Coronary artery disease is more severe in patients with primary hyperparathyroidism

Koubaity, Omar; Mandry, Damien; Nguyen-Thi, Phi-Linh; Bihain, Florence; Nomine-Criqui, Claire; Demarquet, L.; Croisé-Laurent, V.; Brunaud, Laurent

doi:10.1016/j.surg.2019.05.094

Cited by 19 publications

(13 citation statements)

References 25 publications

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“…However, there are several possible mechanisms by which elevated PTH levels can worsen graft outcomes. Normocalcemic hyperparathyroidism in non-CKD patients reportedly increases nephrolithiasis [28][29][30][31] and cardiovascular risk [32][33][34]. Furthermore, some observational studies in cases of secondary hyperparathyroidism have demonstrated the association of PTH with renal anemia [35] or immunodeficiency [36].…”

Section: Discussionmentioning

confidence: 99%

Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia

et al. 2022

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Background Hypercalcemic hyperparathyroidism has been associated with poor outcomes after kidney transplantation (KTx). However, the clinical implications of normocalcemic hyperparathyroidism after KTx are unclear. This retrospective cohort study attempted to identify these implications. Methods Normocalcemic recipients who underwent KTx between 2000 and 2016 without a history of parathyroidectomy were included in the study. Those who lost their graft within 1 year posttransplant were excluded. Normocalcemia was defined as total serum calcium levels of 8.5–10.5 mg/dL, while hyperparathyroidism was defined as when intact parathyroid hormone levels exceeded 80 pg/mL. The patients were divided into two groups based on the presence of hyperparathyroidism 1 year after KTx. The primary outcome was the risk of graft loss. Results Among the 892 consecutive patients, 493 did not have hyperparathyroidism (HPT-free group), and 399 had normocalcemic hyperparathyroidism (NC-HPT group). Ninety-five patients lost their grafts. Death-censored graft survival after KTx was significantly lower in the NC-HPT group than in the HPT-free group (96.7% vs. 99.6% after 5 years, respectively, P < 0.001). Cox hazard analysis revealed that normocalcemic hyperparathyroidism was an independent risk factor for graft loss (P = 0.002; hazard ratio, 1.94; 95% confidence interval, 1.27–2.98). Conclusions Normocalcemic hyperparathyroidism 1 year after KTx was an independent risk factor for death-censored graft loss. Early intervention of elevated parathyroid hormone levels may lead to better graft outcomes, even without overt hypercalcemia.

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Section: Discussionmentioning

confidence: 99%

Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia

et al. 2022

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“…Some studies suggest that hypercalcaemic primary hyperparathyroidism is associated with cardiovascular‐related morbidity and mortality 42 . However, a recent study compared the two variants and found that a cohort of patients with normocalcaemic primary hyperparathyroidism had more prominent coronary artery calcification than those with the hypercalcaemic form of the disease, 43 although other data suggest the lack of an association 44 . Beysel et al conducted a small case‐control study (n = 95) that challenges these findings: patients with normocalcaemic and age‐ and sex‐matched hypercalcaemic PHPT were found to have similarly elevated blood pressure, glucose, insulin, HOMA‐IR (homeostatic model assessment of insulin resistance), lipid profiles and cardiovascular risk scores ( P > .05) when compared with controls ( P < .05) 45 .…”

Section: Clinical Featuresmentioning

confidence: 99%

Normocalcaemic primary hyperparathyroidism: An update on diagnostic and management challenges

Dawood

Yan

Shieh

et al. 2020

Clinical Endocrinology

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Normocalcaemic primary hyperparathyroidism is a condition that can present with intermittent hypercalcemia or may evolve into hypercalcemic primary hyperparathyroidism. This milder biochemical entity remains incompletely understood because of a lack of long-term health outcomes regarding both medical and surgical approaches to its management. Medical therapies have shown some efficacy. A limited number of studies have found that bisphosphonates increase bone mineral density, and cal

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“…One study found no increase in arterial stiffness in patients with NPHPT [ 106 ]. There is conflicting data on coronary calcification in NPHPT [ 107 , 108 ]. Several studies have examined insulin resistance in NPHPT.…”

Section: Nonclassical (Quality Of Life and Cardiovascular/metabolic E...mentioning

confidence: 99%

The Eucalcemic Patient With Elevated Parathyroid Hormone Levels

Shaker

Wermers

2023

Journal of the Endocrine Society

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Primary hyperparathyroidism (PHPT) is classically characterized by hypercalcemia with elevated or inappropriately normal parathyroid hormone (PTH) levels. Elevated PTH levels in the presence of normal calcium levels are not infrequently found during the evaluation of metabolic bone disorders or kidney stone disease. This can be caused by secondary hyperparathyroidism (SHPT) or normocalcemic primary hyperparathyroidism (NPHPT). NPHPT is due to autonomous parathyroid function whereas SHPT is caused by a physiologic stimulation to PTH secretion. Many medical conditions and medications can contribute to SHPT, and differentiation between SHPT and NPHPT may be difficult. Cases are presented to illustrate examples. In this paper, we review the distinction between SHPT and NPHPT as well as end organ effects of NPHPT and outcomes of surgery in NPHPT. We suggest that the diagnosis of NPHPT be made only after careful exclusion of causes of SHPT and consideration of medications that can increase PTH secretion. Further, we advise a conservative approach to surgery in NPHPT.

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Coronary artery disease is more severe in patients with primary hyperparathyroidism

Cited by 19 publications

References 25 publications

Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia

Elevated parathyroid hormone one year after kidney transplantation is an independent risk factor for graft loss even without hypercalcemia

Normocalcaemic primary hyperparathyroidism: An update on diagnostic and management challenges

The Eucalcemic Patient With Elevated Parathyroid Hormone Levels

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