1
|
Olejarz M, Szczepanek-Parulska E, Ruchala M. Lipoprotein alterations in endocrine disorders - a review of the recent developments in the field. Front Endocrinol (Lausanne) 2024; 15:1354098. [PMID: 38628593 PMCID: PMC11018929 DOI: 10.3389/fendo.2024.1354098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Dyslipidemia is one of the most common disorders worldwide, which, if left untreated, results in a multitude of complications. Thus proper diagnostics, which includes identifying of secondary causes of dyslipidemia is crucial. Endocrine disorders are an important cause of secondary dyslipidemia. This paper aims to review the publications on lipoprotein alterations in endocrine disorders from the past two years and provide an overview of the recent discoveries in this dynamically developing and large field. Significant changes in lipoprotein serum concentrations are present in most endocrinological diseases and can be modified with proper treatment. Some lipoproteins have also been proposed as markers in some endocrine diseases, e.g., thyroid carcinoma. From the scope of endocrine disorders, the largest number of studies explored the lipoprotein changes in polycystic ovary syndrome and in women during the menopausal and peri-menopausal period. Even though the association of thyroid disorders with dyslipidemia is already well studied, new research has delivered some exciting findings about lipoprotein alterations in euthyroid patients with either positive antithyroid peroxidase antibodies or reduced sensitivity to thyroid hormones. The problem of the adverse metabolic profile, including dyslipidemia in hypoprolactinemia has been recognized. Moreover, this review describes other significant discoveries encompassing lipoprotein alterations in disorders of the adrenals, thyroid, parathyroid glands, pituitary, and gonads. The up-to-date knowledge of the influence of endocrine disorders and hormonal changes on serum lipoproteins is prudent as it can significantly impact therapeutic decisions.
Collapse
Affiliation(s)
- Michal Olejarz
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | | | | |
Collapse
|
2
|
Cousineau CM, Loftus K, Churchill GA, Bridges D. Cross-sectional association between blood cholesterol and calcium levels in genetically diverse strains of mice. FEBS Open Bio 2024; 14:426-433. [PMID: 38129969 PMCID: PMC10909986 DOI: 10.1002/2211-5463.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023] Open
Abstract
Genetically diverse outbred mice allow for the study of genetic variation in the context of high dietary and environmental control. Using a machine learning approach, we investigated clinical and morphometric factors that associate with serum cholesterol levels in 840 genetically unique Diversity Outbred mice of both sexes (n = 417 male and 423 female), and on both a control chow (% kcals in diet: protein 22%, carbohydrate 62%, fat 16%, no cholesterol) and high fat high sucrose (% kcals in diet: protein 15%, carbohydrate 41%, fat 45%, 0.05% cholesterol). We find expected elevations of cholesterol in male mice, as well as in mice with elevated serum triglycerides and/or fed a high fat high sucrose diet. The third strongest predictor was serum calcium which correlated with serum cholesterol across both diets and sexes (r = 0.39-0.48) in both Diversity Outbred (P = 3.0 × 10-43 ) and BXD (P = 0.005) mice. This is in-line with several human cohort studies which show associations between calcium and cholesterol, and calcium as an independent predictor of cardiovascular events.
Collapse
Affiliation(s)
- Cody M. Cousineau
- Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - Kaelin Loftus
- Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | | | - Dave Bridges
- Department of Nutritional SciencesUniversity of Michigan School of Public HealthAnn ArborMIUSA
| |
Collapse
|
3
|
Ahmad HM, Zaki ZM, Mohamed AS, Ahmed AE. Biochemical markers and FokI and TaqI vitamin D receptor genes polymorphism in rheumatoid arthritis. BMC Med Genomics 2023; 16:252. [PMID: 37858254 PMCID: PMC10585852 DOI: 10.1186/s12920-023-01668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Previous studies have reported the role of genes in different metabolic processes in the human body, and any variation in gene polymorphisms could lead to disturbances in these processes and different diseases. OBJECTIVE This study aimed to compare vitamin D receptor (VDR) FokI and TaqI genotypes in terms of parathyroid hormone (PTH) and some biomarkers of inflammation and susceptibility to rheumatoid arthritis (RA) disease. METHODS This study included 100 patients with rheumatoid arthritis (RA). Genotyping was performed by polymerase chain reaction (PCR) and examined by specific restriction enzymes using restriction fragment length polymorphism (RFLP). Serum intact PTH, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibodies (ACCPs) levels were measured. RESULTS An increased PTH level (> 65 pg/ml) was found in 8% of patients. No significant differences among FokI and TaqI vitamin D receptor genes polymorphism regarding positive and negative RF or ACCPs were found. A significant difference was found among FokI (p = 0.009) and none in TaqI genotypes regarding intact parathyroid hormone level categories. No significant correlation was found between the serum intact PTH level and ESR or CRP levels (P = 0.13 and 0.28, respectively). The parathyroid hormone level was not a good predictor for RF or ACCPs (P = 0.5 and 0.06, respectively). CONCLUSION The FokI gene may play a role in controlling PTH levels in patients with RA. There was no significant correlation found between the serum intact PTH level and RA severity according to ESR and CRP inflammatory biomarkers. There are no differences between VDR genes FokI and TaqI polymorphism in terms of RA susceptibility (for RF and ACCPs).
