Circadian cardiac autonomic nerve dysfunction in primary hyperparathyroidism improves after parathyroidectomy

Nilsson, Inga-Lena; Åberg, Jan; Rastad, Jonas; Lind, Lars

doi:10.1016/j.surg.2003.07.017

Cited by 24 publications

(21 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In classic pHPT, even mildly elevated calcium levels are associated with increased cardiovascular abnormalities and dysfunction [72,73], many of which improved with parathyroidectomy [74,75]. When comparing operative and nonoperative groups with classic disease, those who were observed were found to have significantly increased left ventricular mass 1 year after surgery.…”

Section: Cardiovascular/metabolic Effectsmentioning

confidence: 99%

Mild Primary Hyperparathyroidism: A Literature Review

Applewhite

Schneider

2014

The Oncologist

View full text Add to dashboard Cite

The biochemical profile of classic primary hyperparathyroidism (pHPT) consists of both elevated calcium and parathyroid hormone levels. The standard of care is parathyroidectomy unless prohibited by medical comorbidities. Because more patients are undergoing routine bone density evaluation and neck imaging studies for other purposes, there is a subset of people identified with a biochemically mild form of the pHPT that expresses itself as either elevated calcium or parathyroid hormone levels. These patients often do not fall into the criteria for operation based on the National Institutes of Health consensus guidelines, and they can present a challenge of diagnosis and management. The purpose of this paper is to review the available literature on mild pHPT in an effort to better characterize this patient population and to determine whether patients benefit from parathyroidectomy. Evidence suggests that there are patients with mild pHPTwho have overt symptoms that are found to improve after parathyroidectomy. There is also a group of patients with biochemically mild pHPT who are found to progress to classic pHPT over time; however, it is not predictable which group of patients this will be. Early intervention for this group with mild pHPT may prevent progression of bone, psychiatric, and renal complications, and parathyroidectomy has proven safe in appropriately selected patients at high volume centers. The Oncologist 2014;19:919-929 Implications for Practice: Mild primary hyperparathyroidism (pHPT) is a disease that is being diagnosed with increased frequency; however, recommendations for treatment are not uniform. Current NIH guidelines do not recommend parathyroidectomy for these patients if they are asymptomatic; however, upon focused questioning, many of these patients are found to have subtle symptoms.The biochemically mild nature of the disease has been found to delay diagnosis and treatment, but after it is identified, surgery has shown to provide an improvement in quality of life and bone health. Although the current body of literature suggests that patients with mild pHPT benefit from parathyroidectomy, careful patient and surgeon selection is critical to ensuring safety and efficacy. Universal acceptance of parathyroidectomy in this subset of patients will require more high quality, prospective studies and improved definitions of long-term cure.

show abstract

Section: Cardiovascular/metabolic Effectsmentioning

confidence: 99%

Mild Primary Hyperparathyroidism: A Literature Review

Applewhite

Schneider

2014

The Oncologist

View full text Add to dashboard Cite

show abstract

“…[3][4][5] In some studies, most patients with PHPT and hypertension have blood pressure (BP) values that significantly decrease after parathyroidectomy. 6 That allows these patients to reduce antihypertensive treatment or even to stop it definitively. 3,[7][8][9] Ambulatory monitoring of blood pressure (AMBP), using either invasive or noninvasive recorders, has shown that BP tends to be higher during the day and lower at night in normotensive subjects.…”

Section: Introductionmentioning

confidence: 99%

“…In the patients with PHPT, the circadian blood pressure rhythm (analysed in some studies with Cosinor method by Halberg F) is generally present 19 and the 24 h ambulatory blood pressures and the intima media thickness of the carotid arteries failed to differ significantly between the PHPT patients and control subjects 6 What this work adds K Results of our study confirm and extend the data of arterial hypertension in PHPT, in fact 47% of our patients with PHPT showed arterial hypertension K We found in hypertensive patients with PHPT that the 24-h DBP and daytime DBP values correlated significantly with serum ionized calcium (Ca 2+ ) K In our study the AMBP was performed using the oscillometric technique (Space Labs 90207, Redmond, WA, USA) and we found in 14/25 hypertensive PHPT patients (56%) the absence of the physiological blood pressure nocturnal fall (non-dipper) showing a statistically significant rate when compared with non-dipper patients with essential hypertension more, a noteworthy number of 'non-dipper' hypertensive subjects (56%) has been reported in PHPT patients, much higher than in EH patients (30%). This result seems to suggest that in PHPT this condition may represent an independent cardiovascular risk factor.…”

mentioning

confidence: 99%

Ambulatory monitoring of blood pressure (AMBP) in patients with primary hyperparathyroidism

et al. 2005

View full text Add to dashboard Cite

The purpose of our study was to evaluate the behaviour of blood pressure (BP) by ambulatory monitoring of blood pressure (AMBP) in 53 patients with primary hyperparathyroidism (PHPT) compared to 100 essential hypertensive (EH) and 31 healthy subjects (HS). The correlations between calcium-phosphorus metabolism and haemodynamic parameters in all groups are included in the study. AMBP was performed using the oscillometric technique (Space-Labs, 90207, Redmond, WA, USA) and the following AMBP parameters were evaluated: average day time systolic (S) and diastolic (D) blood pressure (BP) and heart rate (HR) (when awake), average night time SBP, DBP and HR (when asleep) and average 24-h-SBP, DBP and HR. The definition of 'dipper' or 'non-dipper' subjects was established if night time SBP and DBP fall was 410% and o10%, respectively. In total, 25 PHPT patients (47.2%) were hypertensive (HT-PHPT) and 28 PHPT (52.8%) were normotensive (NT-PHPT). Mean 24-h-SBP and DBP obtained by AMBP was higher in HT-PHPT (Po0.05) and EH (Po0.05) than in NT-PHPT and HS. The multiple linear regression has shown that in PHPT-HT patients ionized calcium is an independent factor for the rise of 24-h-DBP values (r: 0.497; Po0.05) and daytime DBP values (r: 0.497; Po0.05). In 56% of HT-PHPT patients there is an absence of physiological BP nocturnal fall ('non-dipper'), which is statistically significant (Po0.05) compared with 'nondipper' EH patients (30%). In conclusion, in our study the prevalence of hypertension in PHPT was 47%. AMBP revealed that the 'non-dipping 'pattern was much higher in HT-PHPT patients in respect to EH patients.

show abstract

“…The monocyte count to HDL-C ratio (MHR) was postulated as a novel marker of prognosis for the development of future CVD 7,8 . A growing body of evidence supports that even mild PHPT has an elevated risk for CVD [9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

“…Cardiomyocytes, endothelial cells, and smooth muscle cells have PTH receptors 23 , and increased PTH has been associated with myocardial fibrosis, calcification, and hypertrophy 24 . Several studies showed that PHPT had increased cardiovascular events and mortality, many of which improved after parathyroidectomy [9][10][11][12][13] . Hypertension, hyperlipidemia, CIMT, CRP, and insulin resistance are all well-studied CVD risk factors 25,26 .…”

mentioning

confidence: 99%