Normocalcemia and persistent elevated serum concentrations of 1–84 parathyroid hormone after operation for sporadic parathyroid adenoma: evidence of increased morbidity from cardiovascular disease

Abstract

Elevated serum concentrations of 1-84 parathyroid hormone (PTH) after operation for sporadic parathyroid adenoma have been reported in previous studies, years after operation for primary hyperparathyroidism (pHPT). The cause and significance of this finding have not been elucidated. Primary hyperparathyroidism was diagnosed in 195 patients from January 1987 to December 1998. Operation for pHPT was performed in 124 patients. To evaluate long-term effects of elevated serum 1-84 PTH, biochemical variables and pre- and postoperative diseases were investigated from hospital case records. Of the 124 patients operated on, 103 had a solitary adenoma. Among these patients, 60 had normal serum concentrations of 1-84 PTH and calcium postoperatively, 38 patients had follow-up for more than 12 months (range 12-207 months-group A). Persistent elevated serum concentrations of 1-84 PTH and normocalcemia were found in 23 patients. Fourteen patients had follow-up for more than 12 months (range 15-76 months-group B). Two patients had persistent pHPT, and 18 were normocalcemic, but in this retrospective study data on serum 1-84 PTH were not available. No significant differences were found between groups A and B at the time of diagnosis concerning clinical characteristics. More that 12 months after operation for pHPT, the patients in group B, with persistent elevated serum concentrations of 1-84 PTH, had a significantly (c2 = 11, p = 0.005, and power of test 0.66) higher frequency of cardiovascular diseases from ischemic heart disease and hypertension. Persistent elevated serum concentrations of 1-84 PTH after operation for sporadic parathyroid adenoma may be associated with development of cardiovascular disease. This group of patients therefore needs lifelong control and, possibly, medical intervention.

Parathyroid hormone and the cardiovascular system

“…Data are available in the context of subjects with persistent hyperparathyroidism. A retrospective comparison of medical records was performed assessing data at 12 months post-parathyroidectomy in 14 patients with persistent PHPT and 38 patients whose PHPT was cured [ 5 ]. The frequency of ischemic heart disease and hypertension was higher in patients with persistent PHPT.…”

Vitamin D Deficiency as an Ignored Cause of Hypocalcemia in Acute Illness: Report of 2 Cases and Review of Literature

“…Hypocalcemia in critical illness is presumably multifactorial. In addition to the common causes of hypocalcemia ( PTH is one of the major regulators of extracellular calcium lying in a negative feedback way responding to changes in ionized calcium levels and vitamin D. PTH reportedly affects vascular smooth cells and ventricular myocytes [29], and impairs cardiac energy production, transfer, and utilization by enhanced entry and the accumulation of calcium in the myocardium [30] leading to development of cardiovascular disease [20,[31][32][33]. There have been several reports of elevated PTH value in patients with acute disease, which was associated with disease severity and poor outcome [17][18][19][20].…”

Hyperparatirosis and Cardiovascular System Pathology

“…Vestergaard и соавт. [74], производя ретрос-пективный анализ пациентов, которым 12 месяцев назад была произведена паратиреоидэктомия, показали, что со-храняющийся повышенный уровень ПГ после операции, не-смотря на отсутствие гиперкальциемии, был ассоциирован с значительно более частым развитием ССЗ (ишемической болезни сердца, артериальной гипертонии), по сравнению с пациентами, у которых послеоперационный уровень ПГ оставался в пределах нормы.…”