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Fucile I, Mancusi C, Visco V, De Luca C, Ambrosino P, Bianco A, Ciccarelli M, Iaccarino G, Morisco C, De Luca N. Serum parathormone, vitamin D and cardiovascular risk factors and markers: A pilot study. Nutr Metab Cardiovasc Dis 2024; 34:2298-2304. [PMID: 39069469 DOI: 10.1016/j.numecd.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND AIMS Vitamin D deficiency is a common cause of secondary hyperparathyroidism, particularly in elderly people. The aim of this study was to evaluate the associations of serum vitamin D and parathormone (PTH) concentrations with blood pressure values and hypertension-mediated target organ damage (HMOD), including left ventricular (LV) hypertrophy and carotid plaque (CP). METHODS AND RESULTS We enrolled consecutive patients admitted to the Hypertension Center of Federico II University Hospital in Naples, Italy. All patients underwent carotid doppler ultrasound and echocardiography, measurement of vitamin D and PTH levels and main clinical and laboratory parameters. A total of 126 patients (mean age 54 years, 68% males) were enrolled. Pearson's correlation analysis indicated that PTH levels directly correlated with age, diabetes, dyslipidemia, hypertension, fasting glucose, and LV mass, and inversely with glomerular filtration rate, LDL cholesterol, and vitamin D. Vitamin D levels correlated inversely with PTH, diabetes and CP. Multivariate regression models indicated that an increased LV mass was associated with the presence of obesity (β = 0.342; P = 0.001). Maximal intima-media thickness was significantly associated with older age (β = 0.303; P = 0.033). Combined presence of low vitamin D/high PTH levels were associated with more than 4-fold increased risk of having CP in both univariate (OR = 4.77, p = 0.0001) and multivariate regression analysis (OR = 4.52, p = 0.014). CONCLUSION In a population at high cardiovascular risk, vitamin D and PTH levels were not directly associated with blood pressure values and HMOD. Secondary hyperparathyroidism due to vitamin D deficiency is associated with carotid atherosclerosis independently of other common cardiovascular risk factors.
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MESH Headings
- Humans
- Male
- Female
- Middle Aged
- Parathyroid Hormone/blood
- Vitamin D/blood
- Vitamin D/analogs & derivatives
- Vitamin D Deficiency/blood
- Vitamin D Deficiency/epidemiology
- Vitamin D Deficiency/diagnosis
- Vitamin D Deficiency/complications
- Biomarkers/blood
- Pilot Projects
- Heart Disease Risk Factors
- Aged
- Italy/epidemiology
- Carotid Artery Diseases/diagnostic imaging
- Carotid Artery Diseases/blood
- Carotid Artery Diseases/epidemiology
- Carotid Artery Diseases/etiology
- Hypertrophy, Left Ventricular/blood
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/epidemiology
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Left Ventricular/diagnosis
- Carotid Intima-Media Thickness
- Risk Assessment
- Hypertension/blood
- Hypertension/diagnosis
- Hypertension/physiopathology
- Hypertension/epidemiology
- Cross-Sectional Studies
- Plaque, Atherosclerotic
- Adult
- Blood Pressure
- Hyperparathyroidism, Secondary/blood
- Hyperparathyroidism, Secondary/etiology
- Hyperparathyroidism, Secondary/diagnosis
- Hyperparathyroidism, Secondary/epidemiology
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/blood
- Cardiovascular Diseases/etiology
- Cardiovascular Diseases/diagnosis
- Hospitals, University
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Affiliation(s)
- Ilaria Fucile
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy; Interdepartmental Center of Research on High Blood Pressure and Related Conditions "CIRIAPA", Federico II University, Naples, Italy.
| | - Valeria Visco
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Carmine De Luca
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, Italy
| | - Antonio Bianco
- Interdepartmental Center of Research on High Blood Pressure and Related Conditions "CIRIAPA", Federico II University, Naples, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Guido Iaccarino
- Interdepartmental Center of Research on High Blood Pressure and Related Conditions "CIRIAPA", Federico II University, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy; Interdepartmental Center of Research on High Blood Pressure and Related Conditions "CIRIAPA", Federico II University, Naples, Italy
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Antignani PL, Jezovnik MK, Blinc A, Mikhailidis DP, Anagnostis P, Schernthaner GH, Jensterle M, Studen KB, Sabovic M, Poredos P. Hyperparathyroidism and Peripheral Arterial Disease. Curr Vasc Pharmacol 2024; 22:88-94. [PMID: 38284694 DOI: 10.2174/0115701611280905231227045826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
Primary hyperparathyroidism (PHPT) is presented in various forms, including classic PHPT, characterised by increased parathyroid hormone (PTH) secretion, normohormonal PHPT, and normocalcaemic PHPT. Secondary hyperparathyroidism is characterised by increased PTH secretion triggered by factors such as vitamin D deficiency and kidney failure. This review aims to discuss the involvement of hyperparathyroidism (HPT) in atherosclerosis, including peripheral arterial disease (PAD). The increased level of PTH is involved in developing subclinical and overt vascular diseases, encompassing endothelial dysfunction, vascular stiffness, hypertension, and coronary and peripheral arterial diseases. It has been consistently associated with an augmented risk of cardiovascular morbidity and mortality, independent of classical risk factors for atherosclerosis. Chronic hypercalcemia associated with increased levels of PTH contributes to the development of calcification of vessel walls and atherosclerotic plaques. Vascular calcification can occur in the intima or media of the arterial wall and is associated with stiffness of peripheral arteries, which the formation of atherosclerotic plaques and narrowing of the vessel lumen can follow. For treating hyperparathyroidism, particularly SHPT, calcimimetics, novel phosphorus binders and novel vitamin D receptor activators are used. However, they are ineffective in severe PHPT. Therefore, parathyroidectomy remains the primary therapeutic option of PHPT.
