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Objective: To evaluate the possible relationship between serum calcium, serum parathyroid hormone (PTH) levels and arterial blood pressure (BP) in patients with primary hyperparathyroidism (HPT). Design: A retrospective population-based study. Methods: Charts of 194 patients with proven primary HPT were reviewed, and the main clinical and biochemical parameters were recorded. There were 48 men (24.7%) and 146 women (75.3%), with a median age of 59 years (range 23-82 years). Patients who used antihypertensive drugs or hormone replacement therapy had been previously excluded. All patients underwent successful parathyroidectomy, and were cured of their disease. Results: There were no differences ðP ¼ NSÞ between men and women in systolic ð143:3^19:1 vs 145:4^17:1 mmHgÞ and diastolic ð87:1^12:3 vs 88:4^9:9 mmHgÞ BP, and in the main biochemical parameters. A significant ðP , 0:01Þ correlation was found between (i) serum calcium and serum PTH levels ðr ¼ 0:39; F ¼ 88:36Þ; (ii) age and BP, both systolic ðr ¼ 0:61; F ¼ 118:16Þ and diastolic ðr ¼ 0:48; F ¼ 64:5Þ; and (iii) body mass index (BMI) and BP (r ¼ 0:45 and 0.36 respectively). There was no significant association of serum calcium levels with systolic ðr ¼ 0:0974; t ¼ 1:3422; P ¼ 0:18Þ or diastolic ðr ¼ 0:1117; t ¼ 1:5409; P ¼ 0:12Þ BP, and of serum PTH levels with systolic ðr ¼ 20:0349; t ¼ 20:4783; P ¼ 0:63Þ or diastolic ðr ¼ 20:0793; t ¼ 21:0913; P ¼ 0:28Þ BP. Multivariate analysis confirmed that none of the independent biochemical parameters significantly correlated with BP, both systolic and diastolic. Conclusions: In patients with primary HPT there is no relationship between PTH, calcium and BP. Thus, in hyperparathyroid patients, BP should be considered as an independent variable, mainly related to age and BMI.

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The aims of this study were (1) to analyze whether correlations exist between lumbar spine (LS) bone mineral density (BMD) and the main preoperative biochemical parameters in a large population of patients with primary hyperparathyroidism (HPT); and (2) to evaluate the LS-BMD changes after parathyroidectomy (PTx) at long-term follow-up. Sixty-two patients (median age 57 years, range 23-82 years) with confirmed primary HPT underwent LS osteodensitometry by dual-energy X-ray absorptiometry with BMD measurements at the L2-L4 region before surgery and at 1 year and 2 years after successful PTx. Three groups of patients were considered: Group A (men, n = 14, 22.6%), Group B (premenopausal women, n = 12, 19.3%), and Group C (postmenopausal women, n = 36, 58.1%). There were no linear correlations (P = NS) among the main biochemical parameters, the age of the patients, and their baseline LS-BMD values that were significantly (P < 0.01) lower in Group C patients. At 2-year follow-up the LS-BMD improved by 13.0%, 11.5%, and 11.7% in Groups A, B, and C, respectively (P = NS). In order to compare groups with the same linear relationship between age and LS-BMD, a subgroup of postmenopausal patients aged < or = 60 years (Group C2) was considered. ANOVA showed that the improvement of the LS-BMD at 1- and 2-year follow-up was higher (P = 0.002) in Group B than in Group C2 patients. The result was confirmed by using the Mann-Whitney U-test (P = 0.0078). Improvement of LS-BMD after successful PTx was significantly (P < 0.01) higher in premenopausal women, suggesting a possible role of estrogen hormone in complete bone remodeling.

Primary hyperparathyroidism (PHPT) results from excessive secretion of parathyroid hormone (PTH), and catabolic and anabolic effects of PTH on bone may lead to overall deleterious effects on skeleton. The aim of this study was to analyze the changes in lumbar spine bone mineral density (BMD) in patients with PHPT who underwent parathyroidectomy (PTx), and to correlate the main demographics and biochemical parameters with pre- and postoperative BMD values. Two groups of age-matched patients (group A = 14 postmenopausal women; group B = 13 men, overall median age 53 years, range 26-56 years) with confirmed PHPT were enrolled in the study. All patients underwent lumbar (L2-L4 region) spine osteodensitometry using a dual-energy X-ray absorptiometry (DXA) prior to surgery. A significant correlation between alkaline phosphatase (ALP) and PTH (R = 0.73, P = 0.003) was found in group A patients. In group B correlations were found between calcemia and ALP (R = 0.71, P = 0.007), and between osteocalcin and both PTH (R = 0.65, P = 0.01) and ALP (R = 0.59, P = 0.03). No correlation (P = NS) was found between BMD, both basal and postoperative, and age or biochemical parameters. The 1-year BMD were 0.937 +/- 0.115 and 0.940 +/- 0.201 g/cm(2) (P = NS) in group A and B, respectively. A significant (P = 0.03) difference between basal and 1-year BMD was found only in group A, while in group B the difference was not significant. In conclusion, in patients with PHPT bone turnover is increased and consequently the BMD is reduced, but unfortunately PTx does not allow for complete bone restoring. However, in premenopausal women the BMD values of the lumbar spine significantly improve after PTx, suggesting a higher bone sensitivity to serum PTH normalization due to a synergic action with estrogens.