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Adrenal responses to subtotal parathyroidectomy for primary hyperparathyroidism

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Summary

Although it is well known that hypertension is often associated with primary hyperparathyroidism and that parathyroidectomy reverses or reduces this abnormality, the etiology of elevated blood pressure in hyperparathyroidism is still conjectural. We have analyzed serum calcium, blood pressure, and metabolites of adrenal cortical hormones before and after surgical therapy for hyperparathyroidism in 10 normotensive and six hypertensive patients with primary hyperparathyroidism. Successful parathyroidectomy lowered serum calcium (P<0.01) and diastolic blood pressure (P<0.05) in all subjects. Mean urinary aldosterone and Porter-Silber chromagens were within normal limits preoperatively in normotensive as well as hypertensive subjects. After parathyroidectomy, aldosterone levels as well as Porter-Silber chromagens decreased significantly in all patients (P<0.01). However, when normotensive and hypertensive subjects were analyzed separately, the decrease in aldosterone levels was significant only in the normotensive group (P<0.05) whereas the decrease in Porter-Silber chromagens reached significancy only in the hypertensive group (P<0.01). The results indicate that surgical therapy for hyperparathyroidism lowers serum calcium and blood pressure and is associated with a decrease in the excretion of adrenal steroid metabolites. It is suggested that the temporal relationship which exists between ionized calcium and steroidogenesis in hyperparathyroid patients contributes at least in part to the generalized decrease in blood pressure observed after successful parathyroidectomy.

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Authors and Affiliations

  1. Division of Bone and Mineral Metabolism, Jewish Hospital of St. Louis at Washington, University School of Medicine, St. Louis, Missouri

    Roberto Pacifici M.D., Donna M. Droke & Louis V. Avioli

  2. Department of Surgery, Jewish Hospital of St. Louis at Washington, University School of Medicine, St. Louis, Missouri

    William Shieber

  3. Division of Endocrinology, St. Louis University School of Medicine, St. Louis, Missouri

    Horace M. Perry III

  4. Division of Endocrinology, University of California at San Francisco Medical School, 216 South Kingshighway, 63110, San Francisco, California

    Edward Biglieri

Authors
  1. Roberto Pacifici M.D.
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  2. Horace M. Perry III
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  3. William Shieber
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  4. Edward Biglieri
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  5. Donna M. Droke
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  6. Louis V. Avioli
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Pacifici, R., Perry, H.M., Shieber, W. et al. Adrenal responses to subtotal parathyroidectomy for primary hyperparathyroidism. Calcif Tissue Int 41, 119–123 (1987). https://doi.org/10.1007/BF02563790

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  • DOI: https://doi.org/10.1007/BF02563790

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