Parathyroid hormone secretion: effect of beta-adrenergic blockade before and after surgery for primary hyperparathyroidism.

Serum immunoreactive parathyroid hormone (iPTH) response to beta-adrenergic blockade by propranolol infusion was determined in 11 normal subjects and 6 patients with primary hyperparathyroidism (PHPT) before and again after the surgical removal of abnormal parathyroid tissue. Propranolol infusion in PHPT patients before surgery resulted in no significant decrease in serum iPTH except at 2 h, when the mean value was 83 +/- 4.4% of baseline. After surgery and achieving a euparathyroid state, the same patients showed a significant propranolol-induced decrease in serum iPTH from baseline at all time periods tested, reaching the nadir value of 57 +/- 7.5% of baseline at 2 h after the start of the propranolol infusion. This response in PHPT patients after surgery was very similar to the response seen in normal subjects. Therefore, this impaired suppressibility of serum iPTH in PHPT is corrected after removal of the abnormal parathyroid tissue. The studies indicate that abnormal parathyroid tissue (either per se or via a metabolic state induced by it) is responsible for the impaired response to beta-adrenergic blockade. It therefore appears unlikely that the impaired beta-adrenergic responsiveness is involved in the pathogenesis of PHPT.