Collapse
Affiliation(s)
- Hosam M Ahmad
- Biotechnology and life sciences department, faculty of post graduate studies for advanced sciences, Beni-Suef university, Beni-Suef, Egypt
- Internal Medicine and Biomedical Chemistry Departments, Ministry of Health and population, Minia, Egypt
| | - Zaki M Zaki
- Clinical Pathology department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Asmaa S Mohamed
- Clinical Pharmacy and pharmacy practice department, Faculty of Pharmacy, Port said University, Port said, Egypt.
| | - Amr E Ahmed
- Biotechnology and life sciences department, faculty of post graduate studies for advanced sciences, Beni-Suef university, Beni-Suef, Egypt
| |
Collapse
|
4
|
Tsai MC, Hsu MS, Hsu HY, Yeh TL, Chiang CJ, Lee WC, Jhuang JR, Cheng SP, Tseng PJ, Chien KL. Investigating the risk of metabolic and cardiovascular comorbidities among patients with parathyroid cancer: a nationwide representative cohort study in Taiwan. BMC Med 2023; 21:249. [PMID: 37424030 DOI: 10.1186/s12916-023-02946-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/16/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND This study aimed to determine whether primary parathyroid cancer patients were associated with increased metabolic and cardiovascular comorbidities in comparison to the general population. METHODS We used the National Taiwan Cancer Registry Database to construct a cohort of patients with parathyroid cancer from January 1, 2004, to December 31, 2019. We compared the incidence of hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, coronary heart disease, and heart failure with the general population matched based on a propensity score in a one-to-five fashion. RESULTS A total of 72 parathyroid cancer patients and 360 matched general population (mean age: 55 years; 59% women) were included, with different exclusive numbers for each metabolic and cardiovascular comorbidity cohort. The number of cases based on a total of 2347.7 person-years of observation included 53 deaths, 29 hypertension, 9 diabetes, 13 hyperlipidemia, 10 atrial fibrillation, 18 coronary artery disease, and 13 heart failure. According to multivariate analysis, parathyroid cancer remained significantly associated with diabetes [hazard ratio (HR): 9.28; 95% confidence interval (CI): 1.72-50.07], hyperlipidemia (HR: 5.86; 95% CI: 1.61-21.31), and heart failure (HR: 4.46; 95% CI: 1.18-16.84). Sub-distribution of competing mortality events and subgroup analysis showed robust evidence of metabolic and cardiovascular comorbidities. This national cohort study demonstrated that adult parathyroid cancer patients had a significantly higher incidence of diabetes mellitus, hyperlipidemia, and heart failure than the general population. CONCLUSIONS An increased risk of metabolic and cardiac comorbidities among parathyroid cancer patients required great caution.
Collapse
Affiliation(s)
- Ming-Chieh Tsai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 517, No.17, Xu-Zhou Rd., Taipei City, 10055, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Mackay Memorial Hospital, Section 2, Zhongshan North Road, No. 92, Taipei City, 10449, Taiwan
- Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 25245, Taiwan
| | - Min-Shu Hsu
- Department of Medical Research, Mackay Memorial Hospital, No. 45, Minsheng Rd., Tamsui Dist., New Taipei City, 251404, Taiwan
| | - Hsin-Yin Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 517, No.17, Xu-Zhou Rd., Taipei City, 10055, Taiwan
- Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 25245, Taiwan
- Department of Family Medicine, Taipei MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Taipei City, 10449, Taiwan
| | - Tzu-Lin Yeh
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 517, No.17, Xu-Zhou Rd., Taipei City, 10055, Taiwan
- Department of Family Medicine, East District, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, Hsinchu City, 30071, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 517, No.17, Xu-Zhou Rd., Taipei City, 10055, Taiwan
- Taiwan Cancer Registry, No.17, Xu-Zhou Rd., Taipei, 10055, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 517, No.17, Xu-Zhou Rd., Taipei City, 10055, Taiwan
- Taiwan Cancer Registry, No.17, Xu-Zhou Rd., Taipei, 10055, Taiwan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd., Taipei, 10055, Taiwan
| | - Jing-Rong Jhuang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 517, No.17, Xu-Zhou Rd., Taipei City, 10055, Taiwan
- Taiwan Cancer Registry, No.17, Xu-Zhou Rd., Taipei, 10055, Taiwan
| | - Shih-Ping Cheng
- Division of General Surgery, Department of Surgery, Taipei Mackay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Taipei City, 10449, Taiwan
| | - Po-Jung Tseng
- Division of Cardiovascular Surgery, Department of Surgery, Hsin Chu Armed Force Hospital, No. 3, Wuling Rd., North Dist., Hsinchu City, 300, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 517, No.17, Xu-Zhou Rd., Taipei City, 10055, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan.
- Population Health Research Center, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
5
|
Barnett MJ. Association Between Primary Hyperparathyroidism and Secondary Diabetes Mellitus: Findings From a Scoping Review. Cureus 2023; 15:e40743. [PMID: 37350980 PMCID: PMC10284313 DOI: 10.7759/cureus.40743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 06/24/2023] Open
Abstract
An ill-defined association exists between diabetes mellitus (insulin resistance) and primary hyperparathyroidism. This article explores this phenomenon while providing an explanation for such a relationship and reviewing the evidence regarding the response to insulin sensitivity following a parathyroidectomy. Primary hyperparathyroidism may increase the risk of developing insulin resistance; peculiarly, this is not present in all patients. It is likely that both intracellular hypercalcemia and hypophosphatemia alter the insulin receptor expression and response; the contribution of parathyroid hormone is less clear. Following parathyroidectomy, patients may demonstrate improvement in their insulin sensitivity, while others have no response or a detrimental effect. A varied phenotype exists among patients, and furthermore, it is unclear why certain patients demonstrate improvement in insulin sensitivity following a parathyroidectomy, whereas others fail to do so. While this review provides a broad overview of the general endocrine community, it is imperative to note that clinical applicability is limited until further studies address these remaining uncertainties. Due to the lack of understanding regarding this endocrinological enigma, the presence of insulin resistance, at this present time, should not be a criterion for a parathyroidectomy.
