{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T12:38:36Z","timestamp":1771591116823,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2012,1,4]],"date-time":"2012-01-04T00:00:00Z","timestamp":1325635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2012,2]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold>Objective\u2002<\/jats:bold> Primary hyperparathyroidism (PHPT) is associated with cardiovascular morbidity and premature death, but the underlying mechanisms are incompletely understood. The aim of this study was to investigate whether adrenergic dysfunction may be a contributing factor.<\/jats:p><jats:p><jats:bold>Patients and methods\u2002<\/jats:bold> Forty\u2010nine patients with mild PHPT (serum calcium 2\u00b77\u2003\u00b1\u20030\u00b71\u2003m<jats:sc>m<\/jats:sc>) and 48 control subjects, matched for age and sex, were examined; patients within 1\u2003month before parathyroidectomy (PTX) and 6\u2003months postoperatively; control subjects at inclusion. Heart rate variability (HRV) was analysed in 24\u2010h electrocardiograms, and plasma concentrations of epinephrine and norepinephrine were measured at rest and immediately after standardized physical tests.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> At baseline, the patients showed, compared to the controls, reduced stress\u2010related increase of circulating epinephrine (<jats:italic>P\u2003<\/jats:italic>&lt;<jats:italic>\u2003<\/jats:italic>0\u00b705) and norepinephrine (<jats:italic>P\u2003<\/jats:italic>&lt;<jats:italic>\u2003<\/jats:italic>0\u00b705). No significant change was observed 6\u2003months after PTX. At baseline, there were no significant differences between patients and controls in HRV or heart rate, but 6\u2003months after curative PTX, the patients showed significantly reduced HRV in both frequency and time domain, and their maximum and average heart rate had decreased (<jats:italic>P\u2003<\/jats:italic>=<jats:italic>\u2003<\/jats:italic>0\u00b7011 and <jats:italic>P\u2003<\/jats:italic>=<jats:italic>\u2003<\/jats:italic>0\u00b7018, respectively). The patients with the highest preoperative levels of circulating parathyroid hormone showed the greatest changes in heart rate and HRV postoperatively.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> This study demonstrates a previously unknown impairment of catecholamine response to physical stress in PHPT along with changes of HRV, also indicating adrenergic dysfunction. These factors should be considered in the ongoing controversy regarding the management of patients with mild \u2018asymptomatic\u2019 PHPT.<\/jats:p>","DOI":"10.1111\/j.1365-2265.2011.04169.x","type":"journal-article","created":{"date-parts":[[2011,7,9]],"date-time":"2011-07-09T15:19:35Z","timestamp":1310224775000},"page":"189-195","source":"Crossref","is-referenced-by-count":6,"title":["Adrenergic and cardiac dysfunction in primary 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