A pilot study investigating the effect of parathyroidectomy on arterial stiffness and coronary artery calcification in patients with primary hyperparathyroidism

Dural, Ahmet Cem; Okoh, Alexis K.; Seicean, Andreea; Yiğitbaş, Hakan; Thomas, George; Yazici, Pınar; Shoenhagen, Paul; Doshi, Krupa; Halliburton, Sandra S.; Berber, Eren

doi:10.1016/j.surg.2015.07.037

Cited by 11 publications

(13 citation statements)

References 20 publications

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“…In symptomatic PHPT patients, six months after PTx, there was no improvement of coronary artery calcification; however, half of the patients studied were affected by hypertension and dyslipidemia (111). In a study carried out with transthoracic Doppler, 6 months following PTx, a reduction in microvascular dysfunction was reported; PTH, age and heart rate were independently associated with microvascular dysfunction and not with disease duration (109).…”

Section: Primary Hyperparathyroidism and Large Vessel Involvementmentioning

confidence: 97%

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Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

114

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Data on cardiovascular disease in primary hyperparathyroidism (PHPT) are controversial; indeed, at present, cardiovascular involvement is not included among the criteria needed for parathyroidectomy. Aim of this narrative review is to analyze the available literature in an effort to better characterize cardiovascular involvement in PHPT. Due to physiological effects of both parathyroid hormone (PTH) and calcium on cardiomyocyte, cardiac conduction system, smooth vascular, endothelial and pancreatic beta cells, a number of data have been published regarding associations between symptomatic and mild PHPT with hypertension, arrhythmias, endothelial dysfunction (an early marker of atherosclerosis), glucose metabolism impairment and metabolic syndrome. However, the results, mainly derived from observational studies, are inconsistent. Furthermore, parathyroidectomy resulted in conflicting outcomes, which may be linked to several potential biases. In particular, differences in the methods utilized for excluding confounding co-existing cardiovascular risk factors together with differences in patient characteristics, with varying degrees of hypercalcemia, may have contributed to these discrepancies. The only meta-analysis carried out in PHPT patients, revealed a positive effect of parathyroidectomy on left ventricular mass index (a predictor of cardiovascular mortality) and more importantly, that the highest pre-operative PTH levels were associated with the greatest improvements. In normocalcemic PHPT, it has been demonstrated that cardiovascular risk factors are almost similar compared to hypercalcemic PHPT, thus strengthening the role of PTH in the cardiovascular involvement. Long-term longitudinal randomized trials are needed to determine the impact of parathyroidectomy on cardiovascular diseases and mortality in PHPT.

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Section: Primary Hyperparathyroidism and Large Vessel Involvementmentioning

confidence: 97%

“…In one study, PHPT patients were characterized by significantly higher mean values of arterial stiffness compared to controls (67,68), that improved 6 months after PTx (67). However, Rosa et al hypothesized that this effect may be determined primarily by improved blood pressure control after surgery (68).…”

Section: Atherosclerosismentioning

confidence: 99%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

114

View full text Add to dashboard Cite

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“…Indeed, in PHPT patients, a higher incidence of calcification has been reported in different arterial districts: both in the large vessels, such as the carotid and abdominal aortic (27,28), and in small vessels such as the coronary arteries (29). However, the issue of coronary artery dysfunction in PHPT is still unresolved; some authors have demonstrated higher coronary calcifications in PHPT (30), while others have not (31), with conflicting results on the role of PTx in this context (32). Independently of this, premature ventricular beats are sign of electrical instability that surely should alerts physicians.…”

Section: Figurementioning

confidence: 99%

Reduction of arrhythmias in primary hyperparathyroidism, by parathyroidectomy, evaluated with 24-h ECG monitoring

Pepe

Cipriani

Curione

et al. 2018

European Journal of Endocrinology

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“…Some reports have indicated that PTX has limited benefits with respect to end-organ functions, such as cardiovascular [14,15] and fracture outcomes [16]. However, there have been few reports on the renal outcomes and recurrent risk of hyperparathyroidism in patients with asymptomatic PHPT undergoing PTX.…”

Section: Introductionmentioning

confidence: 99%

A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease

Li¹,

Chen²,

Meng³

2021

SJCM

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Background: Parathyroidectomy (PTX) is the definitive treatment of primary hyperparathyroidism (PHPT) for symptomatic patients. PTX for hyperparathyroidism is associated with the risk of recurrence; however, this has been mostly demonstrated in chronic kidney disease (CKD) patients with secondary hyperparathyroidism. The recurrent risk of hyperparathyroidism and renal outcomes after PTX in patients with PHPT has been rarely reported. Patient: In this article, we report a case of a 70-year-old man with previously diagnosed CKD, underwent a subtotal PTX for asymptomatic primary hyperparathyroidism induced by parathyroid hyperplasias. The PTX appears to resolve the calcium disturbance in this patient. However, at three months after the surgery, the diagnosis of recurrent hyperparathyroidism was made, based on a remarkably increased level of parathyroid hormone from 42.12 pg/ml to 270.9 pg/ml. Over 2 years of follow-up, his renal function, as evaluated by serum creatinine levels, fluctuated modestly, but persist at a preoperative level of renal impairment. These data indicate that this patient with asymptomatic PHPT has experienced recurrent hyperparathyroidism with persistent renal dysfunction after PTX. Conclusion: The recurrent hyperparathyroidism after PTX in PHPT patients with a coexisting renal impairment appears more common than might be anticipated. We recommend that if hyperparathyroidism recurs or exacerbates by the persistent renal dysfunction after PTX, the potential benefits of PTX should be reconsidered and carefully weighed against the possible surgical risks.

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A pilot study investigating the effect of parathyroidectomy on arterial stiffness and coronary artery calcification in patients with primary hyperparathyroidism

Cited by 11 publications

References 20 publications

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Reduction of arrhythmias in primary hyperparathyroidism, by parathyroidectomy, evaluated with 24-h ECG monitoring

A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease

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