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  1. D. A. Dishmon,
  2. R. N. Khouzam,
  3. V. Farah,
  4. M. D. Nelson,
  5. S. D. Flax,
  6. L. D. Carbone,
  7. K. T. Weber
  1. University of Tennessee Health Sciences Center, Memphis, TN


Purpose CHF with aldosteronism features a systemic illness that includes bone wasting. In rats with aldosteronism, secondary hyperparathyroidism (SHPT) with bone resorption has been observed and can be prevented by parathyroidectomy. SHPT may accompany human CHF as a result of aldosteronism and furosemide-enhanced urinary Ca2+ and Mg2+ excretion. We hypothesized SHPT in patients who were hospitalized for their CHF and where secondary aldosteronism would be expected.

Methods Nine consecutive patients (7 males, 2 females; 8 African Americans, 1 Caucasian; 33-60 yrs of age) were hospitalized during a 28-day period (February 2005) with chronic left ventricular systolic dysfunction (EF < 35%) and CHF (NYHA Class III and IV) secondary to ischemic or idiopathic (dilated) cardiomyopathy. Five had clinical findings of decompensated failure and were untreated medically while 4 were similarly decompensated but treated with an ACE inhibitor, furosemide, and spironolactone. None of these 9 patients were receiving insulin, estrogen, a glucocorticoid, growth hormone, or thyroxine, and none had disorders affecting bone metabolism. Within 48 hours of admission, we monitored: serum parathyroid hormone (PTH); serum calcium corrected for albumin, magnesium, and phosphorus. Serum creatinine at the time of discharge was used to calculate creatinine clearance.

Results Serum PTH was elevated (normal range 12-65 pg/mL) in both untreated (204 6 12 pg/mL) and treated (143 6 5 pg/mL) patients. Albumin-corrected serum calcium was within the normal range (8.4-10.2 mg/dL) in both untreated (9.7 6 0.1 mg/dL) and treated (9.1 6 0.2 mg/dL) patients as were serum magnesium (2.02 6 0.52 and 2.47 6 0.67 mg/dL) and phosphorus (3.5 6 0.1 and 4.2 6 0.3 mg/dL), respectively. Calculated creatinine clearance did not differ significantly between untreated (74 6 15 mL/min) and treated (83 6 21 mL/min) patients.

Conclusions In predominantly African American patients, consecutively hospitalized with CHF during February 2005, SHPT was found in 5 untreated patients, where furosemide was not a consideration, and 4 medically treated patients. Corrected serum calcium was normal while serum-ionized calcium was not measured. Because we did not monitor 25(OH)D levels, we cannot exclude hypovitaminosis D in these housebound patients with CHF. SHPT may contribute to the systemic illness that accompanies CHF, including bone wasting.

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