Parathyroidectomy improves cardiovascular risk factors in normocalcemic and hypercalcemic primary hyperparathyroidism

Abstract

Background Parathyroidectomy has ameliorated cardiovascular risk factors in patients with hypercalcemic primary hyperparathyroidism (PHPT), but the effect of parathyroidectomy on normocalcemic PHPT is not exactly known. This case-controlled study aimed to investigate the effect of parathyroidectomy on cardiovascular risk factors in patients with normocalcemic and hypercalcemic PHPT. Methods Subjects with normocalcemic PHPT ( n = 35), age- and sex-matched hypercalcemic PHPT ( n = 60) and age- and sex-matched control ( n = 60) were included. Cardiometabolic disorders were investigated with traditional cardiometabolic risk factors and the Framingham cardiovascular risk score (CRS) before and 6 months after parathyroidectomy. Results Diabetes, dyslipidemia, hypertension, obesity, insulin resistance, osteoporosis, having fractures were similarly increased in the hypercalcemic and normocalcemic PHPT groups ( p > 0.05) compared with the controls ( p < 0.05). Blood pressures, glucose metabolism (glucose, insulin, HOMA-IR) and lipid profiles were similarly increased in the PHPT groups ( p > 0.05) compared with the controls ( p < 0.05). After parathyroidectomy, blood pressures, serum total cholesterol, and HOMA-IR were decreased in both PHPT groups ( p < 0.05). CRS was lower in the controls (5.74 ± 3.24, p < 0.05). After parathyroidectomy, CRS was decreased in the normocalcemic (11.98 ± 10.11 vs. 7.37 ± 4.48) and hypercalcemic (14.62 ± 11.06 vs. 8.05 ± 7.72) PHPT groups. Increased blood pressures were independent predictors of serum iPTH. Conclusion The normocalcemic and hypercalcemic PHPT groups had similarly increased cardiovascular risk factors, even independently of serum calcium. Parathyroidectomy ameliorated the increased cardiovascular risk factors in both normocalcemic and hypercalcemic PHPT.

Echocardiographic Findings in Patients With Normocalcemic Primary Hyperparathyroidism Compared With Findings in Hypercalcemic Primary Hyperparathyroid Patients and Control Subjects

“…However, in the control group, diabetes was considered an exclusion criterium, while in patients with parathyroid disorder, it was not. In both NCPHPT and PHPT patients, 23 % of the population had diabetes, thus other cardiovascular risk factors, such as dyslipidemia and hypertension may be influenced by diabetes itself (11).…”

“…Several studies regarding the classical form of primary hyperparathyroidism (PHPT), where hypercalcemia is the hallmark, were carried out to study patients' cardiac structures although conflicting results were reported (5,6). Cardiac ventricular hypertrophy is also caused by hypertension; hypertension has a high prevalence in the majority but not in all studies in both PHPT patients (5,6) and NCPHPT patients (7)(8)(9)(10)(11). The NCPHPT patients were age matched with patients affected by the classical form of PHPT, newly diagnosed in the same Center and in the same period of time, and with 20 Caucasian healthy volunteers.…”

Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes

“…In our study, a detailed dietary and exercise regimen was suggested to the participants, whereas in the Hagström et al [12] study no such supervision was reported. Recently, a case-control study investigating the effect of PTx on cardiovascular risk factors in patients with normocalcemic and hypercalcemic PHPT [26] showed that after PTx improvements in blood pressure, serum total cholesterol, HOMA-IR, and cardiovascular risk scores were reported for both groups.…”

Normocalcaemic hyperparathyroidism and primary hyperparathyroidism: least significant change for adjusted serum calcium

“…There has been an increasing number of studies published recently, which show a potential benefit of parathyroid surgery [6][7][8][9][10].…”