Collapse
Affiliation(s)
- Maxim J Barnett
- Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, USA
| |
Collapse
|
6
|
Cousineau CM, Loftus K, Churchill GA, Bridges D. Cross-sectional association between blood cholesterol and calcium levels in genetically diverse strains of mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.08.527123. [PMID: 36798159 PMCID: PMC9934644 DOI: 10.1101/2023.02.08.527123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Genetically diverse outbred mice allow for the study of genetic variation in the context of high dietary and environmental control. Using a machine learning approach we investigated clinical and morphometric factors that associate with serum cholesterol levels in 840 genetically unique mice of both sexes, and on both a control chow and high fat high sucrose diet. We find expected elevations of cholesterol in male mice, those with elevated serum triglycerides and/or fed a high fat high sucrose diet. The third strongest predictor was serum calcium which correlated with serum cholesterol across both diets and sexes (r=0.39-0.48). This is in-line with several human cohort studies which show associations between calcium and cholesterol, and calcium as an independent predictor of cardiovascular events.
Collapse
Affiliation(s)
- Cody M. Cousineau
- Department of Nutritional Sciences, University of Michigan School of Public Health
| | - Kaelin Loftus
- Department of Nutritional Sciences, University of Michigan School of Public Health
| | | | - Dave Bridges
- Department of Nutritional Sciences, University of Michigan School of Public Health
| |
Collapse
|
7
|
Burr AM, Zuckerman PC, Castillo AB, Partridge NC, Parekkadan B. Bioactive, full-length parathyroid hormone delivered using an adeno-associated viral vector. Exp Biol Med (Maywood) 2022; 247:1885-1897. [PMID: 35666091 PMCID: PMC9742744 DOI: 10.1177/15353702221097087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Delivering the parathyroid hormone (PTH) gene has been attempted preclinically in a handful of studies, but delivering full-length PTH (1-84) using adeno-associated viral (AAV) vectors has not. Given the difficulty in achieving therapeutic levels of secreted proteins using gene therapy, this study seeks to determine the feasibility of doing so with PTH. An AAV vector was used to deliver human PTH driven by a strong promoter. We demonstrate the ability to secrete full-length PTH from various cell types in vitro. PTH secretion from hepatocytes was measured over time and a fluorescent marker was used to compare the secretion rate of PTH in various cell types. Potency was measured by the ability of PTH to act on the PTH receptors of osteosarcoma cells and induced proliferation. PTH showed potency in vitro by inducing proliferation in two osteosarcoma cell lines. In vivo, AAV was administered systemically in immunocompromised mice which received xenografts of osteosarcoma cells. Animals that received the highest dose of AAV-PTH had higher liver and plasma concentrations of PTH. All dosing groups achieved measurable plasma concentrations of human PTH that were above the normal range. The high-dose group also had significantly larger tumors compared to control groups on the final day of the study. The tumors also showed dose-dependent differences in morphology. When looking at endocrine signaling and endogenous bone turnover, we observed a significant difference in tibial growth plate width in animals that received the high-dose AAV as well as dose-dependent changes in blood biomarkers related to PTH. This proof-of-concept study shows promise for further exploration of an AAV gene therapy to deliver full-length PTH for hypoparathyroidism. Additional investigation will determine efficacy in a disease model, but data shown establish bioactivity in well-established models of osteosarcoma.
Collapse
Affiliation(s)
- Alexandra M Burr
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Pamela Cabahug Zuckerman
- Department of Orthopedic Surgery, NYU Langone Health, New York University, New York, NY 10016, USA.,Department of Biomedical Engineering, Tandon School of Engineering, New York University, New York, NY 11201, USA.,Rehabilitation Research and Development, Veterans Affairs New York Harbor Healthcare System, New York, NY 11209, USA
| | - Alesha B Castillo
- Department of Orthopedic Surgery, NYU Langone Health, New York University, New York, NY 10016, USA.,Department of Biomedical Engineering, Tandon School of Engineering, New York University, New York, NY 11201, USA.,Rehabilitation Research and Development, Veterans Affairs New York Harbor Healthcare System, New York, NY 11209, USA
| | - Nicola C Partridge
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA
| | - Biju Parekkadan
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| |
Collapse
|
8
|
Tournis S, Makris K, Cavalier E, Trovas G. Cardiovascular Risk in Patients with Primary Hyperparathyroidism. Curr Pharm Des 2021; 26:5628-5636. [PMID: 33155899 DOI: 10.2174/1381612824999201105165642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022]
Abstract
Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders characterized by parathyroid hormone (PTH)-dependent hypercalcemia. Cardinal features include low trauma fractures, nephrolithiasis, and chronic kidney disease. Several experimental studies established that parathyroid hormone exerts actions on the cardiovascular (CV) system, including vasodilatation and positive inotropic and chronotropic effects. Observational studies, especially in severe cases, report a higher prevalence of hypertension, diabetes mellitus, lipid abnormalities, endothelial dysfunction, arrhythmias, and left ventricular hypertrophy in patients with PHPT, while the risk of CV events seems to be increased in severe cases. However, the effect of surgery is inconsistent on CV abnormalities and, more importantly, on CV disease (CVD) events, especially in mild cases. In the current review, we describe the available evidence linking PHPT and CVD, as well as the effect of surgical management and pharmacological treatment on CVD manifestations in patients with PHPT. Based on the current evidence, CVD is not considered an indication for surgery.
