Background: Parathyroid hormone (PTH) is important in the assessment of calcium metabolism disorders. However, there are few data regarding PTH levels in childhood and adolescence. Aim: The aim of this study was to determine PTH levels in a large group of healthy children and adolescents. Patients and Methods: We retrospectively evaluated PTH levels in 1,580 healthy Caucasian children and adolescents (849 females, 731 males, aged 2.0-17.2 years) with 25-hydroxyvitamin D [25(OH)D] levels ≥30 ng/ml. All subjects with genetic, endocrine, hepatic, renal, or other known diseases were excluded. Results: The serum intact PTH concentration (median and inter-quartile range) was 23.00 (15.00-31.60) pg/ml. In our population, the mean 25(OH)D value was 34.27 ± 4.12 ng/ml. The median PTH concentration in boys was 23.00 (15.00-32.00) pg/ml, whereas in girls it was 23.10 (15.00-31.10) pg/ml. However, in girls, PTH levels significantly increased in the age group of 8.1-10.0 years compared to the age group of 2.1-4.0 years (p < 0.0001), whereas in boys it significantly increased in the age groups of 10.1-12.0 years (p < 0.0001) and 12.1-14.0 years (p < 0.0001), leading to the hypothesis of a relationship between PTH level and pubertal and bone growth spurts. Conclusions: PTH levels in healthy children and adolescents covered a narrower range than the adult values. Obtaining reference values of PTH in childhood and adolescence could aid in the estimation of appropriate values of bone metabolites.

1.
Bachrach LK: Acquisition of optimal bone mass in childhood and adolescence. Trends Endocrinol Metab 2001;12:22-28.
2.
Klaus G, Jux C, Leiber K, Hügel U, Mehls O: Interaction between insulin-like growth factor I, growth hormone, parathyroid hormone, 1 alpha,25-dihydroxyvitamin D3 and steroids on epiphyseal chondrocytes. Acta Paediatr Suppl 1996;417:69-71.
3.
Stagi S, Lapi E, Gambineri E, Manoni C, Genuardi M, Colarusso G, Conti C, Chiarelli F, de Martino M, Azzari C: Bone density and metabolism in subjects with microdeletion of chromosome 22q11 (del22q11). Eur J Endocrinol 2010;163:329-337.
4.
Akesson K: Biochemical markers of bone turnover. A review. Acta Orthop Scand 1995;66:376-386.
5.
Risteli L, Risteli J: Biochemical markers of bone metabolism. Ann Med 1993;25:385-393.
6.
Taylor AK, Lueken SA, Libanati C, Baylink DJ: Biochemical markers of bone turnover for the clinical assessment of bone metabolism. Rheum Dis Clin North Am 1994;20:589-607.
7.
Atapattu N, Shaw N, Högler W: Relationship between serum 25-hydroxyvitamin D and parathyroid hormone in the search for a biochemical definition of vitamin D deficiency in children. Pediatr Res 2013;74:552-556.
8.
Portale AA, Lonergan ET, Tanney DM, Halloran BP: Aging alters calcium regulation of serum concentration of parathyroid hormone in healthy men. Am J Physiol 1997;272:E139-E146.
9.
Roux S, Orcel P: Bone loss. Factors that regulate osteoclast differentiation: an update. Arthritis Res 2000;2:451-456.
10.
Koike T, Iwamoto M, Shimazu A, Nakashima K, Suzuki F, Kato Y: Potent mitogenic effects of parathyroid hormone (PTH) on embryonic chick and rabbit chondrocytes. Differential effects of age on growth, proteoglycan, and cyclic AMP responses of chondrocytes to PTH. J Clin Invest 1990;85:626-631.
11.
Mathias R, Salusky I, Harman W, Paredes A, Emans J, Segre G, Goodman W: Renal bone disease in pediatric and young adult patients on hemodialysis in a children's hospital. J Am Soc Nephrol 1993;3:1938-1946.
12.
Salusky IB, Ramirez JA, Oppenheim W: Biochemical markers of renal osteodystrophy in pediatric patients undergoing CAPD/CCPD. Kidney Int 1994;45:253-258.
13.
Goodman WG, Ramirez JA, Belin TR: Development of adynamic bone in patients with secondary hyperparathyroidism after intermittent calcitriol therapy. Kidney Int 1994;46:1160-1166.
