title: Adrenergic and cardiac dysfunction in primary hyperparathyroidism.
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 whether adrenergic dysfunction may be a contributing factor.
  
  
  METHODS
  Forty-nine patients with mild PHPT (serum calcium 2·7 ± 0·1 mM) 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 analysed in 24-h 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.
authors: Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital, Malmö, Sweden. mats.birgander@skane.se
authors: Mats
authors: M
authors: Birgander
authors: Steen
authors: S
authors: Juul-Möller
authors: Anne-Greth
authors: AG
authors: Bondeson
authors: Lennart
authors: L
authors: Bondeson
authors: Erik
authors: E
authors: Rydberg
mesh_terms: D000368:Aged; D002395:Catecholamines / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006339:Heart Rate; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D013564:Sympathetic Nervous System / Q000503:physiopathology*
chemical_list: D002395:Catecholamines