Collapse
Affiliation(s)
- Symeon Tournis
- Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece
| | | | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liege, CHU Sart-Tilman, Domaine du Sart-Tilman, B-4000, Liege, Belgium
| | - George Trovas
- Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", National and Kapodistrian University of Athens, KAT Hospital, Athens, Greece
| |
Collapse
|
9
|
Beysel S, Caliskan M, Kizilgul M, Apaydin M, Kan S, Ozbek M, Cakal E. Parathyroidectomy improves cardiovascular risk factors in normocalcemic and hypercalcemic primary hyperparathyroidism. BMC Cardiovasc Disord 2019; 19:106. [PMID: 31068134 PMCID: PMC6505186 DOI: 10.1186/s12872-019-1093-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/30/2019] [Indexed: 12/21/2022] Open
Abstract
Background Parathyroidectomy has ameliorated cardiovascular risk factors in patients with hypercalcemic primary hyperparathyroidism (PHPT), but the effect of parathyroidectomy on normocalcemic PHPT is not exactly known. This case-controlled study aimed to investigate the effect of parathyroidectomy on cardiovascular risk factors in patients with normocalcemic and hypercalcemic PHPT. Methods Subjects with normocalcemic PHPT (n = 35), age- and sex-matched hypercalcemic PHPT (n = 60) and age- and sex-matched control (n = 60) were included. Cardiometabolic disorders were investigated with traditional cardiometabolic risk factors and the Framingham cardiovascular risk score (CRS) before and 6 months after parathyroidectomy. Results Diabetes, dyslipidemia, hypertension, obesity, insulin resistance, osteoporosis, having fractures were similarly increased in the hypercalcemic and normocalcemic PHPT groups (p > 0.05) compared with the controls (p < 0.05). Blood pressures, glucose metabolism (glucose, insulin, HOMA-IR) and lipid profiles were similarly increased in the PHPT groups (p > 0.05) compared with the controls (p < 0.05). After parathyroidectomy, blood pressures, serum total cholesterol, and HOMA-IR were decreased in both PHPT groups (p < 0.05). CRS was lower in the controls (5.74 ± 3.24, p < 0.05). After parathyroidectomy, CRS was decreased in the normocalcemic (11.98 ± 10.11 vs. 7.37 ± 4.48) and hypercalcemic (14.62 ± 11.06 vs. 8.05 ± 7.72) PHPT groups. Increased blood pressures were independent predictors of serum iPTH. Conclusion The normocalcemic and hypercalcemic PHPT groups had similarly increased cardiovascular risk factors, even independently of serum calcium. Parathyroidectomy ameliorated the increased cardiovascular risk factors in both normocalcemic and hypercalcemic PHPT.
Collapse
Affiliation(s)
- Selvihan Beysel
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey. .,Department of Medical Biology, Baskent University, Ankara, Turkey. .,Department of Endocrinology and Metabolism, Afyonkarahisar Saglik Bilimleri University, Afyonkarahisar, Turkey.
| | - Mustafa Caliskan
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Muhammed Kizilgul
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Mahmut Apaydin
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Seyfullah Kan
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Mustafa Ozbek
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, Ankara Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| |
Collapse
|
10
|
Barale M, Cappiello V, Ghigo E, Procopio M. Increased frequency of impaired fasting glucose and isolated systolic hypertension in Paget's disease of bone. Endocrine 2019; 63:385-390. [PMID: 30284104 DOI: 10.1007/s12020-018-1771-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/24/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Scanty data about glucose metabolism and hypertension have been reported in Paget's disease of bone (PDB) to be related with increased cardiovascular mortality. The aim of the present study was to evaluate glucose and blood pressure levels in PDB, looking for their association with disease severity. METHODS We performed an observational cross-sectional study in 54 patients with PDB and 54 age, sex and BMI-matched controls. Glucose and blood pressure levels and parameters of bone and mineral metabolism were assessed. RESULTS Patients with PDB showed increased glucose levels (6.3 ± 1.7 vs 5.3 ± 1.4 mmol/l, p < 0.001) and prevalence of impaired fasting glucose (14.8%, 5.3-24.3 vs 1.9%, 0-5.4, p < 0.02) as well as enhanced systolic blood pressure (145.9 ± 21.3 vs 132.9 ± 18.9 mmHg, p < 0.005), pulse pressure (69.6 ± 20.0 vs 56.0 ± 16.9 mmHg, p < 0.01) and prevalence of isolated systolic hypertension (46.3%, 33.0-59.6 vs 16.7%, 6.7-26.6, p < 0.003) in comparison to controls. Moreover, we found a positive association of (1) glucose levels with ionized calcium and bone alkaline phosphatase; (2) both systolic and pulse pressure with total and bone alkaline phosphatase (p < 0.05). By multiple linear regression analysis (R2 = 0.26; p < 0.05) serum ionized calcium correlated with glucose levels (β = 0.44; p < 0.04), after adjusting for age and BMI. CONCLUSIONS Our study shows increased fasting glucose, systolic and pulse pressure levels as well as enhanced prevalence of impaired fasting glucose and isolated systolic hypertension in PDB, potentially accounting for increased cardiovascular mortality. Furthermore, our findings suggest high serum calcium and/or increased bone alkaline phosphatase as a link between PDB and cardio-metabolic disorders.
Collapse
Affiliation(s)
- Marco Barale
- Department of General and Specialty Medicine, Division of Endocrinology, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin-Cso Dogliotti, Turin, 14-10126, Italy.
| | - Vincenzo Cappiello
- Department of General and Specialty Medicine, Division of Endocrinology, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin-Cso Dogliotti, Turin, 14-10126, Italy
| | - Ezio Ghigo
- Department of General and Specialty Medicine, Division of Endocrinology, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin-Cso Dogliotti, Turin, 14-10126, Italy
| | - Massimo Procopio
- Department of General and Specialty Medicine, Division of Endocrinology, Diabetology and Metabolic Diseases, Molinette Hospital, University of Turin-Cso Dogliotti, Turin, 14-10126, Italy
| |
Collapse
|
11
|
Karakose M, Caliskan M, Arslan MS, Demirci T, Karakose S, Tutal E, Cakal E. Association of ADAMTS4 and ADAMTS9 levels with cardiovascular risk in patients with primary hyperparathyroidism. Endocr Res 2018; 43:15-20. [PMID: 28937860 DOI: 10.1080/07435800.2017.1368543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Primary hyperparathyroidism (PHPT) has been associated with increased incidence of morbidity and mortality of the cardiovascular system. The pathogenetic mechanisms underlying this association are still not completely clear. A disintegrin and metalloproteinase with thrombospondin-like motifs (ADAMTS) play a critical role in atherosclerosis. This study aimed to investigate the levels of ADAMTS4 and ADAMTS9 and relationship between these proteoglycanases and cardiometabolic abnormalities in PHPT. MATERIALS AND METHODS A case-control study was performed in a training and research hospital. Fifty-six patients with PHPT and 61 healthy volunteers were recruited. The Framingham score was used to calculate cardiovascular risk (CVR). Serum ADAMTS levels were determined by a human enzyme-linked immunoassay in all subjects. RESULTS The ADAMTS9 concentration was significantly higher in patients with PHPT than in the control group (p < 0.05); however, there were no significant differences in ADAMTS4 levels between the groups (p > 0.05). In ROC curve analysis, PHPT can be predicted by the use of ADAMTS9 at a cut-off value of 30.7 pg/mL (69% sensitivity, 65% specificity). CVR score was significantly increased in the PHPT than controls (p < 0.05). ADAMTS4 and ADAMTS9 levels had positive correlations with CVR score (r = 0.322, p = 0.017; r = 0.275, p = 0.044 respectively). CONCLUSIONS Based on the results of the present study, cardiovascular risk is increased in PHPT and associated with ADAMTS4 and ADAMTS9. Further efforts are needed to establish the function of ADAMTS proteases in both PHPT and atherosclerosis.
