The Relation of Serum Phosphates to Parathyroid Tetany”

As early as 1911 Greenwald (1) showed that one of the first detectable results of the removal of the parathyroid glands was a decreased excretion of phosphorus in the urine. In 1913 he (2) extended these studies to show that the effect was on phosphorus directly and not on sodium or potassium. Some years later Greenwald (3) again drew attention to these findings. However, little emphasis was given to phosphorus in its relation to the function of the parathyroid glands until the work of Albright, Bauer, Ropes, and Aub. In 1929 they (4) presented evidence to indicate that the primary action of the parathyroid hormone is on renal excretion of phosphorus. In a later publication Albright and Ellsworth (5) expressed the belief that the whole effect of the parathyroid secretion on the calcium and phosphorus levels of the blood could be explained on the basis of a variation in the ability of the kidney to excrete phosphorus. They believe that in hypoparathyroidism there is a retention of phosphate which forces the concentration of calcium down. The reverse is true during hyperparathyroidism, in which there is a loss of phosphorus with a subsequent solution of calcium phosphate from the skeleton. Albright, Bauer, Claflin, and Cockrill (6) are of the opinion that there is a definite renal threshold for phosphorus; in hypoparathyroidism the threshold is raised and in hyperparathyroidism it is lowered. This idea has been further developed by Ellsworth (7).