Arterial Hypertension, Metabolic Syndrome and Subclinical Cardiovascular Organ Damage in Patients with Asymptomatic Primary Hyperparathyroidism before and after Parathyroidectomy: Preliminary Results

Abstract

Background. Primary hyperparathyroidism (PHPT) is associated with high cardiovascular morbidity, and the role of calcium and parathyroid hormone is still controversial. Objective. To evaluate the prevalence and outcomes of metabolic syndrome, hypertension, and some cardiovascular alterations in asymptomatic PHPT, and specific changes after successful parathyroidectomy. Material and Methods. We examined 30 newly diagnosed PHPT patients (8 males, 22 females; mean age 56 ± 6 yrs), 30 patients with essential hypertension (EH) (9 males, 21 females; mean age 55 ± 4), and 30 normal subjects (NS) (9 males, 21 females: mean age 55 ± 6). All groups underwent evaluation with ambulatory monitoring blood pressure, echocardiography, and color-Doppler artery ultrasonography and were successively revaluated after one year from parathyroidectomy. Results. PHPT patients presented a higher prevalence of metabolic syndrome (38%) with respect to EH (28%). Prevalence of hypertension in PHPT was 81%, and 57% presented altered circadian rhythm of blood pressure, with respect to EH (35%) and NS (15%). PHPT showed an important myocardial and vascular remodelling. During follow-up in PHPT patients, we found significant reduction of prevalence of metabolic syndrome, blood pressure, and “non-dipping phenomenon.” Conclusions. Cardiovascular and metabolic alterations should be considered as added parameters in evaluation of patients with asymptomatic PHPT.

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

“…Univariate analysis indicates that PTH and total calcium levels are significantly associated with plasma glucose, while total calcium is associated with triglycerides and LDL cholesterol levels. These findings partially fit with those already reported by other authors [10,11,17,24,25], though only two [11,25] compare results with a local control group. Noteworthy, among PHPT patients subgrouped according to clinical presentation only those with low-risk asymptomatic form have a higher frequency of MS in comparison to controls, differently from intermediate-high CRS.…”

“…An amelioration of blood pressure after surgery has been found by some Authors [25] but not by others [2]. It could be hypothesized that PHPT could induce over many years structural vascular abnormalities; therefore parathyroidectomy could be effective only if performed in early phase of disease.…”

“…In PHPT patients, a recent study reported an improvement of MS after surgery [25], while contradictory results have been reported on the efficacy of parathyroidectomy on glucose intolerance, insulin resistance and dyslipidemia [7,[29][30][31]]. An amelioration of blood pressure after surgery has been found by some Authors [25] but not by others [2].…”

Interdisciplinary Aspects of Primary Hyperparathyroidism: Symptomatology in a Series of 100 Cases

“…In the present study the incidence of HA was 55%. Other studies confirm this tendency, and in one report the HA incidence was even higher (81%) [35][36][37]. It has also been directly observed that PTH infusion results in HA in healthy subjects [38].…”

“…It has also been directly observed that PTH infusion results in HA in healthy subjects [38]. Still, data describing the impact of surgical PHPT treatment on HA and the circadian rhythm of blood pressure are not consistent [36,37].…”