Collapse
Affiliation(s)
- Melia Karakose
- a Department of Endocrinology and Metabolism , Diskapi Yildirim Beyazit Training and Research Hospital , Ankara , Turkey
| | - Mustafa Caliskan
- a Department of Endocrinology and Metabolism , Diskapi Yildirim Beyazit Training and Research Hospital , Ankara , Turkey
| | - Muyesser Sayki Arslan
- a Department of Endocrinology and Metabolism , Diskapi Yildirim Beyazit Training and Research Hospital , Ankara , Turkey
| | - Taner Demirci
- a Department of Endocrinology and Metabolism , Diskapi Yildirim Beyazit Training and Research Hospital , Ankara , Turkey
| | - Suleyman Karakose
- b Department of Nephrology , Ankara Training and Research Hospital , Ankara , Turkey
| | - Esra Tutal
- a Department of Endocrinology and Metabolism , Diskapi Yildirim Beyazit Training and Research Hospital , Ankara , Turkey
| | - Erman Cakal
- a Department of Endocrinology and Metabolism , Diskapi Yildirim Beyazit Training and Research Hospital , Ankara , Turkey
| |
Collapse
|
12
|
Pepe J, Cipriani C, Sonato C, Raimo O, Biamonte F, Minisola S. Cardiovascular manifestations of primary hyperparathyroidism: a narrative review. Eur J Endocrinol 2017; 177:R297-R308. [PMID: 28864535 DOI: 10.1530/eje-17-0485] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/14/2017] [Accepted: 08/31/2017] [Indexed: 01/02/2023]
Abstract
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.
Collapse
Affiliation(s)
- Jessica Pepe
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - Chiara Sonato
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - Orlando Raimo
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - Federica Biamonte
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| |
Collapse
|
13
|
Duran C, Sevinc B, Kutlu O, Karahan O. Parathyroidectomy Decreases Insulin Resistance Index in Patients with Primary Hyperparathyroidism. Indian J Surg 2016; 79:101-105. [PMID: 28442834 DOI: 10.1007/s12262-015-1431-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 12/23/2015] [Indexed: 12/19/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) has been considered a cause of insulin resistance (IR) and impaired glucose metabolism. However, there are conflicting results related with the recovery of insulin resistance in patients with PHPT following curative parathyroidectomy. Our aim is to evaluate the effects of curative parathyroidectomy on IR in patients with PHPT. This is a prospective interventional study. Twenty-one consecutive patients with symptomatic PHPT were included into the study. All patients underwent parathyroidectomy. Fasting serum glucose, calcium, phosphorous, parathormone, plasma insulin, and vitamin D levels were measured both at baseline and 2 months after parathyroidectomy. Insulin resistance was calculated by homeostasis of model assessment-insulin resistance (HOMA-IR). Two months after curative parathyroidectomy, serum levels of calcium (p = 0.001), PTH (p < 0.001), insulin (p = 0.003), and HOMA-IR (p = 0.003) decreased, while phosphorous levels increased (p = 0.001). During this period, no changes were observed at vitamin D and glucose levels. We concluded that curative parathyroidectomy decreases HOMA-IR index in patients with PHPT. Studies with larger population and longer follow-up period are required to confirm our results.
Collapse
Affiliation(s)
- Cevdet Duran
- Department of Internal Medicine, Endocrinology and Metabolism, Konya Training and Research Hospital, 42100 Konya, Turkey
| | - Barıs Sevinc
- Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Orkide Kutlu
- Department of Internal Medicine, Endocrinology and Metabolism, Konya Training and Research Hospital, 42100 Konya, Turkey
| | - Omer Karahan
- Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey
| |
Collapse
|
14
|
Procopio M, Barale M, Bertaina S, Sigrist S, Mazzetti R, Loiacono M, Mengozzi G, Ghigo E, Maccario M. Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms. Endocrine 2014; 47:581-9. [PMID: 24287796 DOI: 10.1007/s12020-013-0091-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/15/2013] [Indexed: 11/30/2022]
Abstract
Cardiometabolic disorders have been associated with primary hyperparathyroidism (PHPT), while the relationship of cardiovascular risk score (CRS) and metabolic syndrome (MS) with different clinical presentation of PHPT remains undefined. Our aim was to evaluate CRS, MS and its components in PHPT looking for their correlation to different clinical forms. In 68 consecutive PHPT patients and 68 matched controls, CRS, MS and its components were assessed to perform an observational case-control study at an ambulatory referral center for Bone Metabolism Diseases. Patients were stratified in symptomatic and asymptomatic PHPT; these latter were divided in high-risk and low-risk subgroups for end-organ damage. An increased proportion of PHPT patients had intermediate-high CRS and MS (mean, 95 % Confidence Interval (CI) 51.5 %, 39.6-63.3 and 20.6 %, 11.0-30.2, respectively, p < 0.02 vs. controls). Intermediate-high CRS was prevalent both in symptomatic and low-risk asymptomatic PHPT while MS resulted prevalent in low-risk asymptomatic but not in symptomatic PHPT. Type 2 DM, IFG, mixed dyslipidemia, hypertriglyceridemia, HDL-hypocholesterolemia, and LDL-hypercholesterolemia predominated in low-risk asymptomatic, while only LDL-hypercholesterolemia prevailed also in symptomatic PHPT. In patients and controls without cardiometabolic risk factors, HOMA-IR index was significantly increased in PHPT vs. controls (p < 0.03) and associated to total calcium (R = 0.73; p < 0.001). By multivariate analysis low-risk asymptomatic PHPT predicted MS after adjusting for age, sex, and BMI. Our data show an increased frequency of intermediate-high CRS both in symptomatic and low-risk asymptomatic PHPT while MS prevails in low-risk asymptomatic PHPT, supporting the potential for cardiovascular morbidity and mortality also in this form.
