Endothelial vasodilatory dysfunction in primary hyperparathyroidism is reversed after parathyroidectomy

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

doi:10.1067/msy.2099.101422

Cited by 121 publications

(72 citation statements)

References 21 publications

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“…Relevantly, endothelial vasodilatory dysfunction, considered as an early event underlying atherosclerosis, has been documented in hyperparathyroidism. It has been suggested that endothelial dysfunction can be reversed by successful surgery (39)(40)(41). However, it should be stressed that these studies could not distinguish between the effect of restoration of normocalcemia and that of the return of PTH to normal as the immediate reason for the improvement.…”

Section: Discussionmentioning

confidence: 84%

Cardiovascular risk factors and arterial rigidity are similar in asymptomatic normocalcemic and hypercalcemic primary hyperparathyroidism

Tordjman

Yaron²,

Izkhakov³

et al. 2010

European Journal of Endocrinology

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Objective: It is still uncertain whether mild primary hyperparathyroidism (PHPT) carries the same risk for increased cardiovascular (CV) morbidity as the more severe symptomatic form. In recent years, the even more subtle normocalcemic (NC) variant is being increasingly recognized. We sought to compare the prevalence of CV risk factors in patients with NC-and hypercalcemic (HC)-PHPT, and to examine whether they differ on a battery of non-invasive vascular parameters. Design/subjects/methods: A retrospective study of two cohorts of patients with PHPT in a referral center: 32 subjects with NC-PHPT and 81 subjects with HC-PHPT, compared for the presence of clinical and biochemical risk factors, and CV morbidity. Non-invasive parameters of arterial stiffness (augmentation index; pulse wave velocity; and vascular compliance indices, C1 and C2) were extracted from the data of gender-and age-matched subsets of these patients, and were related to those of a group of matched control subjects. Results: Despite a similar prevalence of hypertension (w62%), hyperlipidemia (w30%), and impaired glucose metabolism in both PHPT groups, CV or cerebrovascular disease was more common in the HC-PHPT group (24.7 vs 3.1%, PZ0.007). Arterial stiffness parameters did not differ in the three groups, and were unrelated to serum calcium or parathyroid hormone concentration. Conclusions: NC-PHPT and HC-PHPT subjects exhibit similar high rates of traditional CV risk factors, and have comparable indices of arterial stiffness. The lower clinical CV morbidity observed with NC-PHPT remains unexplained, and requires confirmation. Until then, the CV risk associated with NC-PHPT should not be underestimated. 162 925-933 European Journal of Endocrinology

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Section: Discussionmentioning

confidence: 84%

Cardiovascular risk factors and arterial rigidity are similar in asymptomatic normocalcemic and hypercalcemic primary hyperparathyroidism

Tordjman

Yaron²,

Izkhakov³

et al. 2010

European Journal of Endocrinology

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“…As the clinical manifestations become subtler over time, the investigation has focused on less clinically overt abnormalities (12,16,17).…”

Section: Discussionmentioning

confidence: 99%

“…However, the exact role of PHPT in the development of cardiovascular changes, its extent and clinical significance are still controversial (12). Several mechanisms seem to play a role in the association between PHPT and cardiovascular risk: high serum calcium levels (13), increased circulating parathyroid hormone (PTH) levels (14), enhanced activity of the renin -angiotensin system (15) and vascular wall function impairment (16,17). While acute administration of PTH has a vasodilator effect (18), prolonged exposition to exogenous PTH led to increased blood pressure levels in healthy volunteers (19).…”

Section: Introductionmentioning

confidence: 99%

Increased intima-media thickness of the carotid artery wall, normal blood pressure profile and normal left ventricular mass in subjects with primary hyperparathyroidism

Nuzzo

Tauchmanovà

Fonderico

et al. 2002

European Journal of Endocrinology

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Objective: Despite the increasing evidence that primary hyperparathyroidism (PHPT) contributes to greater risk of cardiovascular morbidity and mortality, its exact role in the development of cardiovascular changes and its clinical significance are still controversial. Given the multiple influence of PHPT on the cardiovascular system, this study aimed to assess the effects of PHPT on blood pressure profile, and on features of the heart and arterial vessels in normotensive symptomless patients. Design: Twenty patients (8 males and 12 females) with a median age of 51.5 years (range 44 to 65 years) were evaluated and the results were compared with those of 20 controls matched for age, gender and body mass index. Patients' parathyroid hormone levels ranged from 172 to 454 pg/ml and Ca levels ranged from 11.4 to 13.5 mg/dl. Fasting levels of glucose, insulin, total and high density lipoprotein cholesterol and triglycerides were within the normal range in all subjects recruited. Methods: Twenty-four-hour blood pressure profile, left ventricle (LV) dimension and carotid artery anatomy were investigated, the latter two by ultrasonography. Results: No difference was found between the patients and controls in blood pressure profile, when the following parameters were considered: supine systolic/diastolic pressure, average 24-h systolic, diastolic and mean arterial pressure, day-time mean arterial pressure and fall in nocturnal blood pressure (217% and 2 18% respectively). Heart rate and all parameters of LV mass were similar in patients and controls. The only alteration found in patients was in significantly greater carotid intimal-medial thickness (IMT) ðP , 0:001Þ: Atherosclerotic plaques were more frequent in patients than in controls, with a difference reaching a trend (40% vs 10%, x 2 ¼ 4:8; P ¼ 0:091). Considering that the carotid IMT is considered to be a marker of systemic atherosclerosis, our finding suggests early atherosclerotic changes in PHPT. No correlation was found between the severity and cardiovascular manifestation of PHPT. Conclusions: Vascular changes may occur due to a combination of structural and functional impairments in PHPT patients, likely as a result of altered calcium metabolism and impaired equilibrium of other factors regulating vascular function. Both extent and duration of PHPT can play a relative role in the development of cardiovascular complications. Considering that PHPT is now recognized as a quite common and often symptomless endocrine disorder, the evidence of cardiovascular manifestation in normotensive patients, found by this morphological study, suggests a possible implication for the management of such patients. In this light, screening for abnormalities in cardiovascular system function should be recommended in all PHPT subjects.

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“…A recent study in mild PHPT (mean calcium 10.5 mg/dl) also indicated increased carotid IMT compared with non-PHPT population-based controls after adjustment for cardiovascular risk factors (65). Other studies in mild disease that show no effect of PHPT or its cure on IMT have been limited by their small sample sizes and by methodological flaws (67)(68)(69)(70).…”

Section: Carotid Atherosclerosismentioning

confidence: 99%

Non-traditional Manifestations of Primary Hyperparathyroidism

Walker

Silverberg

2015

The Parathyroids

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Endothelial vasodilatory dysfunction in primary hyperparathyroidism is reversed after parathyroidectomy

Cited by 121 publications

References 21 publications

Cardiovascular risk factors and arterial rigidity are similar in asymptomatic normocalcemic and hypercalcemic primary hyperparathyroidism

Cardiovascular risk factors and arterial rigidity are similar in asymptomatic normocalcemic and hypercalcemic primary hyperparathyroidism

Increased intima-media thickness of the carotid artery wall, normal blood pressure profile and normal left ventricular mass in subjects with primary hyperparathyroidism

Non-traditional Manifestations of Primary Hyperparathyroidism

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