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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical spectrum of 100 consecutive cases of surgically proved primary hyperparathyroidism treated from 1974 through 1978 was analyzed. Their laboratory test results were compared with 64 cases of other form of hypercalcemia using multivariate discriminant analysis. The clinical spectrum has dramatically shifted during the past three decades from renal calculi and bone disease to the asymptomatic patient discovered by routine serum chemical analysis. Hypertension was twice as common among hyperparathyroid patients as in the general population but failed to improve in 92% after parathyroidectomy. The most useful discriminant laboratory test in descending order of value were the serum chloride, serum calcium, hematocrit, serum phosphorus, and parathormone. Multivariate discriminant analysis of the serum calcium, phosphorus, chloride, and Hct provided a 98% degree of accuracy in separating hyperparathyroidism from other forms of hypercalcemia.
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PMID:Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests. 731 24

Disorders of calcium metabolism are not generally considered important either clinically or pathophysiologically in essential hypertension. Recent reports, though, suggest that increased parathyroid gland function may be one of the more common endocrine disturbances associated with hypertension. We measured serum parathyroid hormone (PTH) concentrations as well as routine blood and urine chemistries in 34 hypertensives. Their mean PTH, 79.1 +/- 3.1 muliter Eq/muliter, was significantly higher (p less than 0.025) than the mean PTH, 66.9 +/- 3.3, of an age- and sex-matched normotensive control population. The mean serum calcium, 9.5 +/- 0.1 mg%, was identical in the two populations. Compared to a second age- and sex-matched normotensive population, the hypertensives demonstrated a significant (p less than 0.005) relative hypercalciuria. For any level of urinary sodium, hypertensives excreted more calcium. These preliminary data suggest that parathyroid gland function may be enhanced in essential hypertension. This increased gland activity appears, in part, to be an appropriate, physiologic response to a previously unrecognized relative hypercalciuria, or renal calcium leak, associated with essential hypertension. We conclude that the increased prevalence of hypertension in subjects with hyperparathyroidism probably represents the final event in a continuum that begins with obligatory urinary calcium losses in hypertensives, but whose pathological presentation is hyperparathyroidism. The results of this pilot study indicate a need for derivative experiments directed at defining the importance of our preliminary findings in the pathogenesis of human and experimental hypertension.
Hypertension
PMID:Enhanced parathyroid function in essential hypertension: a homeostatic response to a urinary calcium leak. 738 May 20

Hyperparathyroidism and hyperaldosteronism coexisted in association with medullary sponge kidneys in a 27-year-old woman with severe hypertension. A modest fall in systolic and diastolic pressure followed removal of a parathyroid adenoma. Blood pressure was controlled with spironolactone therapy and restored to normal after removal of an aldosterone-secreting adrenal tumor. Elevated levels of aldosterone may have been responsible for the severe hypertension, while hypercalcemia may have had a synergistic effect on the arteriolar response to circulating vasoactive peptides.
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PMID:Hyperaldosteronism, hyperparathyroidism, medullary sponge kidneys, and hypertension. 741 8

Pheochromocytoma accounts for about 0.1 per cent of patients with diastolic hyperstension. It mimics many diseases varying from anxiety psychoneurosis to intracranial tumors. Cardinal symptoms include sevre headache (72 to 92 per cent), sweating (60 tp 70 per cent), palpitations (51 to 73 per cent), and hypertension (> 90 per cent) of which 50 per cent is sustained, 50 per cent paroxysmal. Many drugs (phenothiazines, Saralasin, antiemetics, steroids, etc.) have been reported as precipitating factors. Patients who should be screened for pheochromocytoma include: (1) all symptomatic patients with sustained or paroxysmal hyperstension; (2) asymptomatic hypertension; (3) all patients with MEA 2a,b (hyperparathyroidism, medullary carcinoma of the thyroid, neurocutaneous lesions) and their first degree relatives, even if the latter are asymptomatic and normotensive; (4) hypertension plus diabetes mellitis or hypermetabolism; (5) hypertensive episode during induction of anesthesia or radiologic procedure; and (6) hypertensive response during histamine administration, i.e., gastric analysis. Urinary metanephrine is the single best screening test. Plasma catecholamine determination is particularly helpful when collected before and immediately after an attack. Provacative agents (histamine, glucagon, tyramine) are needed rarely. Preoperative localization of the tumor can be done with nephrotomography IVP, computerized axial tomography, ultrasound, 131-I-19-iodocholesterol scan, arteriography, venography.
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PMID:Pheochromocytoma: clinical manifestations and diagnostic tests. 745 90

Parathyrin (PTH) and calcitonin were measured with radioimmunoassay in 39 cases of pregnancy-induced hypertension (PIH) in late pregnancy, 76 cases in normal early pregnancy and 278 cases in late pregnancy without PIH. Markedly increased PTH was noted in the women in late pregnancy, indicating the state of secondary hyperparathyroidism. PTH values in the women in late pregnancy with PIH were higher than those in the normal early pregnancy group, but lower than those in the women in late pregnancy without PIH. The difference between PTH values in the PIH group and late pregnancy without PIH group was of statistical significance (P < 0.05), while no significant difference was seen between calcitonin values of the two groups (P > 0.05). The results suggest that the pathogenesis of PIH may be related to the function of parathyroid.
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PMID:The relation of parathyroid function to pregnancy-induced hypertension. 758 86

