Plasma ionized calcium and cardiovascular risk factors in mild primary hyperparathyroidism: effects of long-term treatment with active vitamin D (alphacalcidol).

Primary hyperparathyroidism (HPT) has been associated with hypertension, hyperinsulinaemia, hypertriglyceridaemia and hyperuricaemia. In the present study, plasma ionized calcium (Ca2+) was studied in relation to cardiovascular risk factors in 20 subjects with mild hypertension. Plasma Ca2+ was found to be negatively correlated with fasting serum insulin, triglycerides and urate, and with diastolic blood pressure (DBP).

Serum levels of 1,25-(OH)2-vitamin D are not altered by long-term supplementation with alphacalcidol (1-OH-vitamin D3). A double-blind, placebo-controlled study.

The endogenous production of 1,25-(OH)2-vitamin D has been estimated to be 1.5 micrograms daily. Despite the use of alphacalcidol (1,25-(OH)2-vitamin D) during more than a decade the long-term effects of the serum levels of 1,25-(OH)2-vitamin D have been poorly investigated.

Cardiovascular risk factors in primary hyperparathyroidism: a 15-year follow-up of operated and unoperated cases.

The need for treatment of mild and apparently asymptomatic primary hyperparathyroidism (HPT) is questioned, but a raised incidence of cardiovascular disease has been regarded as evidence in favour of surgery. While it is well known that several risk factors for cardiovascular disease (hypertension, hyperlipidaemia and diabetes mellitus/impaired glucose tolerance) are overrepresented in HPT, it is not known whether surgery provides long-term normalization in these respects and reduces the risk of premature death. In a 15-year follow-up of a cohort of 172 subjects in whom mild hypercalcaemia was initially detected during a health screening, it was found that 56 subjects had died.

Reduction in serum alkaline phosphatase levels by treatment with active vitamin D (alphacalcidol) in primary and secondary hyperparathyroidism and in euparathyroid individuals.

Raised levels of alkaline phosphatases (ALP) are seen in conditions with a high bone turn-over, such as in primary and secondary hyperparathyroidism (HPT). To study the effects of active vitamin D treatment on ALP, alphacalcidol (1-alpha-hydroxyvitamin D3), was given to patients with primary HPT as well as HPT secondary to chronic renal failure and also to healthy, euparathyroid subjects. Oral alphacalcidol (1 microgram daily) significantly reduced serum ALP (3.

No major metabolic alterations accompany the hypotensive effect of active vitamin D.

A hypotensive effect of active vitamin D treatment (alphacalcidol 1 mg daily) has previously been reported in three double-blind, placebo-controlled studies over 4-6 months in subjects with mild primary hyperparathyroidism (HPT), intermittent hypercalcemia and essential hypertension. The commonly used antihypertensive drugs, thiazides and betablockers, both induce impairments in both glucose and lipid metabolism and the thiazides are known to cause an elevation of serum urate. The effects of vitamin D treatment on these metabolic variables were recorded in these studies.

Delayed hypersensitivity in primary and secondary hyperparathyroidism. Treatment with active vitamin D.

The vitamin D endocrine system, besides its traditional role in mineral metabolism, also affects the immune system. A recent study demonstrated that vitamin D supplementation restored a blunted delayed hypersensitivity response (DH) in elderly vitamin D-deficient subjects. In the present study the DH, as measured by the tuberculin test (PPD), was studied in two groups of patients with a disturbed vitamin D system, i.

Treatment with active vitamin D (alphacalcidol) in patients with mild primary hyperparathyroidism.

The parathyroid gland possesses receptors for 1,25-dihydroxyvitamin D3, the active metabolite of the vitamin D system, and in vitro experiments have shown that 1,25-dihydroxyvitamin D3 can inhibit the secretion of PTH. In this study 31 subjects who had displayed persistent mild hypercalcemia for 14 years and presumably had mild primary hyperparathyroidism (HPT) were challenged with 1.0 microgram alphacalcidol (1 alpha-(OH)-vitamin D3) over 6 months in a double-blind, placebo-controlled study.

Reduction of blood pressure during long-term treatment with active vitamin D (alphacalcidol) is dependent on plasma renin activity and calcium status. A double-blind, placebo-controlled study.

Patients with essential hypertension, in particular those with low plasma renin activity (PRA), are reported to have lowered plasma-ionized calcium and elevated parathyroid hormone levels. In this study 1 microgram alphacalcidol (1 alpha-hydroxy-vitamin D3) was given in a double-blind, placebo-controlled fashion over four months to 39 subjects with mild to moderate hypertension. There was a significant rise in PRA in the treatment group when compared to placebo (P less than .

Relation of serum calcium concentration to metabolic risk factors for cardiovascular disease.

Data from a health screening survey with over 18,000 adult participants were used to determine the relations between serum calcium concentration and the cardiovascular risk factors hypertension, hyperglycaemia, and hyperlipidaemia. Blood pressure and serum glucose and cholesterol concentrations were all positively related to each other independent of age, sex, kidney function, and obesity. Similar relations between the risk factors were found in subjects with hypertension or hyperglycaemia independent of the degree of overweight.

Hypertension in primary hyperparathyroidism--reduction of blood pressure by long-term treatment with vitamin D (alphacalcidol). A double-blind, placebo-controlled study.

Patients with primary hyperparathyroidism (HPT) often have raised blood pressure but a simple cause-and-effect relationship has not been established. In 33 persons with probable primary HPT and mild hypercalcemia detected in a health survey, diastolic blood pressure (DBP) was significantly higher than among age- and sex-matched, normocalcemic, controls (89.4 +/- 9.

