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Adrenergic and cardiac dysfunction in primary hyperparathyroidism.

Birgander, Mats LU ; Juul-Möller, Steen LU ; Bondeson, Anne-Greth LU ; Bondeson, Lennart LU and Rydberg, Erik LU (2012) In Clinical Endocrinology 76. p.189-195
Abstract
Objective: Primary hyperparathyroidism (PHPT) is associated with cardiovascular morbidity and premature death but the underlying mechanisms are incompletely understood. The aim of this study was to investigate if adrenergic dysfunction may be a contributing factor. Patients and methods: Forty-nine patients with mild PHPT (serum calcium 2.7 ± 0.1 mmol/L) and 48 control subjects, matched for age and sex, were examined; patients within 1 month before parathyroidectomy (PTX) and 6 months postoperatively; control subjects at inclusion. Heart rate variability (HRV) was analyzed in 24-hour electrocardiograms, and plasma concentrations of epinephrine and norepinephrine were measured at rest and immediately after standardized physical tests.... (More)
Objective: Primary hyperparathyroidism (PHPT) is associated with cardiovascular morbidity and premature death but the underlying mechanisms are incompletely understood. The aim of this study was to investigate if adrenergic dysfunction may be a contributing factor. Patients and methods: Forty-nine patients with mild PHPT (serum calcium 2.7 ± 0.1 mmol/L) and 48 control subjects, matched for age and sex, were examined; patients within 1 month before parathyroidectomy (PTX) and 6 months postoperatively; control subjects at inclusion. Heart rate variability (HRV) was analyzed in 24-hour electrocardiograms, and plasma concentrations of epinephrine and norepinephrine were measured at rest and immediately after standardized physical tests. Results: At baseline, the patients showed, compared to the controls, reduced stress-related increase of circulating epinephrine (P < 0.05) and norepinephrine (P < 0.05). No significant change was observed 6 months after PTX. At baseline, there were no significant differences between patients and controls in HRV or heart rate but 6 months after curative PTX, the patients showed significantly reduced HRV in both frequency and time domain, and their maximum and average heart rate had decreased (P = 0.011 and P = 0.018, respectively). The patients with the highest preoperative levels of circulating parathyroid hormone showed the greatest changes in heart rate and HRV postoperatively. Conclusions: This study demonstrates a previously unknown impairment of catecholamine response to physical stress in PHPT along with changes of HRV, also indicating adrenergic dysfunction. These factors should be considered in the ongoing controversy regarding the management of patients with mild "asymptomatic" PHPT. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Clinical Endocrinology
volume
76
pages
189 - 195
publisher
Wiley-Blackwell
external identifiers
  • wos:000298790600006
  • pmid:21740454
  • scopus:84855461150
ISSN
1365-2265
DOI
10.1111/j.1365-2265.2011.04169.x
language
English
LU publication?
yes
id
33f8c2ce-c863-43f2-b3c2-7d0bf137c0ca (old id 2058797)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21740454?dopt=Abstract
date added to LUP
2011-08-01 13:58:09
date last changed
2017-11-05 04:42:57
@article{33f8c2ce-c863-43f2-b3c2-7d0bf137c0ca,
  abstract     = {Objective: Primary hyperparathyroidism (PHPT) is associated with cardiovascular morbidity and premature death but the underlying mechanisms are incompletely understood. The aim of this study was to investigate if adrenergic dysfunction may be a contributing factor. Patients and methods: Forty-nine patients with mild PHPT (serum calcium 2.7 ± 0.1 mmol/L) and 48 control subjects, matched for age and sex, were examined; patients within 1 month before parathyroidectomy (PTX) and 6 months postoperatively; control subjects at inclusion. Heart rate variability (HRV) was analyzed in 24-hour electrocardiograms, and plasma concentrations of epinephrine and norepinephrine were measured at rest and immediately after standardized physical tests. Results: At baseline, the patients showed, compared to the controls, reduced stress-related increase of circulating epinephrine (P &lt; 0.05) and norepinephrine (P &lt; 0.05). No significant change was observed 6 months after PTX. At baseline, there were no significant differences between patients and controls in HRV or heart rate but 6 months after curative PTX, the patients showed significantly reduced HRV in both frequency and time domain, and their maximum and average heart rate had decreased (P = 0.011 and P = 0.018, respectively). The patients with the highest preoperative levels of circulating parathyroid hormone showed the greatest changes in heart rate and HRV postoperatively. Conclusions: This study demonstrates a previously unknown impairment of catecholamine response to physical stress in PHPT along with changes of HRV, also indicating adrenergic dysfunction. These factors should be considered in the ongoing controversy regarding the management of patients with mild "asymptomatic" PHPT.},
  author       = {Birgander, Mats and Juul-Möller, Steen and Bondeson, Anne-Greth and Bondeson, Lennart and Rydberg, Erik},
  issn         = {1365-2265},
  language     = {eng},
  pages        = {189--195},
  publisher    = {Wiley-Blackwell},
  series       = {Clinical Endocrinology},
  title        = {Adrenergic and cardiac dysfunction in primary hyperparathyroidism.},
  url          = {http://dx.doi.org/10.1111/j.1365-2265.2011.04169.x},
  volume       = {76},
  year         = {2012},
}