Mortality associated with primary hyperparathyroidism

Clifton‐Bligh, P.; Nery, Maria Liza; Supramaniam, Rajah; Reeve, T. S.; Delbridge, Leigh; Stiel, J. N.; McElduff, Aidan; Wilmshurst, E. G.; Robinson, Bruce G.; Fulcher, Greg; Learoyd, Diana; Posen, Solomon

doi:10.1016/j.bone.2014.12.067

Cited by 36 publications

(29 citation statements)

References 30 publications

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“…They showed that both surgically treated and non-surgically treated patients have an increased risk of mortality, independently of serum calcium. They also emphasized that other factors had a significant impact on mortality, such as, the presence of diabetes mellitus, coronary heart disease and hypertension (113). Therefore, differences in mortality in studies examining the impact of PHPT on morbidity may be ascribed to different incidence of these conditions in the populations studied.…”

Section: Primary Hyperparathyroidism and Mortality For Cardiovascularmentioning

confidence: 99%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

129

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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.

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Section: Primary Hyperparathyroidism and Mortality For Cardiovascularmentioning

confidence: 99%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

129

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“…As a consequence, people undergoing parathyroidectomy within the public system are not included in the patient demographic. Our findings of a 3:1 female to male ratio, gender difference in median ages at operation, increasing age range of persons undergoing parathyroidectomy over time and estimates of overall survival are findings consistent with other Australian reports . The rising median age of participants undergoing surgery over the duration of the study may account for the overall poorer long‐term survival of patients operated later within the data set when compared with those operated in the earlier years (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The range of surgical questions that can be answered using administrative data is limited and the domain of the data set determines the extent of enquiry that can be achieved . However, the advantages of big data sets such as those used in this study are precision and statistical power derived from the large number of individuals recorded, the ability to investigate infrequent events and the longitudinal detail over a range of health care and social settings . Accordingly, these data provide an alternative viewpoint of surgical outcome which can stand alone or complement the results derived by other methodologies .…”

Section: Discussionmentioning

confidence: 99%

“…However, the advantages of big data sets such as those used in this study are precision and statistical power derived from the large number of individuals recorded, the ability to investigate infrequent events and the longitudinal detail over a range of health care and social settings . Accordingly, these data provide an alternative viewpoint of surgical outcome which can stand alone or complement the results derived by other methodologies . In this study we believe that the administrative data utilized has provided a useful evaluation of parathyroidectomy for PHP in Australia.…”

Section: Discussionmentioning

confidence: 99%

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Cervical re‐explorations and proxy survival following parathyroidectomy for primary hyperparathyroidism using Australian administrative data

Purkiss

Keegel

Vally

et al. 2019

ANZ Journal of Surgery

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Background: Administrative data may have utility in the impartial assessment of surgical outcomes and rare events. We have used a publicly available sample of the Australian pharmaceutical and health service provision (medical benefits scheme) databases to assess outcomes following parathyroidectomy for primary hyperparathyroidism (PHP). Methods: A cohort study using linked pharmaceutical and medical benefits schemes data was performed covering the period 1993-2014. Procedure codes identified participants undergoing parathyroidectomy for PHP and subsequent cervical re-exploration surgery (CRX), and the last service date used as a proxy for survival. Time to CRX and survival were modelled using Kaplan-Meier analysis. Demographic data and the era of parathyroid surgery were managed as covariates for Cox regression survival analyses. Results: A total of 2165 persons undergoing parathyroidectomy for PHP were identified. Median follow-up was 5.3 years (range 0.2-22). The annual number of parathyroidectomies for PHP increased gradually; 72 individuals underwent CRX (3.3%). The median time to CRX was 152 days (confidence interval 0-396) in 2000-2004 reducing to 47 days (confidence interval 15-78) for the period 2010-2014 (log-rank P = 0.027). The proportion of persons requiring CRX reduced over time from 6.1% in 1997 to 2.1% in 2012 (r 2 = 0.5817, P = 0.023). Overall median survival (24.6 years) was poorer when compared with age matched controls (log-rank P = 0.025) but was not associated with CRX or gender. Conclusion: Administrative data can be used for the assessment of surgical outcomes and may be useful for comparisons of surgical performance, and the appraisal of infrequent events. CRX rates following parathyroidectomy for PHP are improving in Australia.© 2019 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 872-876ANZJSurg.com

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“…Furthermore, hyperparathyroidism per se may have an indirect effect that accelerates atherogenesis due to its presumed positive relation with hypertension, endothelial dysfunction, and dyslipidemia, which are well-known contributors to the development of atherosclerosis (3,4,5). Accordingly, some studies demonstrate that patients with primary hyperparathyroidism (PHPT) have an increased mortality, mainly related to cardiovascular diseases (CVD) (6,7,8). Surprisingly, studies on the prevalence of cardiovascular risk factors, such as atherosclerosis, in PHPT patients, are few reporting subclinical carotid and coronary artery vascular involvement (9,10).…”

Section: Introductionmentioning

confidence: 99%

High prevalence of abdominal aortic calcification in patients with primary hyperparathyroidism as evaluated by Kauppila score

Pepe

Diacinti

Fratini

et al. 2016

European Journal of Endocrinology

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Objective: The prevalence of abdominal aortic calcification (AAC) in primary hyperparathyroidism (PHPT) is unknown. We assessed both prevalence and severity of AAC in PHPT postmenopausal women. Methods: In this study 70 PHPT postmenopausal women and 70 age-and sex-matched controls were enrolled. Each participant underwent biochemical evaluation, lateral spine radiograph, bone mineral density (BMD) measurement (lumbar, femoral, radial sites), and kidney ultrasound. Lateral lumbar films were analyzed in the region of L1-L4 vertebrae and the Kauppila score (a semi-quantitative grading system) was used to assess the severity of AAC. Results: There were no differences regarding demographic and cardiovascular risk factors in the two groups. PHPT patients had higher prevalence of kidney stones (30% vs 7%, P = 0.0008) and lower radial BMD values (0.558 ± 0.071 vs 0.588 ± 0.082 g/cm 2 , P < 0.05) compared with controls. PHPT patients showed higher prevalence of AAC (31 vs 18, P = 0.03), with more severe calcifications (Kauppila score 7.35 ± 6.1 vs 5.05 ± 3.5, P = 0.007). PHPT patients with AAC were older and had been suffering from the disease for a longer period compared with those without ACC. Moreover, PHPT patients with severe AAC had mean higher serum parathyroid hormone levels compared with patients with moderate or mild calcifications. In PHPT patients with AAC, multiple regression analysis, adjusted for age and years since diagnosis, showed that only parathyroid hormone significantly correlated with Kauppila score. Conclusion: We found a higher prevalence and severity of AAC in PHPT related to parathyroid hormone effect.

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Mortality associated with primary hyperparathyroidism

Cited by 36 publications

References 30 publications

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Cervical re‐explorations and proxy survival following parathyroidectomy for primary hyperparathyroidism using Australian administrative data

High prevalence of abdominal aortic calcification in patients with primary hyperparathyroidism as evaluated by Kauppila score

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