Premenstrual Syndrome
Longstanding primary hyperparathyroidism has been classically associated with mood responses, sometimes characterized as "difficult to deal with" and "cussedness." Thys-Jacobs and coworkers, reflecting on the symptom complex known as premenstrual syndrome (PMS) noted a similarity to certain of the symptoms of hyperparathyroidism and hypothesized that there might be a connection between PMS and the PTH-calcium economy. In a small randomized crossover trial, they showed significant reduction of PMS symptoms on daily supplementation with 1000 mg calcium. Because of the inherently subjective character of PMS Symptoms, a multicenter trial was organized so as to circumvent potential objections of nreproducibility. This trial, treating 466 women at 12 US medical centers, showed nclusively that supplementation with 30 mmol (1200 mg) calcium reduced PMS symptom erity by as much as 50% or more. A small number of other studies have yielded concordant llateral data. Thus, Lee and Kanis showed that women with established vertebral osteoporosis re more likely to have had severe PMS during their reproductive years than age-matched ntrol subjects. This association between the two conditions is unsurprising, as low calcium take may be a predisposing factor for each.
Similarly, Thys-J acobs and coworkers have shown lower values for bone mass at the spine and hip in menstruating women with PMS than in controls, as well as significantly higher PTH values at the time of the luteinizing hormone peak in women with PMS. As with the hypertensive disorders, there is consistency across all the lines of evidence. Nevertheless, how the pieces of the puzzle fit together remains unclear. Even whether PTH is the trigger
uncertain.
However, reduced PTH production is one of the most rapidly occurring changes produced by increasing calcium intake, and elevated PTH can be considered a plausible candidate for the pathogenesis of PMS until proved otherwise. Still, since not every woman with low calcium intake and/or a high PTH gets PMS, and since relief of symptoms with calcium is often not complete, there must be other contributing factors. However, this is true of this entire group of disorders associated \vith the adaptive response to a low calcium intake.
