Skip to main content
SpringerLink
Log in

αANP, AVP, and pituitary-thyroid axis in patients with congestive heart failure and acute respiratory failure

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

The pituitary-thyroid axis and neurohumoral activation indexes were simultaneously investigated in 16 in-patients hospitalized for cardiac heart failure (CHF), New York Heart Association (NYHA), class II-IV, and Killip clinical scale, class II-III, to evaluate their relationship with CHF morbidity and the relative prognostic value. At entry the patients were divided into two subgroups (A and B), according to the severity of CHF. Patients were further classified into two subgroups, according to the subsequent clinical course (C, poor outcome and D, improved clinical course). Blood samples were obtained every day for the radioimmunoassay measurement of plasma a-atrial natriuretic peptide (αANP), arginine vasopressin (AVP), and thyroid hormones, and the results were compared with those of 12 control subjects. At admission, αANP and 3,3′,5′-triiodothyronine (rT3) values were higher, while 3,3′,5-triiodothyronine (T3) to rT3 (T3/rT3) ratio was lower in subgroups A and B than in controls (p<0.001), respectively, and in C than in D (p<0.001), respectively, according to the prognosis. Conversely, no differences in other thyroid indexes, nor a significant correlation between αANP and either rT3 or T3/rT3 ratio were present in any of the subgroups. AVP plasma levels in subgroup A were not statistically different from those of controls, whereas they were significantly decreased in subgroups B and C (p<0.05) and D (p<0.001). In conclusion, these results indicate that in CHF the pituitary-thyroid axis is not altered, that αANP and T3/rT3 ratio are non-invasive and reliable predictors of severity and prognosis, while AVP might be affected by the different pathological processes leading to CHF or by the concomitant use of drugs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Katz A.M. The cardiomyopathy of overload: an unnatural growth response in the hypertrophied hearth. Ann. Intern. Med. 1994, 121: 363–371.

    Article  CAS  PubMed  Google Scholar 

  2. Bonow R.O. New insights into the cardiac natriuretic peptides. Circulation 1996, 93: 1946–1950.

    Article  CAS  PubMed  Google Scholar 

  3. Middlekauff H.R., Mark A.L. The treatment of hearth failure: the role of neurohumoral activation. Intern. Med. 1998, 37: 112–122.

    Article  CAS  PubMed  Google Scholar 

  4. Selvais P.L., Donckier J.E., Robert A., Laloux O., van Linden F., Ahn S., Ketelslegers J.M., Rousseau M.F. Cardiac natriuretic peptides for diagnosis and risk stratification in heart failure: influences of left ventricular dysfunction and coronary artery disease on cardiac hormonal activation. Eur. J.Clin. Invest. 1998, 28: 636–642.

    Article  CAS  PubMed  Google Scholar 

  5. Missouris C.G., Grouzmann E., Buckley M.G., Barron J., MacGregor G.A., Singer D.R. How does treatment influence endocrine mechanisms in acute severe heart failure? Effects on cardiac natriuretic peptides, the renin system, neuropeptide Y and catecholamines. Clin. Sci. 1998, 94: 591–599.

    CAS  PubMed  Google Scholar 

  6. Swedberg K., Eneroth P., Kjekshus J., Wilhelmsen L., for the CONSENSUS trial study group. Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality. Circulation 1990, 82: 1730–1736.

    Article  CAS  PubMed  Google Scholar 

  7. Kimura T., Kanda T., Kuwabara A., Shinohara H., Kobayashi I. Participation of the pituitary-thyroid axis in the cardiovascular system in elderly patients with congestive heart failure. J. Med. 1997, 28: 75–80.

    CAS  PubMed  Google Scholar 

  8. Gomberg-Maitland M., Frishman W.H. Thyroid hormone and cardiovascular disease. Am. Heart J. 1998, 135: 187–196.

    Article  CAS  PubMed  Google Scholar 

  9. Opasich C., Pacini F., Ambrosino N., Riccardi P.G., Febo O., Ferrari R., Cobelli F., Tavazzi L. Sick euthyroid syndrome in patients with moderateto- severe chronic heart failure. Eur. Heart J. 1996, 17: 1860–1866.

