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Pepe J, Diacinti D, Fratini E, Nofroni I, D'Angelo A, Pilotto R, Savoriti C, Colangelo L, Raimo O, Cilli M, Cipriani C, Minisola S. High prevalence of abdominal aortic calcification in patients with primary hyperparathyroidism as evaluated by Kauppila score. Eur J Endocrinol 2016; 175:95-100. [PMID: 27165861 DOI: 10.1530/eje-15-1152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/06/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The prevalence of abdominal aortic calcification (AAC) in primary hyperparathyroidism (PHPT) is unknown. We assessed both prevalence and severity of AAC in PHPT postmenopausal women. METHODS In this study 70 PHPT postmenopausal women and 70 age- and sex-matched controls were enrolled. Each participant underwent biochemical evaluation, lateral spine radiograph, bone mineral density (BMD) measurement (lumbar, femoral, radial sites), and kidney ultrasound. Lateral lumbar films were analyzed in the region of L1-L4 vertebrae and the Kauppila score (a semi-quantitative grading system) was used to assess the severity of AAC. RESULTS There were no differences regarding demographic and cardiovascular risk factors in the two groups. PHPT patients had higher prevalence of kidney stones (30% vs 7%, P=0.0008) and lower radial BMD values (0.558±0.071 vs 0.588±0.082 g/cm(2), P<0.05) compared with controls. PHPT patients showed higher prevalence of AAC (31 vs 18, P=0.03), with more severe calcifications (Kauppila score 7.35±6.1 vs 5.05±3.5, P=0.007). PHPT patients with AAC were older and had been suffering from the disease for a longer period compared with those without ACC. Moreover, PHPT patients with severe AAC had mean higher serum parathyroid hormone levels compared with patients with moderate or mild calcifications. In PHPT patients with AAC, multiple regression analysis, adjusted for age and years since diagnosis, showed that only parathyroid hormone significantly correlated with Kauppila score. CONCLUSION We found a higher prevalence and severity of AAC in PHPT related to parathyroid hormone effect.
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Affiliation(s)
- Jessica Pepe
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology'Sapienza' University, Rome, Italy
| | - Emanuela Fratini
- Department of Radiological Sciences, Oncology and Pathology'Sapienza' University, Rome, Italy
| | - Italo Nofroni
- Department of Public Health and Infectious Diseases'Sapienza' University, Rome, Italy
| | - Antonella D'Angelo
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Roberta Pilotto
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Claudio Savoriti
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Luciano Colangelo
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Orlando Raimo
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Mirella Cilli
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
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Cipriani C, Castro C, Curione M, Piemonte S, Biamonte F, Savoriti C, Pepe J, De Lucia F, Clementelli C, Nieddu L, Minisola S. Acute effect of zoledronic acid on the risk of cardiac dysrhythmias. Intern Emerg Med 2015; 10:151-6. [PMID: 25190623 DOI: 10.1007/s11739-014-1125-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/22/2014] [Indexed: 11/27/2022]
Abstract
There have been recent concerns regarding the risk of serious adverse events, such as cardiac dysrhythmia and atrial fibrillation (AF), associated with bisphosphonate use in osteoporosis. This open-label, non-randomized, crossover pilot study evaluated short-term effects of zoledronic acid and placebo on the occurrence of cardiac dysrhythmias and prodysrhythmic profile in postmenopausal women with osteoporosis and low risk of cardiac dysrhythmias. Fifteen postmenopausal women (mean age 70.7 ± 6.9 years) with osteoporosis received placebo infusion on day 1 and zoledronic acid 5 mg on day 7. Standard 12-lead resting EKG measured QT parameters at baseline and up to 24 h after infusion. Continuous 24-h EKG assessed dysrhythmic events and heart rate variability (HRV) for 24 h after infusion. There were no statistically significant differences in resting EKG parameters between placebo and zoledronic acid: QTc (404.28 ± 9.28 and 410.63 ± 18.43 ms), no significant differences in mean serum electrolytes at baseline and after infusion, and no significant association between QT/QTc parameters and serum electrolytes before and after each infusion (QTc: 401.83 ± 17.73 for zoledronic acid and 404.65 ± 16.79 for placebo). There was no significant difference in HRV parameters between placebo and zoledronic acid, and no dysrhythmias were recorded at rest or with 24 h EKG monitoring. Zoledronic acid does not produce dysrhythmia or prodysrhythmic effects in the short term. Among possible mechanisms proposed for cardiac dysrhythmias with zoledronic acid, no serum electrolyte or autonomous nervous system balance perturbations have been reported.
