Dynamic changes of renin-angiotensin-aldosterone system parameters after surgery of primary hyperparathyroidism
- Authors: Dobreva E.A.1, Bibik E.E.1, Eremkina A.K.1, Ajnetdinova A.R.1, Nikankina L.V.1, Malysheva N.M.1, Mokrysheva N.G.1
-
Affiliations:
- Endocrinology Research Centre
- Issue: Vol 92, No 10 (2020)
- Pages: 63-69
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/50983
- DOI: https://doi.org/10.26442/00403660.2020.10.000725
- ID: 50983
Cite item
Full Text
Abstract
Aim. To study an activity of the Renin-Angiotensin-Aldosterone System (RAAS) components in patients with primary hyperparathyroidism (PHPT) before and after parathyroidectomy (PTE).
Materials and methods. A comparative study of patients with PHPT and control group. The first stage of the study included 56 patients with PHPT (group 1) before and on the third day after PTE. The second stage was carried out in 27 patients with remission of PHPT (group 2). All patients and healthy volunteers were tested for the main parameters of phosphorus-calcium metabolism and the RAAS parameters (plasma renin activity – PRA, serum aldosterone, angiotensin II – AT II).
Results. Patients with active PHPT demonstrated changes in RAAS activity (lower PRA, higher AT II level) comparing to control group, that have statistical significance in group 1 (p<0.001 for both parameters). There were no significant differences in aldosterone levels (p1=0.090; p2=0.140). On the third day after PTE (group 1), a decrease in aldosterone level (p=0.009) and a tendency to decrease in PRA (p=0.030) were detected. However, an increase in PRA (p=0.018), a decrease in AT II concentration (p=0.032) comparing to the initial values and their normalization were observed 12 months after surgery when permanent normal serum calcium and PTH levels had been achieved. There were controversial correlations between the parameters of phosphorus-calcium metabolism and RAAS. The influence of angiotensin-converting-enzyme inhibitors and AT II receptor blockers on phosphorus-calcium metabolism in patients with PHPT was not observed.
Conclusion. In patients with PHPT, there were no сlear correlations of phosphorus-calcium metabolism parameters with RAAS, however an increase of AT II concentration was noted, that can take part in a development of hypertension for this endocrinopathy. PTE can have a positive effect on AT II level.
Full Text
##article.viewOnOriginalSite##About the authors
E. A. Dobreva
Endocrinology Research Centre
Author for correspondence.
Email: bibikaterina@mail.ru
ORCID iD: 0000-0002-8916-7346
к.м.н., ст. науч. сотр. отд-ния патологии околощитовидных желез
Russian Federation, MoscowE. E. Bibik
Endocrinology Research Centre
Email: bibikaterina@mail.ru
ORCID iD: 0000-0001-5952-5846
науч. сотр. отд-ния патологии околощитовидных желез
Russian Federation, MoscowA. K. Eremkina
Endocrinology Research Centre
Email: bibikaterina@mail.ru
ORCID iD: 0000-0001-6667-062X
к.м.н., зав. отд-нием патологии околощитовидных желез
Russian Federation, MoscowA. R. Ajnetdinova
Endocrinology Research Centre
Email: bibikaterina@mail.ru
ORCID iD: 0000-0001-6935-3187
статистик отд-ния патологии околощитовидных желез
Russian Federation, MoscowL. V. Nikankina
Endocrinology Research Centre
Email: bibikaterina@mail.ru
ORCID iD: 0000-0001-8303-3825
к.м.н., зав. клин.-диагност. лаб.
Russian Federation, MoscowN. M. Malysheva
Endocrinology Research Centre
Email: bibikaterina@mail.ru
ORCID iD: 0000-0002-4659-5439
к.б.н., вед. науч. сотр. клин.-диагност. лаб.
