Retinal micro-vascular and aortic macro-vascular changes in postmenopausal women with primary hyperparathyroidism

Abstract

Aim of the study was to evaluate the micro and macro-vascular changes in patients with primary hyperparathyroidism (PHPT) compared to controls. 30 postmenopausal PHPT women (15 hypertensive and 15 normotensive) and 30 normotensive controls underwent biochemical evaluation of mineral metabolism and measurements of arterial stiffness by 24 hour ambulatory blood pressure monitoring. Retinal microcirculation was imaged by a Retinal Vessel Analyzer. PHPT patients also underwent bone mineral density measurements and kidney ultrasound. PHPT patients had higher mean calcium and parathyroid hormone values compared to controls. Evaluating macro-vascular compartment, we found higher values of 24 hours-systolic, diastolic blood pressure, aortic pulse wave velocity (aPWV) and aortic augmentation index (Aix) in hypertensive PHPT, but not in normotensive PHPT compared to controls. The eye examination showed narrowing arterial and venular diameters of retinal vessels in both hypertensive and normotensive PHPT compared to controls. In hypertensive PHPT, 24 hours systolic blood pressure was associated only with parathyroid hormone (PTH) levels (beta = 0.36, p = 0.04). aPWV was associated with retinal diameter (beta = −0.69, p = 0.003), but not with PTH. Retinal artery diameter was associated with PTH (beta = −0.6, p = 0.008). In the normotensive PHPT, only PTH was associated with retinal artery diameter (beta = −0.60, p = 0.01) and aortic AIx (beta = 0.65, p = 0.02). In conclusion, we found macro-vascular impairment in PHPT and that micro-vascular impairment is negatively associated with PTH, regardless of hypertension in PHPT.

Normal parathyroid hormone and non‐proliferative diabetic retinopathy in patients with type 2 diabetes

“…Furthermore, there was a positive correlation between daily proteinuria and PTH levels in patients with diabetic nephropathy 29 . Compared with the normal control group, postmenopausal women with primary hyperparathyroidism have retinal microvascular stenosis 30 , which might lead to retinal ischemia and further retinopathy. On the contrary, a study by Hekimsoy et al 31 .…”

The Relationship between Dietary Calcium and Age-Related Macular Degeneration

“…Patel et al reported that participants with excessive calcium intakes above the median had lower serum PTH concentrations [ 69 ]. In a previous study, low serum PTH levels were suggested to be associated with retinal vascular diameters and a decreased risk of retinal microvascular impairment [ 70 ]. Pathogenesis of ARMD has proposed that retinal vascular diameters was associated with the severity of ARMD [ 71 ].…”

Classical and Nonclassical Manifestations of Primary Hyperparathyroidism

“…PTH associated with stiffness? Calcium ✓ (178,185) X, (179) ✓ (180) X, (179) ✓ (180) X (171) Conflicting data; Danish RCT negative but subgroup with highest calcium improved Left ventricular mass PTH à cardiac myocyte hypertrophy?…”

“…Despite the abundance of observational studies establishing an increased prevalence of abnormalities in surrogate markers of CV outcomes in patients with PHPT (Table 3), ( 73,169‐173,175,178‐180,183‐185,187‐190,192,195,196 ) little evidence exists on causality as could be inferred from reversibility post‐PTX (Table 4). ( 74,170,171,195 )…”

“…Aortic pulse wave velocity (PWV), augmentation index and retinal vessel narrowing were worse in PHPT ( n = 30) versus controls, but only retinal findings were independent of hypertension and correlated with PTH. ( 178 ) Other studies showed opposing results regarding normalcy of flow‐mediated dilatation and improvement post‐PTX. ( 179‐181 ) The Danish RCT found no benefit of PTX on vascular function overall, but in the subgroup with the highest calcium, PWV improved post‐PTX.…”