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Affiliation(s)
- Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy,
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Curione M, Petramala L, Savoriti C, Verrenti M, Baiocco E, Salvatore S, Zinnamosca L, Iannucci G, Sciomer S, Letizia C. Electrical and Myocardial Remodeling in Primary Aldosteronism. Front Cardiovasc Med 2014; 1:7. [PMID: 26664858 PMCID: PMC4668839 DOI: 10.3389/fcvm.2014.00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/28/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE AND DESIGN Primary aldosteronism (PA) represents the most common cause of secondary hypertension. A higher risk of cardiovascular events has been reported in patients with PA than in otherwise similar patients with essential hypertension (EH). So far, only a few studies investigated the electrocardiographic changes in PA patients compared to EH patients. METHODS To investigate the electrocardiographic changes and heart remodeling in PA, we enrolled 61 consecutive patients, 30 with PA [12 with aldosterone-producing adrenal cortical adenoma (APA) and 18 with bilateral adrenal hyperplasia-idiopathic adrenal hyperplasia] and 30 with EH. In all subjects, electrocardiographic parameters were evaluated from 12-lead electrocardiograms and heart remodeling with echocardiogram. RESULTS No significant differences in age, sex, body mass index, and blood pressure were found in two groups. The P wave and PR interval duration were significantly prolonged in patients with PA respect to EH (p < 0.003 and <0.002, respectively). A first degree atrio-ventricular block was present in 16% of the patients with PA and only in 3.2% of those with EH. In PA patients, the interventricular septum thickness (IVST) correlated with PR duration (r = 0.51; p < 0.03). Left ventricular hypertrophy was present in 53% of the patients with PA and in 26% of the patients with EH (χ(2), p < 0.03). CONCLUSION In this case-control study, patients with PA show more anatomic and electrical heart remodeling than those with EH. We hypothesize that in patients with PA these cardiac changes may play a role for the increased risk of future cardiovascular events.
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Affiliation(s)
- Mario Curione
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome , Rome , Italy
| | - Luigi Petramala
- Specialized Center of Secondary Hypertension, Sapienza University of Rome , Rome , Italy
| | - Claudio Savoriti
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome , Rome , Italy
| | - Marisa Verrenti
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome , Rome , Italy
| | - Erika Baiocco
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome , Rome , Italy
| | - Stephanie Salvatore
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome , Rome , Italy
| | - Laura Zinnamosca
- Specialized Center of Secondary Hypertension, Sapienza University of Rome , Rome , Italy
| | - Gino Iannucci
- Specialized Center of Secondary Hypertension, Sapienza University of Rome , Rome , Italy
| | - Susanna Sciomer
- Specialized Center of Secondary Hypertension, Sapienza University of Rome , Rome , Italy
| | - Claudio Letizia
- Specialized Center of Secondary Hypertension, Sapienza University of Rome , Rome , Italy
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Cipriani C, Romagnoli E, Carnevale V, Clerico R, Pepe J, Cilli M, Diacinti D, Savoriti C, Colangelo L, Minisola S. Effect of a single oral dose of 600,000 IU of cholecalciferol on muscle strength: a study in young women. J Endocrinol Invest 2013; 36:1051-4. [PMID: 23888368 DOI: 10.3275/9062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The effect of a single large oral dose of vitamin D on muscle function in young people with vitamin D deficiency has not been investigated so far. AIM We evaluated the effect of a single oral dose of 600,000 IU of cholecalciferol on muscle strength. SUBJECTS AND METHODS Eighteen young women with vitamin D deficiency received a single oral dose of 600,000 IU of cholecalciferol. We evaluated changes in maximal voluntary contraction (MVC) and speed of contraction (S) in response to cholecalciferol by using an hand held dynamometer at 3, 15, 30, 60 and 90 days, compared to baseline. RESULTS We observed no significant change in MVC and S values, a significant increase of 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] and a significant decrease in serum parathyroid hormone (PTH) (p<0.001 for all). A significant correlation was found between MVC and S and serum phosphorus (P) after supplementation (p<0.02 and p<0.05, respectively). Conversely, we observed no association between the parameters of muscle strength and 25(OH)D, ionized calcium (Ca2+), PTH and 1,25(OH)2D. CONCLUSIONS A single dose of 600,000 IU of cholecalciferol does not directly enhance handgrip strength in young women with vitamin D deficiency. More studies are needed on the indirect effect of the hormone on muscle.