Russian Federation, MoscowN. G. Mokrysheva
Endocrinology Research Centre
Email: bibikaterina@mail.ru
ORCID iD: 0000-0002-9717-9742
чл.-кор. РАН, д.м.н., проф., дир. ФГБУ
Russian Federation, MoscowReferences
- Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. doi: 10.1093/eurheartj/ehy339
- Kalla A, Krishnamoorthy P, Gopalakrishnan A, et al. Primary hyperparathyroidism predicts hypertension: Results from the National Inpatient Sample. Int J Cardiol. 2017;227:335-7. doi: 10.1016/j.ijcard.2016.11.080
- Pepe J, Cipriani C, Sonato C, et al. Cardiovascular manifestations of primary hyperparathyroidism: a narrative review. Eur J Endocrinol. 2017;177(6):R297-R308. doi: 10.1530/EJE-17-0485
- Wetzel J, Pilz S, Grübler MR, et al. Plasma parathyroid hormone and cardiovascular disease in treatment-naive patients with primary hyperparathyroidism: The EPATH trial. J Clin Hypertens (Greenwich). 2017;19(11):1173-80. doi: 10.1111/jch.13064
- Pal R, Mukherjee S, Bhadada SK, et al. Persistence of “non-dipping” pattern in blood pressure after curative parathyroidectomy in apparently normotensive patients with symptomatic primary hyperparathyroidism. Minerva Endocrinol. 2020;45(3):181-8. doi: 10.23736/S0391-1977.19.03104-3
- Nelson JA, Alsayed M, Milas M. The role of parathyroidectomy in treating hypertension and other cardiac manifestations of primary hyperparathyroidism. Gland Surg. 2020;9(1):136-41. doi: 10.21037/gs.2019.12.12
- Hassan M, Qureshi W, Sroujieh LS, et al. Interplay of parathyroid hormone and aldosterone antagonist in prevention of heart failure hospitalizations in chronic kidney disease. J Renin Angiotensin Aldosterone Syst: JRAAS. 2014;15(3):278-85. doi: 10.1177/1470320314539180
- Gambardella J, De Rosa M, Sorriento D, et al. Parathyroid Hormone Causes Endothelial Dysfunction by Inducing Mitochondrial ROS and Specific Oxidative Signal Transduction Modifications. Oxid Med Cell Longev. 2018;2018:9582319. doi: 10.1155/2018/9582319
- Fisher SB, Perrier ND. Primary hyperparathyroidism and hypertension. Gland Surg. 2020;9(1):142-9. doi: 10.21037/gs.2019.10.21
- Tomaschitz A, Pilz S, Rus-Machan J, et al. Interrelated aldosterone and parathyroid hormone mutually modify cardiovascular mortality risk. Int J Cardiol. 2015;184:710-6. doi: 10.1016/j.ijcard.2015.03.062
- Brown JM, Vaidya A. Interactions between adrenal-regulatory and calcium-regulatory hormones in human health. Curr Opin Endocrinol Diabetes Obes. 2014;21(3):193-201. doi: 10.1097/ MED.0000000000000062
- Isales CM, Barrett PQ, Brines M, et al. Parathyroid hormone modulates angiotensin II-induced aldosterone secretion from the adrenal glomerulosa cell. Endocrinology. 1991;129(1):489-95. doi: 10.1210/endo-129-1-489
- Mazzocchi G, Aragona F, Malendowicz LK, Nussdorfer GG. PTH and PTH-related peptide enhance steroid secretion from human adrenocortical cells. Am J Physiol Endocrinol Metabol. 2001;280(2):E209-13. doi: 10.1152/ajpendo.2001.280.2.E209
- Olgaard K, Lewin E, Bro S, et al. Enhancement of the stimulatory effect of calcium on aldosterone secretion by parathyroid hormone. Miner Electrolyte Metab. 1994;20(5):309-14.
- Rosenberg J, Pines M, Hurwitz S. Response of adrenal cells to parathyroid hormone stimulation. J Endocrinol. 1987;112(3):431-37. doi: 10.1677/joe.0.1120431
- Saussine C, Judes C, Massfelder T, et al. Stimulatory action of parathyroid hormone on renin secretion in vitro: a study using isolated rat kidney, isolated rabbit glomeruli and superfused dispersed rat juxtaglomerular cells. Clin Sci (Lond). 1993;84(1):11-9. doi: 10.1042/cs0840011
- Helwig JJ, Musso MJ, Judes C, Nickols GA. Parathyroid hormone and calcium: interactions in the control of renin secretion in the isolated, nonfiltering rat kidney. Endocrinology. 1991;129(3):1233-42. doi: 10.1210/endo-129-3-1233
- Maniero C, Fassina A, Guzzardo V, et al. Primary hyperparathyroidism with concurrent primary aldosteronism. Hypertension. 2011;58(3):341-6. doi: 10.1161/HYPERTENSIONAHA.111.173948
- Lenzini L, Prisco S, Vanderriele PE, et al. PTH Modulation by Aldosterone and Angiotensin II is Blunted in Hyperaldosteronism and Rescued by Adrenalectomy. J Clin Endocrinol Metab. 2019;104(9):3726-34. doi: 10.1210/jc.2019-00143
- Brown J, de Boer IH, Robinson-Cohen C, et al. Aldosterone, parathyroid hormone, and the use of renin-angiotensin-aldosterone system inhibitors: the multi-ethnic study of atherosclerosis. J Clin Endocrinol Metab. 2015;100(2):490-9. doi: 10.1210/jc.2014-3949
- Fischer E, Hannemann A, Rettig R, et al. A high aldosterone to renin ratio is associated with high serum parathyroid hormone concentrations in the general population. J Clin Endocrinol Metab. 2014;99(3):965-71. doi: 10.1210/jc.2013-3214
- Tomaschitz A, Verheyen N, Meinitzer A, et al. Effect of eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism: results from the EPATH randomized, placebo- controlled trial. J Hypertens. 2016;34(7):1347-56. doi: 10.1097/ HJH.0000000000000927
- Zaheer S, Brown JM, Connors M, et al. Angiotensin-Converting Enzyme Inhibition and Parathyroid Hormone Secretion. Int J Endocrinol. 2017;2017:4138783. doi: 10.1155/2017/4138783
- Asbach E, Bekeran M, König A, et al. Primary and Secondary Hyperparathyroidism in Patients with Primary Aldosteronism – Findings From the German Conn’s Registry. Exp Clin Endocrinol Diabetes. 2020;128(4):246-54. doi: 10.1055/a-1027-6472
- Zhou D, Liu M, Yan Z. Primary aldosteronism complicated by hyperparathyroidism: report of one case and literature review. Int J Clin Exp Pathol. 2019;12(8):3096-101.