Collapse
Affiliation(s)
- M Procopio
- Division of Endocrinology, Diabetology and Metabolism, Department of Biomedical Sciences, University of Turin, Turin, Italy,
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Bandeira F, Griz L, Chaves N, Carvalho NC, Borges LM, Lazaretti-Castro M, Borba V, Castro LCD, Borges JL, Bilezikian J. Diagnosis and management of primary hyperparathyroidism--a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism. ACTA ACUST UNITED AC 2014; 57:406-24. [PMID: 24030180 DOI: 10.1590/s0004-27302013000600002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/03/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To conduct a literature review on the diagnosis and management of primary hyperparathyroidism including the classical hipercalcemic form as well as the normocalcemic variant. MATERIALS AND METHODS This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society for Endocrinology as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including "D", are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. CONCLUSION We present a scientific statement on primary hyperparathyroidism providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment.
Collapse
|
16
|
Abstract
This review discusses recent findings on the clinical presentation, evaluation, medical and surgical management of primary hyperparathyroidism. Medical management includes the use of cinacalcet and bisphosphonates for bone loss and correction of vitamin D deficiency. Surgical updates reviewed recent studies on the preoperative localization of the disease, specifically, sestamibi scans, 4DCT and MRI. Focused parathyroidectomy continues to be the preferred surgical approach for a select group of patients, guided by intraoperative use of PTH and new technology, such as endoscopic and robotic platforms; however, there appears to be no difference in long-term success compared to the traditional approach.
Collapse
Affiliation(s)
- Zeina Habib
- a Mercy Hospital and Medical Center - Internal Medicine, Section of Endocrinology and Metabolism, 2525 S Michigan Ave, Chicago, IL 60616, USA
| | - Adam Kabaker
- b Loyola University - Surgery, Section of Endocrine Surgery, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - Pauline Camacho
- c Loyola University - Endocrinology and Metabolism, 2160 S. First Avenue, Maywood, IL 60153, USA
| |
Collapse
|
17
|
Walker MD, Rubin M, Silverberg SJ. Nontraditional manifestations of primary hyperparathyroidism. J Clin Densitom 2013; 16:40-7. [PMID: 23374740 PMCID: PMC3564501 DOI: 10.1016/j.jocd.2012.11.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/18/2012] [Indexed: 02/02/2023]
Abstract
Classical primary hyperparathyroidism (PHPT) was previously a multisystemic symptomatic disorder not only with overt skeletal and renal complications but also with neuropsychological, cardiovascular, gastrointestinal, and rheumatic effects. The presentation of PHPT has evolved, and today most patients are asymptomatic. Osteitis fibrosa cystica is rarely seen today, and nephrolithiasis is less common. Gastrointestinal and rheumatic symptoms are not part of the clinical spectrum of modern PHPT. It remains unclear whether neuropsychological symptoms and cardiovascular disease, neither of which are currently indications for recommending parathyroidectomy (PTX), are part of the modern phenotype of PHPT. A number of observational studies suggest that mild PHPT is associated with depression, decreased quality of life, and changes in cognition, but limited data from randomized controlled trials (RCTs) have not indicated consistent benefits after surgery. The increased cardiovascular morbidity and mortality in severe PHPT has not been definitively demonstrated in mild disease, although there is some evidence for more subtle cardiovascular abnormalities, such as increased vascular stiffness, among others. Results from observational studies that have assessed the effect of PTX on cardiovascular health have been conflicting. The single RCT in this area did not demonstrate that PTX was beneficial. Despite recent progress in these areas, more data from rigorously designed studies are needed to better inform the clinical management of patients with asymptomatic PHPT.