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Affiliation(s)
- C Cipriani
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Pepe J, Curione M, Morelli S, Varrenti M, Cammarota C, Cilli M, Piemonte S, Cipriani C, Savoriti C, Raimo O, De Lucia F, Colangelo L, Clementelli C, Romagnoli E, Minisola S. Parathyroidectomy eliminates arrhythmic risk in primary hyperparathyroidism, as evaluated by exercise test. Eur J Endocrinol 2013; 169:255-61. [PMID: 23744591 DOI: 10.1530/eje-13-0293] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate whether parathyroidectomy (PTx) reverses risk factors for arrhythmias related to the QT dynamic changes evaluated during bicycle ergometry exercise test (ET). METHODS Twenty-four postmenopausal women with primary hyperparathyroidism (PHPT) (mean age 60.08.4 years) and 30 sex- and age-matched controls underwent ET, echocardiography, and biochemical evaluation. The following stages were considered during ET: rest, peak exercise, and recovery. The patients were randomized to two groups: 12 underwent PTx (group A) and 12 were followed-up conservatively (group B). After 6 months, the patients were studied again. RESULTS Groups A and B showed no differences in mean baseline biochemical values, echocardiographic parameters, and QTC interval. PHPT patients showed an increased occurrence of ventricular premature beats (VPBS) during ET compared with controls (37.0 vs 6.6%, P=0.03). Serum calcium level was a predictor of VPBS (P=0.05). Mean value of QTC was in the normal range at baseline (Group A: 401±16.9; group B: 402.25±13.5 ms) but significantly lower than controls (417.8±25.1 ms, P<0.01). A negative correlation was found between QTc and calcium values (P=0.03). Physiological reduction of QTc interval from rest to peak exercise was not observed in PHPT patients before surgery. After PTx, group A had a significant reduction in VPBs compared with baseline (at baseline, 5 of 12 vs none of 12 patients after PTx, P=0.03) and a restored normal QT adaptation during ET. Group B showed no significant changes after a 6-month period. CONCLUSIONS PTx reduces the occurrence of VPBs and restored the QTc adaptation during ET.
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Affiliation(s)
- Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
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Petramala L, Savoriti C, Zinnamosca L, Marinelli C, Settevendemmie A, Calvieri C, Catani M, Letizia C. Primary aldosteronism with concurrent primary hyperparathyroidism in a patient with arrhythmic disorders. Intern Med 2013; 52:2071-5. [PMID: 24042515 DOI: 10.2169/internalmedicine.52.8794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 25-year-old Caucasian woman was admitted to our department with severe hypokalemia that was associated with hypercalcemia. An endocrinological investigation showed the coexistence of primary hyperparathyroidism (PHPT) and primary aldosteronism (PA), arising from an adenoma of the left cortical adrenal gland. The patient underwent left laparoscopic adrenalectomy, but refused the surgical neck exploration that would be required for parathyroidectomy. The post-operative course was uneventful, and the patient realized a normalization of her potassium serum level and a reduction of her blood pressure values. We herein report the important issues regarding the management of a severe electrolyte imbalance, in view of the reciprocal interaction between aldosterone and parathyroid hormone, and their combined potential for causing cardiovascular damage.
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Affiliation(s)
- Luigi Petramala
- Secondary Arterial Hypertension Unit, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy
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Colotto M, Rubini G, Savoriti C, D'Adduogo N, Mercuri S. [Impact of depression syndrome in the management of cardiovascular risk factors in primary prevention: State of the art]. Clin Ter 2010; 161:e105-e110. [PMID: 20589342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Our aim is to investigate, through a broad review of medical literature, the role of depressive syndrome on the adherence to lifestyle modifications (TLC) in patients with risk factors for cardiovascular disease (CVD). We conducted a systematic computerized literature search of MEDLINE using the following key words: depressive syndrome, cardiovascular risk factors, lifestyle, physical activity, diet, smoking, blood pressure, metabolic syndrome and diabetes. We have considered metanalyses studies, reviews, original articles, case-control studies published between 1992 and 2010. Furthermore, we have considered the impact of depressive syndrome on the different cardiovascular risk factors. From our search we have selected 42 English articles published between 1992 and 2010 of whose 16 were longitudinal cohort studies, 5 research reports, 10 longitudinal case-control studies, 2 metanalyses, 5 reviews and 4 prevalence studies. All our selected studies agree to give to depressive syndrome a negative role on the adherence to lifestyle modifications. For this reason, depression represents an indirect and independent cardiovascular risk factor that needs to be detected and treated for a successful cardiovascular prevention.
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Affiliation(s)
- M Colotto
- Dipartimento di Scienze Cliniche, Policlinico Umberto I, Sapienza Università di Roma, Italia.
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