The influence of calcium intake and the status of intestinal calcium absorption on the diagnostic utility of measurements of 24-hour cyclic adenosine 3',5'-monophosphate excretion.

Twenty-five normal subjects, 45 patients with idiopathic hypercalciuria, and 50 patients with primary hyperparathyroidism were studied with an oral calcium tolerance test and with measurements of 24-h calcium and total cAMP excretion on defined 400-mg and 1000-mg calcium diets. There was a strong positive correlation (r = 0.62; P less than 0.001) between the calciuric response to the tolerance test and the increase in calcium excretion on the 100-mg relative to the 400-mg calcium diet. The increase in daily calcium intake was associated with a significant (P less than 0.001) suppression in total cAMP excretion in each patient group. The suppression in cAMP excretion was sufficient to completely segregate patients with absorptive hypercalciuria from those with renal hypercalciuria on the 1000-mg calcium diet (ranges, 1.24-3.50 and 3.97-4.87 nmol/100 ml glomerular filtrate, respectively). In patients with primary hyperparathyroidism, results for total cAMP excretion were elevated in 48 (96%) patients on the restricted calcium diet but were within the normal range in 14 (28%) patients on the high-normal calcium diet. Net intestinal calcium absorption has a prominent influence on results for 24-h total cAMP excretion, which may be used to diagnostic advantage or seriously impair diagnostic accuracy, depending upon the patient population and the conditions of study.