Adrenergic and cardiac dysfunction in primary hyperparathyroidism.
(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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/2058797
- author
- Birgander, Mats LU ; Juul-Möller, Steen LU ; Bondeson, Anne-Greth LU ; Bondeson, Lennart LU and Rydberg, Erik LU
- organization
- publishing date
- 2012
- 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
- pmid:21740454
- ISSN
- 1365-2265
- DOI
- 10.1111/j.1365-2265.2011.04169.x
- language
- English
- LU publication?
- yes
- additional info
- The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Internal Medicine Research Unit (013242520), Pathology (Malmö) (013031000), Emergency medicine/Medicine/Surgery (013240200)
- 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
- 2016-04-04 08:21:51
- date last changed
- 2022-02-20 21:39:53
@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 < 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.}},
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}},
doi = {{10.1111/j.1365-2265.2011.04169.x}},
volume = {{76}},
year = {{2012}},
}