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

Hagström, Emil; Lundgren, Ewa; Rastad, Jonas; Hellman, Per

doi:10.1530/eje.1.02173

Cited by 83 publications

(73 citation statements)

References 44 publications

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“…19,20 Individuals with normocalcemic hyperparathyroidism have been shown to have increased BMI, triglycerides, LDL cholesterol and blood glucose. 21 Our findings confirm the relationships between PTH and BMI, fat mass, blood pressure and lipid levels, and also highlight an association between PTH and coronary artery calcification that has not, to our knowledge, been previously reported. Associations between PTH and cardiometabolic risk factors were present throughout the entire cohort, indicating that this relationship is not unique to those with the highest PTH levels.…”

Section: Discussionsupporting

confidence: 90%

“…36,37 To our knowledge, no studies have documented reductions in weight, cardiovascular events or mortality following parathyroidectomy for primary hyperparathyroidism. 21 On the other hand, if cardiometabolic risk influences PTH, then PTH concentrations would be expected to mimic fluctuations in cardiovascular and metabolic parameters. Previous work by our group suggests that weight gain predates PTH elevation in women with primary hyperparathyroidism, 38 and a study in obese adolescents found that PTH decreased significantly following weight loss.…”

Section: Discussionmentioning

confidence: 99%

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Parathyroid hormone reflects adiposity and cardiometabolic indices but not bone density in normal men

2016

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Hyperparathyroidism may be associated with skeletal and cardiovascular abnormalities, but it is unclear whether these associations exist for high-normal levels of parathyroid hormone (PTH). We assessed relationships between PTH and anthropometric, skeletal and cardiometabolic indices in normal men. Body composition, blood pressure, biochemistry and bone mineral density (BMD) were evaluated in 151 healthy men. BMD was reassessed at 2 years, and coronary artery calcium (CAC) was measured at 3.5 years. Relationships between PTH and other baseline characteristics, CAC scores and change in BMD were evaluated. PTH correlated positively with baseline body mass index, fat mass, diastolic blood pressure, triglycerides, total and low-density lipoprotein (LDL) cholesterol, (r ¼ 0.19-0.25, P ¼ 0.02-0.002), and with category of CAC score. Relationships between PTH and cardiometabolic indices remained significant after adjustment for age, 25-hydroxyvitamin D and estimated glomerular filteration rate. Men in the top PTH tertile (X4.4 pmol l À 1 , n ¼ 51) were more likely to have LDL cholesterol X3.5 mmol l À 1 , diastolic blood pressure X85 mm Hg, and CAC score 40 than men in lower tertiles. PTH was not associated with history of fracture, baseline BMD, or change in BMD over 2 years. In summary, in this cohort of healthy men, PTH levels are linearly related to adiposity and to cardiometabolic indices, but not to BMD or bone loss. These findings suggest that adiposity should be considered as an independent cause of secondary hyperparathyroidism, and they may be relevant to patients with normocalcemic hyperparathyroidism, in whom high PTH levels may be a marker of adiposity and cardiometabolic risk rather than always indicating parathyroid autonomy.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Parathyroid hormone reflects adiposity and cardiometabolic indices but not bone density in normal men

2016

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“…On the other hand, these findings support a risk for cardiovascular morbidity and mortality in low-risk asymptomatic PHPT at least not lower than in symptomatic PHPT [2,3,12]. Consistently, also normocalcemic PHPT has been associated to metabolic and cardiovascular abnormalities [26,27]. These data are in line with recent consideration of MacFarlane et al [28] who suggest that "mild PHPT," that commonly refers to individuals not meeting the NIH criteria for parathyroidectomy, should be reclassified as an insidious disease.…”

Section: Discussionmentioning

confidence: 78%

Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

et al. 2013

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Cardiometabolic disorders have been associated with primary hyperparathyroidism (PHPT), while the relationship of cardiovascular risk score (CRS) and metabolic syndrome (MS) with different clinical presentation of PHPT remains undefined. Our aim was to evaluate CRS, MS and its components in PHPT looking for their correlation to different clinical forms. In 68 consecutive PHPT patients and 68 matched controls, CRS, MS and its components were assessed to perform an observational case-control study at an ambulatory referral center for Bone Metabolism Diseases. Patients were stratified in symptomatic and asymptomatic PHPT; these latter were divided in high-risk and low-risk subgroups for end-organ damage. An increased proportion of PHPT patients had intermediate-high CRS and MS (mean, 95 % Confidence Interval (CI) 51.5 %, 39.6-63.3 and 20.6 %, 11.0-30.2, respectively, p < 0.02 vs. controls). Intermediate-high CRS was prevalent both in symptomatic and low-risk asymptomatic PHPT while MS resulted prevalent in low-risk asymptomatic but not in symptomatic PHPT. Type 2 DM, IFG, mixed dyslipidemia, hypertriglyceridemia, HDL-hypocholesterolemia, and LDL-hypercholesterolemia predominated in low-risk asymptomatic, while only LDL-hypercholesterolemia prevailed also in symptomatic PHPT. In patients and controls without cardiometabolic risk factors, HOMA-IR index was significantly increased in PHPT vs. controls (p < 0.03) and associated to total calcium (R = 0.73; p < 0.001). By multivariate analysis low-risk asymptomatic PHPT predicted MS after adjusting for age, sex, and BMI. Our data show an increased frequency of intermediate-high CRS both in symptomatic and low-risk asymptomatic PHPT while MS prevails in low-risk asymptomatic PHPT, supporting the potential for cardiovascular morbidity and mortality also in this form.

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“…It has been argued that the excess mortality seen among patients with PHPT belongs to the era of severe symptomatic disease, whereas nowadays the disease is mostly recognized in a mild asymptomatic state characterized by lower serum calcium concentrations (2,7). Although there is some suggestion that the degree of hypercalcemia is directly correlated with the increased CV risk (8), an atherogenic metabolic profile has been reported in patients with normocalcemic (NC)-PHPT (9). The issue is further compounded by the lack of agreement in the literature over the possible amelioration of metabolic parameters, or the putative reversibility of hypertension and myocardial hypertrophy following successful surgery (2,10).…”

Section: Introductionmentioning

confidence: 99%

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

Cited by 83 publications

References 44 publications

Parathyroid hormone reflects adiposity and cardiometabolic indices but not bone density in normal men

Parathyroid hormone reflects adiposity and cardiometabolic indices but not bone density in normal men

Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

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

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