- Concistré A, Petramala L, Zinnamosca L, et al. Primary aldosteronism with concurrent primary hyperparathyroidism: clinical case load in a single centre. Eur Rev Med Pharmacol Sci. 2015;19(6):971-76. https://www.europeanreview.org/article/8681
- Vaidya A, Brown JM, Williams JS. The renin-angiotensin-aldosterone system and calcium-regulatory hormones. J Hum Hypertens. 2015;29(9):515-21. doi: 10.1038/jhh.2014.125
- Beysel S, Caliskan M, Kizilgul M, et al. Parathyroidectomy improves cardiovascular risk factors in normocalcemic and hypercalcemic primary hyperparathyroidism. BMC Cardiovasc Disord. 2019;19(1):106. doi: 10.1186/s12872-019-1093-4
- Bernini G, Moretti A, Lonzi S, et al. Renin-angiotensin-aldosterone system in primary hyperparathyroidism before and after surgery. Metabolism. 1999;48(3):298-300. doi: 10.1016/s0026-0495(99)90075-6
- Kovacs L, Goth MI, Szabolcs I, et al. The effect of surgical treatment on secondary hyperaldosteronism and relative hyperinsulinemia in primary hyperparathyroidism. Eur J Endocrinol. 1998;138(5):543-47. doi: 10.1530/eje.0.1380543
- Pacifici R, Perry HM 3rd, Shieber W, et al. Adrenal responses to subtotal parathyroidectomy for primary hyperparathyroidism. Calcif Tissue Int. 1987;41(3):119-23. doi: 10.1007/bf02563790
- Brunaud L, Germain A, Zarnegar R, et al. Serum aldosterone is correlated positively to parathyroid hormone (PTH) levels in patients with primary hyperparathyroidism. Surgery. 2009;146(6):1035-41. doi: 10.1016/j.surg.2009.09.041
- Добрева Е.А., Бибик Е.Е., Еремкина А.К. и др. Взаимосвязь показателей кальциевого обмена и ренин-ангиотензин-альдостероновой системы при первичном гиперпаратиреозе в до- и раннем послеоперационном периодах. Артериальная гипертензия. 2019;25(6):630-8 [Dobreva EA, Bibik EE, Eremkina AK, et al. Correlations between parameters of calcium metabolism and renin-angiotensin-aldosterone system in patients with primary hyperparathyroidism in the pre- and early postoperative periods. Arterial Hypertension. 2019;25(6):630-8 (In Russ.)]. doi: 10.18705/1607-419X-2019-25-6-630-638
- Brown JM, Williams JS, Luther JM, et al. Human interventions to characterize novel relationships between the renin-angiotensin-aldosterone system and parathyroid hormone. Hypertension. 2014;63(2):273-80. doi: 10.1161/HYPERTENSIONAHA.113.01910
- DeLuccia R, Cheung M, Ramadoss R, et al. The Endocrine Role of Bone in Cardiometabolic Health. Cur Nutr Rep. 2019;8(3):281-94. doi: 10.1007/s13668-019-00286-0
- Sorriento D, De Luca N, Trimarco B, Iaccarino G. The Antioxidant Therapy: New Insights in the Treatment of Hypertension. Front Physiol. 2018;9:258. doi: 10.3389/fphys.2018.00258
- Grubler MR, Marz W, Pilz S, et al. Vitamin-D concentrations, cardiovascular risk and events - a review of epidemiological evidence. Rev Endocr Metabc Disord. 2017;18(2):259-72. doi: 10.1007/s11154-017
Supplementary files
![](/img/style/loading.gif)