Suppression of serum parathyroid hormone levels by intravenous alphacalcidol in uremic patients on maintenance hemodialysis. A pilot study.

Seven patients on chronic hemodialysis were given alphacalcidol (1 alpha-OH-vitamin D3) intravenously in a pilot study during 3 months. Before treatment all patients had serum calcium values within the normal range, but elevated levels of parathyroid hormone (PTH). When serum calcium was raised above the normal range by treatment with alphacalcidol, all patients displayed marked suppression of PTH levels with a mean reduction of 40 +/- 20% (SD; p less than 0.

A pilot study of metabolic effects of intravenously given alpha-calcidol in patients with chronic renal failure.

Disturbances of calcium homeostasis might be involved in the pathogenesis of the metabolic derangements associated with uraemia. Indices of glucose and lipoprotein metabolism as well as blood pressure were measured in nine patients with chronic renal failure who were on regular hemodialysis. Seven of them thereafter received alpha-calcidol (a synthetic analogue to active vitamin D) intravenously for three months.

Blood pressure is lowered by vitamin D (alphacalcidol) during long-term treatment of patients with intermittent hypercalcaemia. A double-blind, placebo-controlled study.

There is epidemiologic evidence of a relationship between calcium deficiency and hypertension. The present study evaluated the effects of alphacalcidol, a synthetic analogue of active vitamin D, given to 29 patients with marginal, intermittent hypercalcaemia. Before therapy there was an inverse relationship between serum calcium levels and diastolic blood pressure (p less than 0.

Treatment with clodronate in patients with hypercalcemia secondary to malignancy.

Dichloromethylene bisphosphonate (clodronate, Cl2MDP) is a synthetic analogue to pyrophosphate, which inhibits increased bone resorption. This drug was given to 12 patients with hypercalcemia secondary to advanced malignant disease. Clodronate in a daily dose of 1.

Enzymatic sulphation of bile salts in man. Bile salt sulphotransferase activity in percutaneous liver biopsy specimens from patients with liver disease.

Bile salt sulphation in liver disease was investigated by measuring the bile salt sulphotransferase level in percutaneous liver biopsy specimens from 27 patients. The same magnitude of mean specific enzyme activity was found in patients with cholestatic and non-cholestatic liver disease. No significant difference of the mean bile salt sulphotransferase activity was found when patients with and without reduced liver function as evidence from the intravenous galactose tolerance test were compared.

Primary sclerosing cholangitis associated with fibrosis of the submandibular glands and the pancreas.

A new syndrome of primary sclerosing cholangitis associated with fibrosis of the submandibular glands and the pancreas is described in a 43-year-old male. The sclerosing cholangitis was diagnosed at laparotomy because of cholestasis and the fibrosis of the submandibular glands and pancreas confirmed at microscopical investigation of biopsy specimens. The cholangitis responded well to treatment with a low dose of prednisolone (7.

Enzymatic sulphation of bile salts in man.

An investigation of the occurrence of glycolithocholate sulphotransferase in the human gastrointestinal tract and kidney is described. In addition to in the liver, glycolithocholate sulphotransferase was found in the small intestine, but no activity could be detected in the gastric mucosa, colonic mucosa, or kidney.

Enzymatic sulphation of bile salts in human liver.

An enzyme catalyzing the transfer of the sulphate group from 3' -phosphoadenosine-5' -phosphosulphate to lithocholate and glycolithocholate is identified in the cytosol of human liver. The rate of sulphation was greatest with unconjugates lithocolate. Km values for lithocholate and glycolithocholate were 2 .

Hypercalcemia and primary hyperparathyroidism. Prevalence in patients receiving thiazides as detected in a health screen.

Twenty patients being treated with thiazides were found among 95 subjects (21%) with hyercalcemia verified in repeated determinations in a health screening of 15,903 persons. There were 1,034 patients treated with thiazides in this total health screening. The prevalence of hypercalcemia in the patients treated with thiazides in this total health screening.

Blood pressure in subjects with hypercalcaemia and primary hyperparathyroidism detected in a health screening programme.

Primary hyperparathyroidism was the most likely diagnosis in sixty-eight non-thiazide treated patients with hypercalcaemia detected in a health screening. The group included fifty-five females and thirteen males with a mean +/- SEM age of 55.0 +/- 0.

A nitrofurantoin-induced disorder simulating chronic active hepatitis. A case report.

A 78-year-old woman with liver damage resembling chronic active hepatitis and occuring during long-term nitrofurantoin treatment is described. On admission to hospital she displayed jaundice, ascites and high serum levels of GOT, GPT, bilirubin and gamma-globulin as well as high titres of ANF and antibodies against smooth muscle cells. After withdrawal of nitrofurantoin the clinical and laboratory picture normalized without corticosteroid treatment, suggesting that the liver reaction was drug-induced.

Indications for surgery in the elderly patient with primary hyperparathyroidism.

The major symptoms presented by the elderly patient with primary hyperparathyroidism (HPT) were studied in 30 patients, all of whom were over 70 years of age (70-89). Neuromuscular symptoms, fatigue or mental symptoms were the main complaint in 14 patients. Nephrolithiasis, pancreatitis, skeletal changes or thyroid diseases were associated with HPT in 13 patients.

Clinical and laboratory findings in subjects with hypercalcaemia. A study including cases with primary hyperparathyroidism detected in a health screening.

Primary hyperparathyroidism (PHPT) was the most likely diagnosis in 68 non-thiazide-treated patients with hypercalcaemia detected in a health screening. The group comprised 55 females and 13 males, with a mean age of 55.0 +/- 0.