Kovács L, Góth M I, Szabolcs I, Dohán O, Ferencz A, Szilágyi G
1st Department of Internal Medicine, Haynal Imre University of Health Sciences, Budapest, Hungary.
Eur J Endocrinol. 1998 May;138(5):543-7. doi: 10.1530/eje.0.1380543.
To evaluate the renin-aldosterone system and insulin secretion in hyperparathyroidism and their effects on blood pressure regulation.
Studies were carried out on patients with primary hyperparathyroidism (PHPT) prior to and following removal of the parathyroid tumor.
Sixteen normotensive and euglycemic patients with PHPT were studied. The following parameters were measured: basal and stimulated plasma renin activity (PRA) and aldosterone (ALD) secretion: parathormone (PTH) and serum electrolytes. Insulin and glucose levels were measured during an oral glucose tolerance test.
Systolic but not diastolic blood pressure showed a decrease following surgery, from 123.3+/-13.0/80+/-8.6 to 116.7+/-13.5/77.3+/-8.8 mmHg. The decrease in the systolic pressure was not clinically significant. After surgery, both the basal and stimulated PRA and ALD values decreased, and the preoperative pathological values returned to normal: PRA basal: 1.79 --> 0.70 ng/ml/h, P=0.0049; PRA stimulated: 7.76 --> 1.90 ng/ml/h, P=0.0031; ALD basal: 111.5 --> 73.0 pg/ml, P=0.0258; ALD stimulated: 392.5 --> 236.0 pg/ml, P=0.0157. The postoperative decrease in the PRA correlated with the changes in PTH levels (r=0.5442, P < 0.05, n=16) but did not correlate with the changes in serum calcium concentrations. Both the fasting and stimulated insulin levels decreased after surgery but remained within the normal range: insulin fasting: 10.2 --> 5.0 mIU/l, P=0.0218; insulin area under the curve: 5555 --> 3296 mIU/l*min, P=0.0218. There was no correlation between the changes in insulin levels and PTH or ion levels. Sodium, potassium and blood glucose levels remained unaffected by parathyroid surgery.
In a population of normotensive hyperparathyroid patients an increased activity of the renin-aldosterone system related to PTH was found and surgery resulted in a small and insignificant decrease in blood pressure. This change was accompanied by a significant decrease in the activity of the renin-aldosterone system indicating the role of the renin-aldosterone system in the regulation of blood pressure in PHPT. Both fasting and stimulated insulin values decreased following removal of the parathyroid tumor, but with no individual correlation with PTH and calcium levels.
评估甲状旁腺功能亢进症患者的肾素 - 醛固酮系统及胰岛素分泌情况，以及它们对血压调节的影响。
对原发性甲状旁腺功能亢进症（PHPT）患者在切除甲状旁腺肿瘤前后进行研究。
研究了16例血压正常且血糖正常的PHPT患者。测量了以下参数：基础和刺激后的血浆肾素活性（PRA）及醛固酮（ALD）分泌、甲状旁腺激素（PTH）和血清电解质。在口服葡萄糖耐量试验期间测量胰岛素和葡萄糖水平。
术后收缩压下降，但舒张压未下降，收缩压从123.3±13.0/80±8.6 mmHg降至116.7±13.5/77.3±8.8 mmHg。收缩压的下降在临床上无显著意义。术后，基础和刺激后的PRA及ALD值均下降，术前的病理值恢复正常：基础PRA：1.79 --> 0.70 ng/ml/h，P = 0.0049；刺激后PRA：7.76 --> 1.90 ng/ml/h，P = 0.0031；基础ALD：111.5 --> 73.0 pg/ml，P = 0.0258；刺激后ALD：392.5 --> 236.0 pg/ml，P = 0.0157。术后PRA的下降与PTH水平的变化相关（r = 0.5442，P < 0.05，n = 16），但与血清钙浓度的变化无关。术后空腹和刺激后的胰岛素水平均下降，但仍在正常范围内：空腹胰岛素：10.2 --> 5.0 mIU/l，P = 0.0218；胰岛素曲线下面积：5555 --> 3296 mIU/l*min，P = 0.0218。胰岛素水平的变化与PTH或离子水平之间无相关性。钠、钾和血糖水平不受甲状旁腺手术的影响。
在血压正常的甲状旁腺功能亢进患者群体中，发现肾素 - 醛固酮系统与PTH相关的活性增加，手术导致血压有小幅且无显著意义的下降。这种变化伴随着肾素 - 醛固酮系统活性的显著下降，表明肾素 - 醛固酮系统在PHPT血压调节中的作用。切除甲状旁腺肿瘤后，空腹和刺激后的胰岛素值均下降，但与PTH和钙水平无个体相关性。
