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

A 61-year-old patient with treated Conn's syndrome due to multiple bilateral adrenocortical adenomata developed primary hyperparathyroidism. At operation, a parathyroid adenoma and a thyroid colloid nodule were found. Although adrenocortical adenomata and hyperplasia are common findings in multiple endocrine adenopathy type I, they are only rarely functional. Hypertension is often associated with primary hyperparathyroidism, but the relationship is usually unexplained.
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PMID:Primary hyperparathyroidism in a patient with Conn's syndrome. 738 50

Forty-two patients with sarcoidosis were studied with special attention to renal disease and disturbance of calcium metabolism. Abnormal calcium metabolism was found in 19 patients and prednisone corrected hypercalcaemia in those affected within two weeks, except in one patient who had concomitant primary hyperparathyroidism. Renal failure was found in 19 patients, 15 of whom had hypercalcaemia. Prednisone had a beneficial effect on kidney function within four weeks in all patients except in one with co-existing glomerulonephritis. Arterial hypertension was found in six patients, proteinuria in six, and calcinosis in six. Among 14 patients who underwent renal biopsy, granulomas were found in five. In only one of these was granulomatosis extensive bringing out renal failure and death within two years after temporary remission with prednisone. Co-existent non-sarcoid diseases affecting the kidneys or calcium metabolism occurred in ten out of 23 patients with sarcoidosis and kidney disease/calcium abnormality. In most cases these conditions contributed more to the prognosis than did sarcoidosis. From the present series and review of the literature it appears that young males within the first two years of diagnosis are at the greatest risk of hypercalcaemia or kidney disease.
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PMID:Renal manifestations and abnormal calcium metabolism in sarcoidosis. 746 60

Primary hyperparathyroidism (HPTH) is frequently associated with hypertension. To date, the relationship between these two conditions is still not clear. We have studied 34 consecutive patients with primary HPTH due to a parathyroid adenoma. The diagnosis was later surgically confirmed in 32 cases. Ten of thirty-four HPTH patients were hypertensive. Before adenomectomy (PTHX) and 1-2 months after PTHX, we measured the following parameters in all patients: circulating levels of total and ionized Ca, intact immunoreactive parathormone (iPTH) (1-84), plasma renin activity (PRA), aldosterone, and daily total urinary catecholamine excretion. Moreover, 10 hypertensive HPTH patients, 10 normotensive HPTH patients, compared to 10 to 10 sex- and age-matched healthy normotensive subjects, underwent an acute norepinephrine test to assess vascular reactivity to a pressor agent. Before PTHX, no significant difference was observed between normotensive and hypertensive patients in all the above-mentioned variables, except for PRA and plasma aldosterone levels which were higher in hypertensive patients. Furthermore, the pressor response to the norepinephrine test was significantly greater in hypertensive HPTH patients than in the other 2 groups. After PTXH, serum Ca and intact iPHT (1-84) levels were reduced to normal values in all patients, while blood pressure, PRA and plasma aldosterone levels became normal in 8 of 10 hypertensive patients. The pressor response to the norepinephrine test was similar in the 2 groups. These results are consistent with the hypothesis of a direct effect of PTH on renin secretion which could contribute to the pathogenesis of hypertension and to the vessels sensitization to pressor agents.
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PMID:Hypertension and primary hyperparathyroidism: the role of adrenergic and renin-angiotensin-aldosterone systems. 756 68

Comparing patients with primary hyperparathyroidism (PHP) to a normocalcemic control population, those with PHP have a higher incidence of cardiovascular disease and cardiac abnormalities. This study aimed at correlating cardiac findings (valvular and myocardial calcification, myocardial hypertrophy) with clinical data (age, sex, clinical manifestation, nephrolithiasis, nephrocalcinosis, hypertension, skeletal abnormalities, hypercalcemic syndrome) and biochemical data (serum calcium, serum phosphate, serum iPTH level, serum creatinine). A group of 132 consecutive patients with surgically verified PHP (94 women, 38 men; ages 15-86, mean age 57 +/- 16 years) were included in this study. Blood chemistry, clinical presentation, radiography, and echocardiography were carried out in all patients for univariate and multivariate analyses of all parameters. There was no statistical correlation between clinical symptoms, biochemical data, and cardiac calcific alterations. Typical skeletal manifestations (osteolysis/subperiostal resorption) and valvular calcifications were significantly correlated to left ventricular hypertrophy (p = 0.005). Cardiac abnormalities such as calcific myocardial deposits or mitral and aortic valvular calcifications do not correlate with laboratory findings and clinical presentation at the time of diagnosis. There was no biochemical or clinical variable that could predict the frequency or severity of valvular sclerosis or calcific deposits in the myocardium. However, PHP-related skeletal abnormalities and valvular calcification were predicting factors for left ventricular hypertrophy, a reversible cardiac manifestation of PHP. Myocardial hypertrophy is more often found with classic symptomatic PHP with osseous abnormalities.
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PMID:Primary hyperparathyroidism and the heart: cardiac abnormalities correlated to clinical and biochemical data. 772 54

Retrospective analysis has been performed in 404 patients, undergoing initial operation for primary hyperparathyroidism for differences in clinical presentation, laboratory data, pathological findings and outcome of surgery. In elderly patients (> = 60 years of age, n = 116), neuromuscular and psychic symptoms, hypertension, cholelithiasis and pseudogout were significantly more common, while renal stones were less common than in younger patients. There were no significant difference in preoperative laboratory findings, parathyroid pathology and surgical cure rate. Parathyroidectomy could be safely performed under local anesthesia, particularly in elderly patients in whom general anesthesia was involved with an increased operative risk. An attack of pseudogout was the most common postoperative complication. Hence, immediate calcium supplementation after operation is recommended in patients with a radiologic finding of chondrocalcinosis.
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PMID:[Primary hyperparathyroidism in elderly patients]. 775 87

