Document Detail


A pilot study on hypothalamo-pituitary-adrenocortical axis in primary hyperparathyroidism.
MedLine Citation:
PMID:  19942745     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & OBJECTIVE: Parathormone (PTH) and calcium, both have been shown to stimulate adrenal steroidogenesis in animal models and in vitro experiments. This is attributed to structural similarity between 15-25 amino acid region of the parathyroid hormone (PTH) and 1-11 amino acid region of adrenocorticotropin (ACTH). However, there are no in vivo human data regarding the effect of PTHcalcium axis on adrenocortical function.
METHODS: Ten patients with primary hyperparathyroidism underwent evaluation for cortisol dynamics including 0800 h and 2000 h plasma cortisol on day 1, cortisol response to insulin induced hypoglycaemia (IIH) on day 2, and 1 mg overnight dexamethasone suppression test (ONDST) on day 4. Serum aldosterone was also measured at 0800 h in fasting state on salt ad libitum for three days. These parameters were repeated 3 months after curative parathyroidectomy.
RESULTS: Basal plasma cortisol level at 0800 h and 2000 h were within upper normal range and loss of circadian rhythm in cortisol secretion was observed in half and forty per cent of patients had nonsuppressibility with ONDST. The defined peak cortisol response to insulin induced hypoglycaemia (>550 nmol/l) was achieved in all and nearly one third of patients had exaggerated response (>2000 nmol/l). After curative parathyroidectomy, the abnormalities in circadian rhythm and non-suppressibility with ONDST continued to prevail in 40 per cent of patients. The peak cortisol response to IIH showed a decrement but remained higher than normal. No correlation was observed between circulating parathyroid hormone and calcium with cortisol levels. Serum aldosterone was in upper normal range pre - and postoperatively, though it decreased postoperatively, but it could not attain a statistical significance (p = 0.5).
INTERPRETATION & CONCLUSION: Abnormalities in hypothalamo-pituitary-adrenocortical axis in primary hyperparathyroidism do occur, however these are inconsistent and do not recover in majority of patients even after 3 months of curative parathyroidectomy.
Authors:
Rajesh Rajput; Anil Bhansali; Sanjay Kumar Bhadada; Arunanshu Behera; B R Mittal; Ravinder Sialy; N Khandelwal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Indian journal of medical research     Volume:  130     ISSN:  0971-5916     ISO Abbreviation:  Indian J. Med. Res.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-11-27     Completed Date:  2010-02-01     Revised Date:  2013-04-18    
Medline Journal Info:
Nlm Unique ID:  0374701     Medline TA:  Indian J Med Res     Country:  India    
Other Details:
Languages:  eng     Pagination:  418-22     Citation Subset:  IM    
Affiliation:
Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
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MeSH Terms
Descriptor/Qualifier:
Adrenocorticotropic Hormone / blood
Adult
Aldosterone / blood
Animals
Dexamethasone / metabolism
Female
Glucocorticoids / metabolism
Humans
Hydrocortisone / blood
Hyperparathyroidism, Primary / physiopathology*,  surgery
Hypothalamo-Hypophyseal System / physiology*,  physiopathology
Middle Aged
Parathyroid Hormone / genetics,  metabolism
Pilot Projects
Pituitary-Adrenal System / physiology*,  physiopathology
Young Adult
Chemical
Reg. No./Substance:
0/Glucocorticoids; 0/Parathyroid Hormone; 50-02-2/Dexamethasone; 50-23-7/Hydrocortisone; 52-39-1/Aldosterone; 9002-60-2/Adrenocorticotropic Hormone

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