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New York City, NY, United States

Landry D.W.,22 West 168th Street | Oliver J.A.,30 West 168th Street
Critical Care | Year: 2010

Vasopressin is becoming a widely used pressor in conditions with severe hypotension. Like several other hormones important in cardiovascular and extracellular fluid control, however, vasopressin can activate several receptors that when pharmacologically or pathologically stimulated may result in conflicting effects. In the present issue of Critical Care, Rehberg and colleagues examined the hypothesis that blockade of vasopressin V2 receptor during septic shock may be beneficial. Their tantalizing results indicate that future work must consider the precise vasopressin receptors that are stimulated and/or inhibited. © 2010 BioMed Central Ltd.

Walker M.D.,30 West 168th Street | Cong E.,30 West 168th Street | Kepley A.,30 West 168th Street | Di Tullio M.R.,30 West 168th Street | And 8 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: Vitamin D (25OHD) deficiency may be a modifiable cardiovascular (CV) risk factor. 25OHD insufficiency (20-29 ng/mL) and deficiency (<20 ng/mL) are common in primary hyperparathyroidism (PHPT), but their association with CV disease in PHPT has not been systematically investigated. Objective: This study evaluated whether low 25OHD is associated with subclinical CV disease in PHPT. Design: This is a cross-sectional analysis of PHPT patients with and without low 25OHD. Settings and Participants: We studied 110 PHPT patients in a university hospital setting. Outcome Measures: We measured carotid intima-media thickness; carotid plaque presence/thickness; carotid strain and stiffness; left ventricular mass index; cardiac systolic and diastolic function; and mitral annular calcification. Results: Low 25OHD levels (<30 ng/mL) were observed in 28%, but only 9% had 25OHD deficiency (<20 ng/mL). In the whole group, 25OHD levels negatively correlated with body mass index (r = -0.33, P=.0005), PTH (r=-0.30, P=.001), calcium (r=-0.29, P=.002), renal function, and PHPT duration. CV indices were normal except for carotid intima-media thickness, stiffness, and plaque thickness, which were increased, regardless of 25OHD status. Isovolumic relaxation time was the only CV measure associated with 25OHD (r=-0.26, P=.01). Those with 25OHD less than 20 ng/mL had more severe PHPT and a higher rate of nephrolithiasis. Those with 25OHD less than 30 ng/mL were younger, had higher body mass index, had lower serum phosphate, and were more likely to be male, nonwhite, and Hispanic. Other than lower tissue Doppler e' and higher isovolumic relaxation time within normal range in those with25OHDless than 30 vs greater than 30 ng/mL, there were no differences in CV indices using either 25OHD threshold. Conclusions: Patients with mild PHPT have subclinical carotid abnormalities, but low 25OHD is not associated with abnormal carotid or cardiac measures. To the extent that PTH levels differentiated those with25OHDless than 20 but not 30 ng/mL, these data support a25OHDthreshold of 20 ng/mL as clinically relevant in PHPT. Copyright © 2014 by the Endocrine Society.

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