Cardiac dysfunction in mild primary hyperparathyroidism assessed by radionuclide angiography and echocardiography before and after parathyroidectomy

Almqvist, Erik G.; Bondeson, Anne‐Greth; Bondeson, Lennart; Nissborg, Anders; Smedgård, P; Svensson, Sören

doi:10.1067/msy.2002.128692

Cited by 89 publications

(90 citation statements)

References 19 publications

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“…Cases with mild pHPT also have an increased risk of morbidity and mortality of the cardiovascular system (3,(33)(34)(35). Several populationbased studies and investigations with patients recruited consecutively have confirmed the association between pHPT and cardiovascular diseases, where both calcium and PTH are associated directly or indirectly with increased morbidity and mortality (2,(36)(37)(38).…”

Section: Discussionmentioning

confidence: 99%

Metabolic abnormalities in patients with normocalcemic hyperparathyroidism detected at a population-based screening

et al. 2006

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Objective: Dyslipidemia, hypertension, diabetes mellitus and also primary hyperparathyroidism (pHPT) are associated with an increased risk of cardiovascular diseases. Metabolic abnormalities in mild pHPT have been reported, but never in cases with normal calcium and high parathyroid hormone (PTH) levels, i.e. suffering from 'normocalcemic pHPT'. Our aim was to explore the occurrence of these metabolic abnormalities in individuals with normocalcemic pHPT identified in a population-based screening, and the effects of parathyroidectomy vs conservative treatment on metabolic variables. Design and methods: A population-based screening of 5202 post-menopausal women identified 30 patients with normal calcium, inappropriately high PTH and normal creatinine. A 5-year follow-up included 15 parathyroidectomized (PTx) and nine conservatively followed cases, in a non-randomized setting, together with age-matched controls. Biochemical variables and body mass index (BMI) were investigated. Results: At study entry, cases had higher calcium, PTH, glucose, low-density lipoprotein (LDL)/highdensity lipoprotein (HDL)-cholesterol, very low-density lipoprotein (VLDL)-cholesterol, total triglycerides, and BMI compared to controls (PZ!0.0001-0.035). The cases had a lower HDL-cholesterol value (PZ0.013) and one third of the cases had hypertriglyceridemia. During follow-up, the PTx cases decreased in calcium, PTH, LDL/HDL-cholesterol, total and LDL-cholesterol (PZ0.0076-0.022). Investigated biochemical variables remained adverse in conservatively followed cases during follow-up except a decreased LDL-cholesterol value. All surgically treated patients had parathyroid adenoma. Conclusions: Cases with normocalcemic pHPT have increased proatherogenic lipoprotein levels, BMI and glucose levels compared to age-matched controls. Parathyroidectomy has positive effects on some of these variables and reverses them to the same level as the controls, while conservative treatment fails to normalize the investigated metabolic variables.

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Section: Discussionmentioning

confidence: 99%

Metabolic abnormalities in patients with normocalcemic hyperparathyroidism detected at a population-based screening

et al. 2006

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“…Left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular mortality and a positive correlation with PTH, independent of hypertension, has been identified in many studies of PHPT [Almqvist et al 2002;Piovesan et al 1999]. Some studies, but not all, have demonstrated a reduction in LVH following successful parathyroidectomy [Almqvist et al 2002;Piovesan et al 1999].…”

Section: Consequences Of Untreated Asymptomatic Phptmentioning

confidence: 99%

Review: New perspectives in the management of primary hyperparathyroidism

Ayuk

Cooper

Gittoes

2010

Therapeutic Advances in Endocrinology

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Primary hyperparathyroidism (PHPT) is a biochemical syndrome caused by the inappropriate or unregulated overproduction of parathyroid hormone, leading to hypercalcaemia. It was previously considered a relatively rare disorder, with clinical manifestations dominated by renal and/or bone disease. However, in modern times the diagnosis is most frequently recognized coincidentally on biochemical testing in patients evaluated for unrelated complaints. Parathyroidectomy is the only curative treatment for PHPT, with improved outcomes in symptomatic patients following this procedure. However, surgical intervention in patients with no clear clinical features remains controversial. The National Institutes for Health (NIH) have developed consensus guidelines giving specific indications for when surgery is recommended in patients with asymptomatic PHPT. This article examines the impact of treatment on asymptomatic PHPT, focusing on bone disease, neurocognitive function, quality of life, cardiovascular disease and mortality. Medical treatment options, including bisphosphonates and cinacalcet, are also discussed.

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“…It is difficult to detect because the symptoms are often non-specific and the severity of the symptoms does not correlate to the serum calcium level [1]. Patients with pHPT have an increased frequency of renal calculus [2], osteoporosis, and psychiatric diseases, as well as increased morbidity and mortality from cardiovascular disease [3,4] and cancer [5].…”

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confidence: 99%