What predicts adverse outcomes in untreated primary hyperparathyroidism? The Parathyroid Epidemiology and Audit Research Study (PEARS)

Yu, Ning; Leese, Graham; Donnan, Peter T.

doi:10.1111/cen.12206

Cited by 46 publications

(20 citation statements)

References 29 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5,12,13 Kidney function (creatinine levels) and total alkaline phosphatase (a nonspecific marker for bone turnover) were not predictors of long-term outcome in the present study. 14 In accordance with PTH as the major predictor of outcome in the present study, 14 previous studies have demonstrated that PTH was directly correlated with bone turnover and thereby bone mass in PHPT, 5 as PTH was correlated with arterial stiffness 10 and left ventricular mass in the mild form of the disease. 9 Although PHPT is a chronic and stable disease with confirmed increased risk of CVD and CVD-related mortality, it is still highly debatable whether surgical treatment of the uncomplicated milder cases is of benefit for the patients.…”

supporting

confidence: 87%

The important players in primary hyperparathyroidism

Bollerslev

2013

Clinical Endocrinology

View full text Add to dashboard Cite

supporting

confidence: 87%

The important players in primary hyperparathyroidism

Bollerslev

2013

Clinical Endocrinology

View full text Add to dashboard Cite

“…In a retrospective population based observational study of mild PHPT patients (PEARS), selected from a cohort between 1997 and 2006, both cardiovascular morbidity and mortality ratio appeared to be increased (114), contrary to several studies carried out before the '90 (115,116). These authors, in an effort to identify the best biochemical risk factors alongside other factors for predicting adverse outcomes in untreated PHPT patients showed that calcium was associated with increased risk of all-cause mortality in the short term but had no significant impact on other outcomes, while baseline PTH, rather than calcium, best predicts long-term outcomes (117). Thus, the question remains unresolved as to which of the two, i.e.…”

Section: Primary Hyperparathyroidism and Mortality For Cardiovascularmentioning

confidence: 88%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

120

View full text Add to dashboard Cite

Data on cardiovascular disease in primary hyperparathyroidism (PHPT) are controversial; indeed, at present, cardiovascular involvement is not included among the criteria needed for parathyroidectomy. Aim of this narrative review is to analyze the available literature in an effort to better characterize cardiovascular involvement in PHPT. Due to physiological effects of both parathyroid hormone (PTH) and calcium on cardiomyocyte, cardiac conduction system, smooth vascular, endothelial and pancreatic beta cells, a number of data have been published regarding associations between symptomatic and mild PHPT with hypertension, arrhythmias, endothelial dysfunction (an early marker of atherosclerosis), glucose metabolism impairment and metabolic syndrome. However, the results, mainly derived from observational studies, are inconsistent. Furthermore, parathyroidectomy resulted in conflicting outcomes, which may be linked to several potential biases. In particular, differences in the methods utilized for excluding confounding co-existing cardiovascular risk factors together with differences in patient characteristics, with varying degrees of hypercalcemia, may have contributed to these discrepancies. The only meta-analysis carried out in PHPT patients, revealed a positive effect of parathyroidectomy on left ventricular mass index (a predictor of cardiovascular mortality) and more importantly, that the highest pre-operative PTH levels were associated with the greatest improvements. In normocalcemic PHPT, it has been demonstrated that cardiovascular risk factors are almost similar compared to hypercalcemic PHPT, thus strengthening the role of PTH in the cardiovascular involvement. Long-term longitudinal randomized trials are needed to determine the impact of parathyroidectomy on cardiovascular diseases and mortality in PHPT.

show abstract

“…Further, Yu et al [46] have also recently observed that baseline calcium levels were not significantly related to fatal cardiovascular disease or non-fatal cardiovascular disease in PHPT. However, serum PTH rather than serum calcium appeared to be associated with an increased risk of fatal and non-fatal cardiovascular disease.…”

Section: Presentationmentioning

confidence: 99%

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

et al. 2016

View full text Add to dashboard Cite

The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

show abstract

What predicts adverse outcomes in untreated primary hyperparathyroidism? The Parathyroid Epidemiology and Audit Research Study (PEARS)

Abstract: Baseline PTH, rather than calcium, best predicts long-term outcomes in untreated PHPT.

Cited by 46 publications

References 29 publications

The important players in primary hyperparathyroidism

The important players in primary hyperparathyroidism

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

Contact Info

Product

Resources

About