.<\/span><\/div>\n<div><span style=\"font-size: 10pt;\">6. Laboratory Corporation of America. Directory of Services and Interpretive Guide. Parathyroid Hormone (PTH), Intact. www.labcorp.com 2010. Ref Type: Internet Communication.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">7. Lothar Thomas, Cristian Kasperk, Reinhard Ziegler. Parathyroid hormone. In Clinical Laboratory Diagnostics-Use and Assessment of Clinical Laboratory Results. Lothar Thomas. TH-Books Verlagsgesellschaft mbH, Frankfurt \/Main, Germany,.1 Ed., 1998, 248-250.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">8. Mayo Clinic. Mayo Medical Laboratories. Test Catalog: 25-Hydroxyvitamin D2 and D3, Serum. <a href=\"http:\/\/www.mayomedicallaboratories.com\" rel=\"nofollow noopener\" target=\"_blank\">www.mayomedicallaboratories.com<\/a>. Ref Type: Internet Communication.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">9. Richard A. Mc.Pherson, Mattew R. Pincus. Biochemical markers of bone metabolism. In Henry\u00b4S.Clinical Diagnosis and Management By Laboratory Methods, Ed.Saunders, 2007, 173-174.<\/span><\/div>","protected":false},"excerpt":{"rendered":"<p>\u041f\u0430\u0440\u0430\u0442\u0438\u0440\u0435\u043e\u0438\u0434\u043d\u044b\u0439 \u0433\u043e\u0440\u043c\u043e\u043d \u2013 \u043f\u043e\u043b\u0438\u043f\u0435\u043f\u0442\u0438\u0434 \u0441 \u043c\u043e\u043b\u0435\u043a\u0443\u043b\u044f\u0440\u043d\u043e\u0439 \u043c\u0430\u0441\u0441\u043e\u0439 \u043e\u043a\u043e\u043b\u043e 9,5 \u043a\u0414\u0430, \u043a\u043e\u0442\u043e\u0440\u044b\u0439 \u0432\u044b\u0440\u0430\u0431\u0430\u0442\u044b\u0432\u0430\u0435\u0442\u0441\u044f \u0432 \u043f\u0430\u0440\u0430\u0449\u0438\u0442\u043e\u0432\u0438\u0434\u043d\u044b\u0445 \u0436\u0435\u043b\u0435\u0437\u0430\u0445 \u0438 \u043e\u0431\u0435\u0441\u043f\u0435\u0447\u0438\u0432\u0430\u0435\u0442 \u043f\u043e\u0434\u0434\u0435\u0440\u0436\u0430\u043d\u0438\u0435 \u043d\u043e\u0440\u043c\u0430\u043b\u044c\u043d\u043e\u0439 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\u043a\u0440\u043e\u0432\u0438.<\/li>\n<\/ul>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[927],"product_tag":[],"class_list":{"0":"post-9280","1":"product","2":"type-product","3":"status-publish","5":"product_cat-markeri-ososi","7":"first","8":"instock","9":"sold-individually","10":"shipping-taxable","11":"purchasable","12":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/9280","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=9280"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=9280"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=9280"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=9280"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=9280"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}