    Article  CAS  PubMed  Google Scholar 

  10. Hamilton M.A., Stevenson L.W., Luu M., Walden J.A. Altered thyroid hormone metabolism in advanced heart failure. J. Am. Coll. Cardiol. 1990, 16: 91–95.

    Article  CAS  PubMed  Google Scholar 

  11. Braunwald E. Heart Disease, ed. 5. W.B. Saunders Company, Philadelphia, 1988, p. 12.

    Google Scholar 

  12. Braunwald E. Heart Disease, ed. 3. W.B. Saunders Company, Philadelphia, 1988, p. 1273.

    Google Scholar 

  13. Benedict C.R., Weiner D.H., Johnstone D.E., Bourassa M.G., Ghali J.K., Nicklas J., Kirlin P., Greenberg B., Quinones M.A., Yusuf S., for the SOLVD Investigators. Comparative neurohormonal responses in patients with preserved and impaired left ventricular ejection fraction: results of the studies of left ventricular dysfunction (SOLVD) registry. J. Am. Coll. Cardiol. 1993, 22: 146A–153A.

    Article  CAS  PubMed  Google Scholar 

  14. Maeda K., Tsutamoto T., Wada A., Hisanaga T., Kinoshita M. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction. Am. Heart J. 1998, 135: 825–832.

    Article  CAS  PubMed  Google Scholar 

  15. Dickstein K., Abrahamsen S., Aarsland T. Plasma N-terminal atrial natriuretic peptide predicts hospitalization in patients with heart failure.

  16. Scand. Cardiovasc. J. 1998, 32: 361–364. 16._Gutkowska J., Antunes-Rodriguez J., McCann S.M. Atrial natriuretic peptide in brain and pituitary gland. Physiol. Rev. 1997, 77: 465–515.

    Google Scholar 

  17. Schrier R.W., Martin P.Y. Recent advances in the understanding of water metabolism in heart failure. Adv. Exp. Med. Biol. 1998, 449: 415–426.

    Article  CAS  PubMed  Google Scholar 

  18. Yamamoto S., Morimoto I., Yanagihara N., Kangawa K., Inenaga K., Eto S., Yamashita H. C-type natriuretic peptide suppresses arginine-vasopressin secretion from dissociated magnocellular neurons in newborn rat supraoptic nucleus. Neurosci. Lett. 1997, 229: 97–100.

    Article  CAS  PubMed  Google Scholar 

  19. Sigurdsson A., Swedberg K. The role of neurohormonal activation in chronic heart failure and postmyocardial infarction. Am. Heart J. 1996, 132: 229–234.

    Google Scholar 

  20. Volpe M., Tritto C., De Luca N., Mele A.F., Lembo G., Rubattu S., Romano M., De Campora P., Enea I., Ricciardelli B., Trimarco B., Condorelli M. Failure of atrial natriuretic factor to increase with saline load in patients with dilated cardiomyopathy and mild heart failure. J.Clin. Invest. 1991, 88: 1481–1489.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Sagnella G.A. Measurement and significance of circulating natriuretic peptides in cardiovascular disease. Clin. Sci. 1998, 95: 519–529.

    Article  CAS  PubMed  Google Scholar 

  22. Santini F., Chopra I.J. A radioimmunoassay of rat type I iodothyronine 5′- monodeiodinase (5′-MD). Endocrinology 1992, 131: 2521–2526.

    CAS  PubMed  Google Scholar 

  23. Kohrle J., Hesch R.D., Leonard J.L. Intracellular pathways of iodothyronine metabolism. In: Braverman L.E., Utiger R.D. (Eds.), The thyroid. Lippincott Company, Philadelphia, 1991, p. 144.