14.
Block GA, Port FK: Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis 2000;35:1226-1237.
15.
Heaney RP: Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr 2004;80:1706S-1709S.
16.
Outila TA, Kärkkäinen MU, Lamberg-Allardt CJ: Vitamin D status affects serum parathyroid hormone concentrations during winter in female adolescents: associations with forearm bone mineral density. Am J Clin Nutr 2001;74:206-210.
17.
Cheng S, Tylavsky F, Kröger H, Kärkkäinen M, Lyytikäinen A, Koistinen A, Mahonen A, Alen M, Halleen J, Väänänen K, Lamberg-Allardt C: Association of low 25-hydroxyvitamin D concentrations with elevated parathyroid hormone concentrations and low cortical bone density in early pubertal and prepubertal Finnish girls. Am J Clin Nutr 2003;78:485-492.
18.
Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ: Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 1997;7:439-443.
19.
Tanner JM, Whitehouse RH: Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 1976;51:170-179.
20.
Stagi S, Galli L, Cecchi C, Chiappini E, Losi S, Gattinara CG, Gabiano C, Tovo PA, Bernardi S, Chiarelli F, de Martino M: Final height in patients perinatally infected with the human immunodeficiency virus. Horm Res Paediatr 2010;74:165-171.
21.
Lips P: Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001;22:477-501.
22.
Hill KM, McCabe GP, McCabe LD: An inflection point of serum 25-hydroxyvitamin D for maximal suppression of parathyroid hormone is not evident from multi-site pooled data in children and adolescents. J Nutr 2010;140:1983-1988.
23.
Diamond TH, Levy S, Smith A, Day P: High bone turnover in Muslim women with vitamin D deficiency. Med J Aust 2002;177:139-141.
24.
Gannagé-Yared MH, Chemali R, Yaacoub N: Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. J Bone Miner Res 2000;15:1856-1862.
25.
Shaw NJ, Wheeldon J, Brocklebank JT: Indices of intact serum parathyroid hormone and renal excretion of calcium, phosphate, and magnesium. Arch Dis Child 1990;65:1208-1211.
26.
Houghton LA, Gray AR, Harper MJ, Winichagoon P, Pongcharoen T, Gowachirapant S, Gibson RS: Vitamin D status among Thai school children and the association with 1,25-dihydroxyvitamin D and parathyroid hormone levels. PLoS One 2014;9:e104825.
27.
Chung IH, Kim HJ, Chung S, Yoo EG: Vitamin D deficiency in Korean children: prevalence, risk factors, and the relationship with parathyroid hormone levels. Ann Pediatr Endocrinol Metab 2014;19:86-90.
28.
Amini Z, Bryant S, Smith C, Singh R, Kumar S: Is the serum vitamin D-parathyroid hormone relationship influenced by obesity in children? Horm Res Paediatr 2013;80:252-256.
29.
Pappa HM, Mitchell PD, Jiang H, Kassiff S, Filip-Dhima R, DiFabio D, Quinn N, Lawton RC, Varvaris M, Van Straaten S, Gordon CM: Treatment of vitamin D insufficiency in children and adolescents with inflammatory bowel disease: a randomized clinical trial comparing three regimens. J Clin Endocrinol Metab 2012;97:2134-2142.
30.
Garnero P, Munoz F, Sornay-Rendu E, Delmas PD: Associations of vitamin D status with bone mineral density, bone turnover, bone loss and fracture risk in healthy postmenopausal women. The OFELY study. Bone 2007;40:716-722.
31.
Cioffi M, Corradino M, Gazzerro P, Vietri MT, Di Macchia C, Contursi A, Colicigno R, Catalano T: Serum concentrations of intact parathyroid hormone in healthy children. Clin Chem 2000;46:863-864.
32.
Larson NI, Neumark-Sztainer D, Harnack L, Wall M, Story M, Eisenberg ME: Calcium and dairy intake: longitudinal trends during the transition to young adulthood and correlates of calcium intake. J Nutr Educ Behav 2009;41:254-260.
33.
Lu HK, Zhang Z, Ke YH, He JW, Fu WZ, Zhang CQ, Zhang ZL: High prevalence of vitamin D insufficiency in China: relationship with the levels of parathyroid hormone and markers of bone turnover. PLoS One 2012;7: e47264.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.