Collapse
Affiliation(s)
- Marcella Donovan Walker
- Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
| | | | | |
Collapse
|
18
|
Tassone F, Gianotti L, Baffoni C, Cesario F, Magro G, Pellegrino M, Emmolo I, Maccario M, Borretta G. Prevalence and characteristics of metabolic syndrome in primary hyperparathyroidism. J Endocrinol Invest 2012; 35:841-6. [PMID: 22189414 DOI: 10.3275/8192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Primary hyperparathyroidism (pHPT) is characterized by an increased frequency of glucose tolerance abnormalities associated with insulin resistance. Few studies evaluated the prevalence of metabolic syndrome (MetS) in pHPT and whether there are differences between asymptomatic pHPT patients and symptomatic ones. Thus, we sought to investigate the prevalence of MetS in pHPT patients in comparison to the prevalence of MetS in Italian population. SUBJECTS AND METHODS We conducted a retrospective chart review of 294 pHPT patients, of these 154 [age (mean ± SD) 58.7 ± 13.3 yr, body mass index 25.6 ± 4.8 kg/m(2); serum calcium (11.3 ± 1.2 mg/dl) 2.8 ± 0.3 mmol/l; PTH 234.8 ± 224.3 ng/l] met the inclusion criteria. A modified National Cholesterol Educational Program (NCEP)/Adult Treatment Panel III (ATP III) definition of the MetS was used. Prevalence of MetS was compared with that reported for the Italian population (Progetto Cuore Study). RESULTS The prevalence of the MetS (34/154, 22.1%) was similar to that reported in the general Italian population. Asymptomatic pHPT patients were older (62.1 ± 12.7 vs 56.4 ± 13.2 yr, p<0.008) and showed higher prevalence of MetS than symptomatic ones (30.2% vs 16.5%, p<0.045). Moreover the prevalence of nephrolitiasis or overt bone disease was not different between patients MetS+pHPT compared to MetS-pHPT, whereas femoral bone mineral density (BMD) was higher in MetS+pHPT (p<0.003). In the logistic regression model age and femoral BMD were independent predictors of MetS. CONCLUSIONS The prevalence of MetS in pHPT is not increased in comparison to the general population, thus, its diagnosis is not an appropriate tool to identify the additional cardiovascular risk related to pHPT. Difference in age affects the increased prevalence of MetS in asymptomatic pHPT patients.
Collapse
Affiliation(s)
- F Tassone
- Division of Endocrinology, Diabetology and Metabolism, Santa Croce e Carle Hospital, Cuneo, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Almqvist EG, Bondeson AG, Bondeson L, Svensson J. Increased markers of inflammation and endothelial dysfunction in patients with mild primary hyperparathyroidism. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 71:139-44. [DOI: 10.3109/00365513.2010.543694] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
20
|
Current world literature. Curr Opin Endocrinol Diabetes Obes 2010; 17:568-80. [PMID: 21030841 DOI: 10.1097/med.0b013e328341311d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Abstract
PURPOSE OF REVIEW Primary hyperparathyroidism (PHPT) is a constantly evolving disease. As more evidence on the cardiovascular and neuropsychiatric manifestations of apparently asymptomatic disease accumulates, and since medical therapeutic options and surgical indications are being further investigated, it is important to review this disease entity to gain a fresh, updated perspective on the current disease phenotype and treatment approach. RECENT FINDINGS The pathogenesis of PHPT has not been completely elucidated yet, but some potential culprits, such as gene mutations, growth factors, calcium sensing receptor antibodies, and chronic vitamin D deficiency are being identified. There is increasing evidence that even mild, asymptomatic PHPT is associated with some aspects of cardiovascular and neuropsychiatric dysfunction, but the clinical significance as well as the reversibility with parathyroidectomy of these abnormalities remain to be determined. Medical therapies such as bisphosphonates and calcimimetics are showing some promise in the treatment of PHPT, although surgery remains the only curative intervention. The indications for surgical intervention in patients with asymptomatic PHPT have been recently revised. SUMMARY Parathyroidectomy is the treatment of choice for patients with symptomatic PHPT and patients with asymptomatic PHPT who fulfill certain age, bone density, serum calcium, and creatinine criteria. Further research is needed to determine whether patients with prominent cardiovascular and neuropsychiatric manifestations would benefit from such intervention.
Collapse
Affiliation(s)
- Zeina Habib
- Division of Endocrinology and Metabolism, Loyola University Medical Center, Maywood, Illinois, USA
| | | |
Collapse
|
22
|
Gasparri G, Palestini N, Catalano S, Talarico F, Ronchetta C, Balbo G, Camandona M. Hyperparathyroidism, an emerging disease. Updates Surg 2010; 62:175-81. [PMID: 21076902 DOI: 10.1007/s13304-010-0031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 10/29/2010] [Indexed: 11/26/2022]
Abstract
A retrospective study based on 35 years of personal experience was done. Up to today 2,175 patients were operated, 1,318 for primary hyperparathyroidism (HPT) and 857 for secondary and tertiary HPT. Considering recent years (1999 to July 2010), 918 patients were operated for primary HPT. Preoperatively all the patients performed a cervical ultrasound and/or a sestamibi scan. Open mininvasive procedure was preferred: it is an easily reproducible and costless technique. Using magnifying glasses up to 2.5, an excellent three-dimensional vision was obtained. The operating time is short and if there are any doubts it is possible to extend the exploration to the other side of the neck. Immediate and long-term results were excellent, with a cure rate greater than 99%. Complications in the treatment of a single adenoma are around 0.3%. Patients can be discharged 24-48 h after the operation. Regarding reoperations, a correct diagnostic and therapeutic approach is essential. CT, MRI and SPECT must correlate with the information given by ultrasound and scintigraphy. The intraoperative PTH assay (io-PTH) is required and the approach should be limited to the area where the missed gland probably is. The functionality of the autotransplantation (AT) performed immediately was good. The functionality of the cryopreserved tissue is better for the HPT I in comparison with HPT II. Considering HPT I or HPT II the use of io-PTH is helpful. MIBI scanning is helpful but not essential, except in reoperations. Surgeon experience is another very important factor for good results.
