Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests

Lafferty, F. W.

doi:10.1001/archinte.141.13.1761

Cited by 128 publications

(42 citation statements)

References 19 publications

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“…Although several common laboratory values such as the chloride phosphate ratio and serum albumin may serve as a guide for the differential diagnosis between PHP and hypercalcemia of malignancy (39,40), our data showed these values were less specific. Incorrect classification remained a significant problem, although 80 percent discrimination could be achieved by the chloride phosphate ratio and serum albumin using logistic regression analysis in our study.…”

Section: The Major Causes Of Hypercalcemia Were Found To Be Malignanccontrasting

confidence: 60%

The Causes of Hypercalcemia in Okinawan Patients: AnInternational Comparison

2007

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Section: The Major Causes Of Hypercalcemia Were Found To Be Malignanccontrasting

confidence: 60%

The Causes of Hypercalcemia in Okinawan Patients: AnInternational Comparison

2007

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“…34 " 37 The association initially was thought to be due to a direct effect of hypercalcemia on blood pressure, a pressor action of parathyroid hormone, or renal damage from antecedent stone disease. 33 The retrospective reports that blood pressure decreased following parathyroidectomy 33 -M supported these possibilities; however, in his prospective assessment Lafferty 36 indicated otherwise. First, he noted that the demographics of this clinical correlation were similar to that of hypertension in our society, that is, there was a greater prevalence among blacks and older persons.…”

Section: Calcium: the Case For A Protective Role Historical Perspectivementioning

confidence: 99%

Is calcium more important than sodium in the pathogenesis of essential hypertension?

McCarron¹

1985

Hypertension

161

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SUMMARY The hypothesis that abnormalities of calcium homeostasis at both an organ and cellular level are a primary factor in the pathogenesis of human and experimental hypertension forms the basis of this review. The rapidly expanding data base relating disordered calcium metabolism to altered vascular smooth muscle function and increased peripheral vascular resistance is summarized and integrated with the observations that reduced dietary calcium intake is the most consistent nutritional correlate of hypertension in the United States. The role of sodium and sodium chloride in pathogenesis of hypertension is reassessed in the light of new data from epidemiological clinical research, experimental models, and cell physiology investigations. The data supporting the thesis that the effects of sodium or chloride or both on blood pressure may represent, in selected situations, secondary influences mediated through induced changes in calcium homeostasis are presented. The interface between these nutritional factors and the normal regulation of vascular smooth muscle is discussed, providing a theoretical framework in which to assess the current information and to formulate the necessary future research. (Hypertension 7: 607-627, 1985) KEY WORDS • calcium • sodium • vascular smooth muscle cells • spontaneously hypertensive rats • deoxycorticosterone acetate rat • calmodulin • Ca -activated adenosine triphosphatase * nutrition F EW concepts in medicine are more widely accepted than the theoretical link between dietary sodium and the pathogenesis of essential hypertension.l-) In spite of this perceived consensus, however, many investigators have remained skeptical of the notion that sodium or a defect in sodium balance, or both, is the principal cause of high blood pressure in most humans with essential hypertension.

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“…Clinical presentation of PHPT has changed in recent decades due to the large availability of routine serum calcium measurements, and PHPT is often discovered by chance. The clinical features of PHPT are mostly mild and sometimes totally asymptomatic (10,12); however, an accurate evaluation can reveal some subclinical pathologies including cardiovascular system impairment, one of the most important target systems of PTH action (20,21).…”

Section: Introductionmentioning

confidence: 99%

Increased intima-media thickness of the carotid artery wall, normal blood pressure profile and normal left ventricular mass in subjects with primary hyperparathyroidism

Nuzzo

Tauchmanovà

Fonderico

et al. 2002

European Journal of Endocrinology

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Objective: Despite the increasing evidence that primary hyperparathyroidism (PHPT) contributes to greater risk of cardiovascular morbidity and mortality, its exact role in the development of cardiovascular changes and its clinical significance are still controversial. Given the multiple influence of PHPT on the cardiovascular system, this study aimed to assess the effects of PHPT on blood pressure profile, and on features of the heart and arterial vessels in normotensive symptomless patients. Design: Twenty patients (8 males and 12 females) with a median age of 51.5 years (range 44 to 65 years) were evaluated and the results were compared with those of 20 controls matched for age, gender and body mass index. Patients' parathyroid hormone levels ranged from 172 to 454 pg/ml and Ca levels ranged from 11.4 to 13.5 mg/dl. Fasting levels of glucose, insulin, total and high density lipoprotein cholesterol and triglycerides were within the normal range in all subjects recruited. Methods: Twenty-four-hour blood pressure profile, left ventricle (LV) dimension and carotid artery anatomy were investigated, the latter two by ultrasonography. Results: No difference was found between the patients and controls in blood pressure profile, when the following parameters were considered: supine systolic/diastolic pressure, average 24-h systolic, diastolic and mean arterial pressure, day-time mean arterial pressure and fall in nocturnal blood pressure (217% and 2 18% respectively). Heart rate and all parameters of LV mass were similar in patients and controls. The only alteration found in patients was in significantly greater carotid intimal-medial thickness (IMT) ðP , 0:001Þ: Atherosclerotic plaques were more frequent in patients than in controls, with a difference reaching a trend (40% vs 10%, x 2 ¼ 4:8; P ¼ 0:091). Considering that the carotid IMT is considered to be a marker of systemic atherosclerosis, our finding suggests early atherosclerotic changes in PHPT. No correlation was found between the severity and cardiovascular manifestation of PHPT. Conclusions: Vascular changes may occur due to a combination of structural and functional impairments in PHPT patients, likely as a result of altered calcium metabolism and impaired equilibrium of other factors regulating vascular function. Both extent and duration of PHPT can play a relative role in the development of cardiovascular complications. Considering that PHPT is now recognized as a quite common and often symptomless endocrine disorder, the evidence of cardiovascular manifestation in normotensive patients, found by this morphological study, suggests a possible implication for the management of such patients. In this light, screening for abnormalities in cardiovascular system function should be recommended in all PHPT subjects.

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Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests

Cited by 128 publications

References 19 publications

The Causes of Hypercalcemia in Okinawan Patients: AnInternational Comparison

The Causes of Hypercalcemia in Okinawan Patients: AnInternational Comparison

Is calcium more important than sodium in the pathogenesis of essential hypertension?

Increased intima-media thickness of the carotid artery wall, normal blood pressure profile and normal left ventricular mass in subjects with primary hyperparathyroidism

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