A pilot study on hypothalamo-pituitary-adrenocortical axis in primary hyperparathyroidism.

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dc.contributor.authorRajput, Rajesh
dc.contributor.authorBhansali, Anil
dc.contributor.authorBhadada, Sanjay Kumar
dc.contributor.authorBehera, Arunanshu
dc.contributor.authorMittal, B R
dc.contributor.authorSialy, Ravinder
dc.contributor.authorKhandelwal, N
dc.date.accessioned2011-12-15T09:47:20Z
dc.date.available2011-12-15T09:47:20Z
dc.date.issued2009-10
dc.description.abstractBackground & objectives: 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. Materials: 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.en_US
dc.identifier.citationRajput Rajesh, Bhansali Anil, Bhadada Sanjay Kumar, Behera Arunanshu, Mittal B R, Sialy Ravinder, Khandelwal N. A pilot study on hypothalamo-pituitary-adrenocortical axis in primary hyperparathyroidism. Indian Journal of Medical Research. 2009 Oct; 130(4): 418-422.en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/135914
dc.language.isoenen_US
dc.source.urihttps://icmr.nic.in/ijmr/2009/October/1010.pdfen_US
dc.subjectcortisolen_US
dc.subjecthyperparathyroidismen_US
dc.subjectosteoporosisen_US
dc.subject.meshAdrenocorticotropic Hormone --blood
dc.subject.meshAdult
dc.subject.meshAldosterone --blood
dc.subject.meshAnimals
dc.subject.meshDexamethasone --metabolism
dc.subject.meshFemale
dc.subject.meshGlucocorticoids --metabolism
dc.subject.meshHumans
dc.subject.meshHydrocortisone --blood
dc.subject.meshHyperparathyroidism, Primary --physiopathology
dc.subject.meshHyperparathyroidism, Primary --surgery
dc.subject.meshHypothalamo-Hypophyseal System --physiology
dc.subject.meshHypothalamo-Hypophyseal System --physiopathology
dc.subject.meshMiddle Aged
dc.subject.meshParathyroid Hormone --genetics
dc.subject.meshParathyroid Hormone --metabolism
dc.subject.meshPilot Projects
dc.subject.meshPituitary-Adrenal System --physiology
dc.subject.meshPituitary-Adrenal System --physiopathology
dc.subject.meshYoung Adult
dc.titleA pilot study on hypothalamo-pituitary-adrenocortical axis in primary hyperparathyroidism.en_US
dc.typeArticleen_US
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