Collapse
Affiliation(s)
- Guido Gasparri
- 3rd General and Esophageal Surgical Unit, Department of Clinical Fisiopathology, University of Turin, Turin, Italy,
| | | | | | | | | | | | | |
Collapse
|
23
|
Franchello A, Camandona M, Gasparri G. Acute hyperparathyroidism and vascular thrombosis; an unrecognized association. J Endocrinol Invest 2010; 33:683. [PMID: 21099247 DOI: 10.1007/bf03346669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
24
|
Reddy Vanga S, Good M, Howard PA, Vacek JL. Role of vitamin D in cardiovascular health. Am J Cardiol 2010; 106:798-805. [PMID: 20816120 DOI: 10.1016/j.amjcard.2010.04.042] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 04/20/2010] [Accepted: 04/20/2010] [Indexed: 12/31/2022]
Abstract
Observational studies strongly associate vitamin D deficiency with a variety of cardiovascular diseases beyond defects in bone and calcium metabolism. Vitamin D has multiple mechanisms that potentially may affect cardiovascular health. Because vitamin D deficiency is common, therapies directed at the replacement of vitamin D may be beneficial. To date however, studies evaluating vitamin D supplementation are few and have not consistently shown benefit. It is possible that the lack of benefit in these studies may have arisen from suboptimal levels of vitamin D supplementation or other unknown factors. Nevertheless, the growing body of observational data and consistent findings of relatively high rates of low vitamin D serum levels warrant further well-designed studies to investigate the relation between vitamin D and cardiovascular health. In conclusion, vitamin D is now recognized as important for cardiovascular health and its deficiency as a potential risk factor for several cardiovascular disease processes.
Collapse
Affiliation(s)
- Subba Reddy Vanga
- Mid America Cardiology, Division of Cardiovascular Medicine, University of Kansas Medical Center and Hospital, Kansas City, Kansas, USA
| | | | | | | |
Collapse
|
25
|
Tordjman KM, Yaron M, Izkhakov E, Osher E, Shenkerman G, Marcus-Perlman Y, Stern N. Cardiovascular risk factors and arterial rigidity are similar in asymptomatic normocalcemic and hypercalcemic primary hyperparathyroidism. Eur J Endocrinol 2010; 162:925-33. [PMID: 20421337 DOI: 10.1530/eje-09-1067] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE It is still uncertain whether mild primary hyperparathyroidism (PHPT) carries the same risk for increased cardiovascular (CV) morbidity as the more severe symptomatic form. In recent years, the even more subtle normocalcemic (NC) variant is being increasingly recognized. We sought to compare the prevalence of CV risk factors in patients with NC- and hypercalcemic (HC)-PHPT, and to examine whether they differ on a battery of non-invasive vascular parameters. DESIGN/SUBJECTS/METHODS: A retrospective study of two cohorts of patients with PHPT in a referral center: 32 subjects with NC-PHPT and 81 subjects with HC-PHPT, compared for the presence of clinical and biochemical risk factors, and CV morbidity. Non-invasive parameters of arterial stiffness (augmentation index; pulse wave velocity; and vascular compliance indices, C1 and C2) were extracted from the data of gender- and age-matched subsets of these patients, and were related to those of a group of matched control subjects. RESULTS Despite a similar prevalence of hypertension (approximately 62%), hyperlipidemia (approximately 30%), and impaired glucose metabolism in both PHPT groups, CV or cerebrovascular disease was more common in the HC-PHPT group (24.7 vs 3.1%, P=0.007). Arterial stiffness parameters did not differ in the three groups, and were unrelated to serum calcium or parathyroid hormone concentration. CONCLUSIONS NC-PHPT and HC-PHPT subjects exhibit similar high rates of traditional CV risk factors, and have comparable indices of arterial stiffness. The lower clinical CV morbidity observed with NC-PHPT remains unexplained, and requires confirmation. Until then, the CV risk associated with NC-PHPT should not be underestimated.
Collapse
Affiliation(s)
- Karen M Tordjman
- The Sackler Faculty of Medicine, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
| | | | | | | | | | | | | |
Collapse
|
26
|
Walker MD, Fleischer JB, Di Tullio MR, Homma S, Rundek T, Stein EM, Zhang C, Taggart T, McMahon DJ, Silverberg SJ. Cardiac structure and diastolic function in mild primary hyperparathyroidism. J Clin Endocrinol Metab 2010; 95:2172-9. [PMID: 20228165 PMCID: PMC2869545 DOI: 10.1210/jc.2009-2072] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Data on the presence, extent, and reversibility of cardiovascular disease in primary hyperparathyroidism (PHPT) are conflicting. OBJECTIVE To evaluate the heart in PHPT, we assessed cardiac structure and diastolic function in patients with mild PHPT compared with age- and sex-matched controls. DESIGN This was a case-control study. SETTINGS The study was conducted in a university hospital Metabolic Bone Diseases Unit. PARTICIPANTS Fifty-four men and women with PHPT and 76 controls without PHPT participated in the study. OUTCOME MEASURES We measured left ventricular mass index (LVMI), the presence of mitral annular calcification, the ratio of early to late diastolic mitral inflow velocities (E/A), and early diastolic velocity of the lateral mitral annulus using Doppler tissue imaging (tissue Doppler e'). RESULTS Patients had mild disease with mean (+/-sd) serum calcium 10.5 +/- 0.5 mg/dl and PTH 96 +/- 45 pg/ml. LVMI and diastolic function were normal in PHPT. There was no difference in LVMI (98 +/- 23 vs. 96 +/- 24 g/m(2), P = 0.69) or the frequency of mitral annular calcification between PHPT cases and controls. Diastolic function variables (E/A and tissue Doppler e') were higher (better) in cases compared with controls, although both were within the reference range. PHPT patients with low E/A had higher serum PTH (121 +/- 36 vs. 89 +/- 46 pg/ml, P = 0.03) and calcium (10.8 +/- 0.4 vs. 10.5 +/- 0.5 mg/dl, P = 0.05) than those with normal values. Finally, we found LVMI to be inversely associated with serum 25-hydroxyvitamin D in PHPT (r = -0.29, P < 0.05). All findings persisted after adjustment for group differences in cardiovascular risk factors. CONCLUSIONS Patients with biochemically mild PHPT do not have evidence of increased left ventricular mass, diastolic dysfunction, or increased valvular calcifications. However, the data support an association between low vitamin D levels and the development of left ventricular hypertrophy in this disorder. Finally, the increased serum calcium and PTH levels in those with diastolic dysfunction suggest that disease severity may determine the presence of cardiac manifestations in PHPT.
Collapse
Affiliation(s)
- M D Walker
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|