Hormona paratiroidea, aldosterona e hipertensión arterial ¿una amenaza infravalorada?
No hay miniatura disponible
Fecha
2017
Autores
Rojas, Joselyn
Olivar, Luis Carlos
Chávez Castillo, Mervin
Martínez, María Sofia
Wilches-Durán, Sandra
Título de la revista
ISSN de la revista
Título del volumen
Editor
Cooperativa servicios y suministros 212518 RS
Resumen
El Hiperparatiroidismo primario (HPTP) es un
trastorno endocrino frecuente caracterizado
por una secreción autónoma de hormona
paratiroidea (PTH). Si bien, su variante asintomática es la
más frecuentemente encontrada en la práctica clínica (la
cual se diagnostica incidentalmente), las complicaciones
óseas y renales afectan de forma importante la calidad
de vida del paciente. Sin embargo, el espectro de manifestaciones
de este trastorno no se limita al metabolismo
mineral, puesto que las concentraciones elevadas de PTH
se asocian a un mayor riesgo de alteraciones metabólicas
como el síndrome metabólico, diabetes mellitus 2 y enfermedades
cardiovasculares. En este ámbito, la hipertensión
arterial (HTA), relacionada con aproximadamente 9,4 millones
de muerte al año, ha sido considerada una manifestación
no clásica del HPTP. La interacción PTH-Aldosterona
ha surgido como un importante eslabón para tratar de
explicar esta relación, planteándose diversos mecanismos
teóricos que posicionan a la PTH como estimulador directo
de la síntesis de aldosterona en las células de la zona
glomerular. Sin embargo, estos mecanismos teóricos han
estado rodeados de controversia en su aspecto epidemiológico
y clínico, existiendo aún muy pocos estudios poblacionales
explorando este vínculo y su relación con la
morbimortalidad cardiovascular, por lo que es necesario
mayor investigación en el área con el fin de conocer el
verdadero impacto de estos mecanismos en la salud de los
individuos. Esta revisión resume aspectos del metabolismo
del calcio, al igual que los principales mecanismos subyacentes
al vínculo HPTP-HTA, y los datos epidemiológicos
disponibles sobre el tópico, a fin de brindar un mejor entendimiento
sobre este novel planteamiento.
Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by autonomic parathyroid hormone secretion (PTH). Although its asymptomatic variant is the most frequently found in clinical practice (which is incidentally diagnosed), bone and kidney complications significantly affect the patient’s quality of life. However, the spectrum of manifestations of this disorder is not limited to mineral metabolism, since elevated concentrations of PTH are associated with an increased risk of metabolic syndrome, type 2 diabetes mellitus and cardiovascular disease. In this area, hypertension (AHT), related to approximately 9.4 million deaths per year, has been considered a non-classical manifestation of PHPT. The interaction PTH-Aldosterone has emerged as an important link to try to explain this relationship, posing various theoretical mechanisms that position PTH as a direct stimulator of aldosterone synthesis in the glomerular zone cells. However, these theoretical mechanisms have been surrounded by controversy in their epidemiological and clinical aspects, and there are still very few population studies exploring this link and its relation with cardiovascular morbimortality, which is why more research is needed in the area in order to know. The true impact of these mechanisms on the health of individuals. This review summarizes aspects of calcium metabolism, as well as the main mechanisms underlying the HPTP-HTA link, and available epidemiological data on the topic, in order to provide a better understanding of this novel approach.
Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by autonomic parathyroid hormone secretion (PTH). Although its asymptomatic variant is the most frequently found in clinical practice (which is incidentally diagnosed), bone and kidney complications significantly affect the patient’s quality of life. However, the spectrum of manifestations of this disorder is not limited to mineral metabolism, since elevated concentrations of PTH are associated with an increased risk of metabolic syndrome, type 2 diabetes mellitus and cardiovascular disease. In this area, hypertension (AHT), related to approximately 9.4 million deaths per year, has been considered a non-classical manifestation of PHPT. The interaction PTH-Aldosterone has emerged as an important link to try to explain this relationship, posing various theoretical mechanisms that position PTH as a direct stimulator of aldosterone synthesis in the glomerular zone cells. However, these theoretical mechanisms have been surrounded by controversy in their epidemiological and clinical aspects, and there are still very few population studies exploring this link and its relation with cardiovascular morbimortality, which is why more research is needed in the area in order to know. The true impact of these mechanisms on the health of individuals. This review summarizes aspects of calcium metabolism, as well as the main mechanisms underlying the HPTP-HTA link, and available epidemiological data on the topic, in order to provide a better understanding of this novel approach.
Descripción
Palabras clave
Hiperparatirodismo primario, Aldosterona, Hormona paratiroidea, Hipertensión arterial, Riesgo cardiovascular, Mortalidad cardiovascular, Primary Hiperparathyroidism, Aldosterone, Parathyroid hormone, Hypertension, Cardiovascular risk, Cardiovascular mortality