    Google Scholar 

  24. Chopra I.J. Euthyroid sick syndrome: is it a misnomer? J. Clin. Endocrinol. Metab. 1997, 82: 329–334.

    Article  CAS  PubMed  Google Scholar 

  25. Hamilton M.A., Stevenson L.W. Thyroid hormone abnormalities in heart failure: possibilities for therapy. Thyroid 1996, 6: 527–529.

    Article  CAS  PubMed  Google Scholar 

  26. Utiger R.D. Altered thyroid function in nonthyroidal illness and surgery. To treat or not to treat? N. Engl. J. Med. 1995, 333: 1562–1563.

    Article  CAS  PubMed  Google Scholar 

  27. Nelson J.C., Tomei R.T. Direct determination of free thyroxin in undiluted serum by equilibrium dialysis/radioimmunoassay. Clin. Chem. 1988, 34: 1737–1744.

    CAS  PubMed  Google Scholar 

  28. Nguyen T.T., Chapa F., DiStefano J.J. 3rd. Direct measurement of the contribution of type I and type II 5′-deiodinases to whole body steady state 3,5,3′- triiodothyronine production from thyroxine in the rat. Endocrinology 1998, 139: 4626–4633.

    CAS  PubMed  Google Scholar 

  29. Rolandi E., Santaniello B., Bagnasco M., Cataldi A., Garibaldi C., Franceschini R., Barreca T. Thyroid hormones and atrial natriuretic hormone secretion: study in hyper- and hypothyroid patients. Acta Endocrinol. (Copenh.) 1992, 127: 23–26.

    CAS  Google Scholar 

  30. Cavallini G., Clerico A., Del Chicca M., De Tata V., Gori Z., Bergamini E. Effects of the administration of thyroid hormone on the plasma levels of atrial natriuretic peptides and on atrial myoendocrine cells in the rat: an immunochemical, ultrastructural, and stereological study. J.Endocrinol. Invest. 1992, 15: 727–734.

    CAS  PubMed  Google Scholar 

  31. Anker S.D., Chua T.P., Ponikowski P., Harrington D., Swan J.W., Kox W.J., Poole-Wilson P.A., Coats A.J.S. Hormonal changes and catabolic/anabolic imbalance in chronic heart failure and their importance for cardiac cachexia. Circulation 1997, 96: 526–534.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dipartimento di Endocrinologia e Oncologia Molecolare e Clinica, Via G. Santacroce 40, 80129, Napoli, Italy

    S. Savastano (Cattedra di Endocrinologia), V. Cannavale (Cattedra di Endocrinologia), A. P. Tommaselli (Cattedra di Endocrinologia), R. Rossi (Cattedra di Endocrinologia), A. Luciano (Cattedra di Endocrinologia), L. Tauchmanovà (Cattedra di Endocrinologia) &  G. Lombardi (Cattedra di Endocrinologia)

  2. Dipartimento di Biologia e Patologia Cellulare e Molecolare “E. Califano”, Centro di Endocrinologia ed Oncologia Sperimentale del CNR, Italy

    R. Valentino

  3. Dipartimento di Patologia Clinica, Facoltà di Medicina e Chirurgia, Università “Federico II”, Italy

    A. Mariano & V. Macchia

  4. Medicina D’Urgenza, Ospedale Cardarelli, Napoli, Italy

    L. Mazzitelli

Authors
  1. S. Savastano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Cannavale
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Valentino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. P. Tommaselli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Luciano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. Tauchmanovà
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Mariano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. L. Mazzitelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. V. Macchia
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. G. Lombardi
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Savastano, S., Cannavale, V., Valentino, R. et al. αANP, AVP, and pituitary-thyroid axis in patients with congestive heart failure and acute respiratory failure. J Endocrinol Invest 22, 766–771 (1999). https://doi.org/10.1007/BF03343642

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03343642

Key-words

Search

Navigation