In the period 1981-1993, 102 patients underwent surgery for primary hyperparathyroidism (HP). Parathyroid adenoma was found in 81, carcinoma in 4 and hyperplasia in 17 patients. HP was usually diagnosed late with marked skeletal or renal damage, psychiatric symptoms and hypertension. Following the first operation in our institution hypercalcemia was successfully reduced in 100 of 102 patients, in two hypercalcemia persisted after the operation and both were reoperated. Postoperative hypocalcemic syndrome (transitory hypoparathyroidism) due to advanced stage of HP and enormous calcium deficit in bones, occurred in 47% of patients (most frequently with skeletal and hypercalcemic form of the disease).
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PMID:[Results of surgical treatment of primary hyperparathyroidism]. 778 88

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

Hypertension is a well known finding in primary hyperparathyroidism (HPT). In the present study, systolic blood pressure (SBP) and heart rate were recorded before, during and after surgery for HPT in 101 patients (mean serum calcium 2.96 +/- 0.22 mmol/l) and compared to 91 scheduled general surgical patients matched for age, sex, duration of surgery and type of general anesthesia. The HPT patients displayed an increased mean SBP, given as mean +/- standard deviation, both before (147 +/- 28 vs 131 +/- 25 mm Hg in controls) and during surgery (142 +/- 24 vs 117 +/- 21 mm Hg in controls) as well as postoperatively (141 +/- 23 vs 118 +/- 17 mm Hg in controls, all p < 0.0001). The preoperative SBP was correlated to both the intraoperative and postoperative SBP (r = 0.59 and r = 0.61, both p < 0.00001). However, the blood pressure elevation during and after surgery was still significant (both p < 0.001) when corrected for the influence of the preoperative blood pressure level using multiple regression analysis. The heart rate was increased in the HPT subjects only in the postoperative period (88 +/- 12 vs 83 +/- 12 beats/min in controls, p < 0.007). In conclusion, the systolic blood pressure was found to be elevated both before, during and after surgery in HPT subjects when compared to a general surgical population. In the postoperative period, also the heart rate was increased in the HPT subjects. These findings suggest an increased cardiovascular response to surgical stress in HPT subjects.
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PMID:Blood pressure reaction during the intraoperative and early postoperative periods in patients with primary hyperparathyroidism. 786 5

To examine the effects of primary hyperparathyroidism separately from those of hypertension per se on blood pressure regulation in patients with primary hyperparathyroidism, we studied the pressor response to infused angiotensin II (AII) and to norepinephrine (NE) in 7 normotensive patients with primary hyperparathyroidism before and after surgical cure, and compared it to that observed in 10 subjects with idiopathic hypertension and 10 normal controls. While the subjects were on an ad libitum diet, we measured urinary and plasma electrolytes, creatinine, and plasma renin activity. Except for calcium, these values were not significantly different among the three groups. The blood pressure was measured basally and in response to graded doses of AII or of NE until a 20-mmHg increase in the diastolic blood pressure was reached ("pressor dose"). The pressor doses of AII and of NE were lower in the normotensive patients with primary hyperparathyroidism than in normal controls [4.6 +/- 2.0 vs. 7.3 +/- 3.5 ng/kg/min (p < 0.05) and 164 +/- 114 vs. 302 +/- 176 ng/kg/min (p < 0.05) respectively] and not significantly different from those found in idiopathic hypertension (3.1 +/- 1.2 and 137 +/- 95 ng/kg/min). When the patients with primary hyperparathyroidism were studied again between 2-6 months after surgical cure, their pressor doses of AII and of NE remained unchanged from their preoperative values (5.4 +/- 2.9 and 137 +/- 80 mg/kg/min). We conclude that the hyperparathyroid condition can disrupt the normal responsiveness to pressor agents even if the blood pressure remains within normal limits, and that this abnormality may persist after surgical cure.
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PMID:Primary hyperparathyroidism and hypertension: persistently abnormal pressor sensitivity in normotensive patients after surgical cure. 807 14

We retrospectively studied clinical problems for 55 patients with primary hyperparathyroidism who were operated on at our hospital. The chance to discovery of primary hyperparathyroidism and its accompanied symptoms were various. Other than classical symptoms, hypertension was noted in 12 patients and malignant tumors in 9. Forty-four percent of patients who had no bone related symptoms were found to have decreased bone mineral density (BMD). Even the patients with normal BMD were seen to increase the BMD, postoperatively. We thought that the parathyroidectomy was indicated for the asymptomatic patients with normal BMD. Biochemical investigation showed that positive rate were 50% for PTH-C, 94% for PTH-HS, 78% for intact PTH, 87% for serum total calcium and 98% for serum ionized calcium. Serum ionized calcium and intact PTH were useful for the diagnosis of patients who had normocalcemia or slight elevation of serum calcium. The sensitivity was 61% for ultrasound sonography (US) and 49% for computer tomography (CT) and scintigram, respectively. The detection rate of US and CT was positively related to the size of the parathyroid glands, but scintigram was not. The rate with which the parathyroid glands can be recognized during operation increased from 30% in the former group to 52% in the later group. As a result, 11% of the patients with adenoma had too much surgery and 29% of the patients with hyperplasia had too little surgery.
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PMID:[Clinical study of primary hyperparathyroidism--diagnosis, parathyroidectomy and late result of operation]. 812 Nov 14


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