Cardiovascular complications are the main cause of mortality in patients with chronic renal failure. Hypertension and lipid abnormalities which often lead to left ventricular hypertrophy and accelerated atherosclerosis as well as coronary artery disease are a common cause of death. On the other hand uremia often causes pericarditis and thereby may lead to cardiac tamponade and constrictive pericarditis. Renal failure can also cause secondary hyperparathyroidism, amyloidosis, hemosiderosis and oxalosis which can produce visceral infiltrations and lead to a variety of disturbances of cardiovascular functions. Life-threatening arrhythmias are one of the major cardiovascular complications during maintenance dialysis as their occurrence might result in sudden death. The aim of cardiologic management which includes the complex of preventive and therapeutic measures is to reduce the morbidity and mortality and to improve the quality of life.
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PMID:[Cardiologic management in patients on a long-term dialysis program]. 763 9

The success of maintenance haemodialysis in the 1960s was blighted by the problem of anaemia. Treatment with iron, folic acid, androgens and transfusions did no more than minimize its effects. The need for a renewable source of erythropoietin was appreciated very early but the hope took 25 years to realize. Cloning and expression of the human gene was achieved in 1984 and clinical trials planned even before the descriptions of the recombinant hormone were published. The Amgen material was tested in parallel studies in Seattle and England and by the end of 1986 the efficacy of recombinant human erythropoietin (r-HuEPO) given in large intravenous bolus doses in reversing the anaemia of uraemia was established. The benefits were immediately obvious: relief from transfusion dependence was the unequivocal evidence but the effect on 'wellbeing' though subjective was remarkable. Large clinical trials were completed in Europe and the USA so that r-HuEPO was licensed as a therapeutic drug less than two years later. The pilot studies flagged a number of key issues: hypertension, sometimes with encephalopathy, occurred in patients whose blood pressure was labile before treatment; vascular access failure seemed more frequent and hyperkalaemia was thought to reflect less efficient dialysis. Failure to respond focused attention on iron balance as well as on factors such as infection, aluminium, and hyperparathyroidism. A more clear understanding of the pathogenesis of the anaemia of uraemia was made possible by dissection of the specific effects of the exogenous erythropoietin on erythroid function.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Historical review on the use of recombinant human erythropoietin in chronic renal failure. 764 3

This article begins with a discussion on changes in the maternal calcium-parathyroid axis in response to pregnancy, followed by calcium disorders that can take place during pregnancy. Hypercalcemia and its subsequent disorders, including hyperparathyroidism, hypocalciuric hypercalcemia, and thyroid disease, are reviewed. Also, hypocalcemia and its subsequent disorders, including hypoparathyroidism, vitamin D deficiency, and hypomagnesemia, are addressed. Concluding the article are discussions on bone status and osteoporosis, calcium metabolism in pregnancy-induced hypertension and preeclampsia, and nephrolithiasis in pregnancy.
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PMID:Calcium disorders of pregnancy. 778 23

The burden of cardiac disease is high in chronic uremia. Cardiomyopathy results from a combination of cardiac disorders, particularly dilated cardiomyopathy, left ventricular hypertrophy with normal systolic function, and ischemic heart disease. The prognosis for these cardiac disorders is poor. Known potentially reversible risk factors include uremia, anemia, hypertension, smoking, coronary artery disease, hyperparathyroidism, hyperlipoproteinemia, and left ventricular hypertrophy. Randomized controlled clinical trials of interventions that may prevent or ameliorate cardiac disease in dialysis patients are required. These interventions include normalization of hematocrit with erythropoietin compared with partial correction of anemia, increased amount of dialysis compared with that provided by a dialysis prescription of KT/V of 1., control of blood pressure using angiotensin-converting enzyme inhibitors compared with other antihypertensive agents, control of hyperlipidemia, and treatment of diabetes with agents that prevent collagen cross-linking.
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PMID:The management of cardiac disease in chronic uremia. 784 64

Primary hyperparathyroidism is most frequently caused by a single parathyroid adenoma and is more frequent in females than in males. Its frequency increases with age. Its annual incidence has been estimated at 41 per 100,000 in Rochester, and its prevalence at 4.3 per 1000 in Stockholm. Since the introduction of automated serum calcium measurements, the recognition of primary hyperparathyroidism has increased and the clinical presentation of the disease has changed. Classical osseous and renal features of the disease have become rare, due to the increased proportion of asymptomatic forms and to earlier diagnosis. Primary hyperparathyroidism is nowadays usually recognized because serum calcium is measured either systematically or in the clinical setting of mild manifestations, such as arthenia, anxiety, hypertension... Bone histology gives evidences of an accelerated bone turn-over, without major unbalance between formation and resorption. Bone densitometry has shown only minor decrease of mineral content of the lumbar spine in several modern series, so that the deleterious effect of mild or asymptomatic hyperparathyroidism on cancelous bone is presently questioned by several authors.
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PMID:[Primary hyperparathyroidism. Clinical, epidemiological and histological aspects]. 785 78


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