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Affiliation(s)
| | - Mateja K Jezovnik
- Department of Advanced, Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ales Blinc
- Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Dimitri P Mikhailidis
- Department of Surgical Biotechnology, Division of Surgery and Interventional Science, University College London Medical School, University College London (UCL) and Department of Clinical Biochemistry, Royal Free Hospital Campus (UCL), London, UK
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical, School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Mojca Jensterle
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, Ljubljana, Slovenia
| | - Katica Bajuk Studen
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
- Department of Nuclear Medicine, University Medical Centre, Ljubljana, Slovenia
| | - Miso Sabovic
- Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Pavel Poredos
- Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
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Soto-Pedre E, Lin YY, Soto-Hernaez J, Newey PJ, Leese GP. Morbidity Associated With Primary Hyperparathyroidism-A Population-based Study With a Subanalysis on Vitamin D. J Clin Endocrinol Metab 2023; 108:e842-e849. [PMID: 36810667 PMCID: PMC10438903 DOI: 10.1210/clinem/dgad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) is associated with increased risk of morbidity and death, and vitamin D levels are a potentially confounding variable. OBJECTIVE The aim of this study was to assess morbidity and mortality associated with primary hyperparathyroidism (PHPT). METHODS In this population-based retrospective matched cohort study, data linkage of biochemistry, hospital admissions, prescribing, imaging, pathology, and deaths was used to identify patients across the region of Tayside, Scotland, who had PHPT from 1997 to 2019. Cox proportional hazards models and hazards ratios (HR) were used to explore the relationship between exposure to PHPT and several clinical outcomes. Comparisons were made with an age- and gender-matched cohort. RESULTS In 11 616 people with PHPT (66.8% female), with a mean follow-up period of 8.8 years, there was an adjusted HR of death of 2.05 (95% CI, 1.97-2.13) for those exposed to PHPT. There was also an increased risk of cardiovascular disease (HR = 1.34; 95% CI, 1.24-1.45), cerebrovascular disease (HR = 1.29; 95% CI, 1.15-1.45), diabetes (HR = 1.39; 95% CI, 1.26-1.54), renal stones (HR = 3.02; 95% CI, 2.19-4.17) and osteoporosis (HR = 1.31; 95% CI, 1.16-1.49). Following adjustment for serum vitamin D concentrations (n = 2748), increased risks for death, diabetes, renal stones, and osteoporosis persisted, but not for cardiovascular or cerebrovascular disease. CONCLUSION In a large population-based study, PHPT was associated with death, diabetes, renal stones, and osteoporosis, independent of serum vitamin D concentration.
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Affiliation(s)
- Enrique Soto-Pedre
- Division of Population Health & Genomics, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Yeun Yi Lin
- Department of Endocrinology and Diabetes, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
| | | | - Paul J Newey
- Department of Endocrinology and Diabetes, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
- Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Graham P Leese
- Division of Population Health & Genomics, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Endocrinology and Diabetes, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
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4
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Karwacka I, Kmieć P, Kaniuka-Jakubowska S, Pisowodzka I, Fijałkowski M, Sworczak K. Improvement of hypertension control and left-ventricular function after cure of primary hyperparathyroidism. Front Endocrinol (Lausanne) 2023; 14:1163877. [PMID: 37492200 PMCID: PMC10364630 DOI: 10.3389/fendo.2023.1163877] [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: 02/11/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Cardiovascular mortality is significantly higher in patients with primary hyperparathyroidism (PHPT) compared to the general population. The role of the renin-angiotensin-aldosterone system (RAAS) as a mediator of cardiovascular pathology in PHPT is unclear, as is the question whether successful parathyroidectomy (PTX) mitigates hypertension (HT), and left-ventricular (LV) dysfunction. Methods In 45 consecutive, hypercalcemic PHPT patients (91% female, 20 normotensive, mean age 54.6 ± 14.6), laboratory examinations, and 24 h ambulatory blood pressure monitoring (ABPM) were performed before, one and six months after successful PTX, while transthoracic echocardiography (TTE) pre- and six months post-PTX. Results Both in patients with normotension (NT) and HT, lower calcemia and parathyroid hormone (PTH) as well as higher phosphatemia were observed on follow-up, while B-type natriuretic peptide, aldosterone, plasma renin activity, and aldosterone-to-renin ratios were comparable. Six months post-PTX, only in patients with HT, median 24-hour SBP/DBP decreased by 12/6 mmHg, daytime SBP by 10, and nighttime DBP by 5 mmHg. Improvement in BP was observed in approximately 78% of patients with HT. Six months post-PTX, TTE revealed: 1) decrease in median LV mass index (by 2 g/m2) and end-diastolic dimension (by 3 mm) among patients with HT; 2) normalization of global longitudinal strain in 22% of patients (comparable between those with NT and HT); 3) a mean 12.7% reduction in left-atrium volume index among patients with HT, which underlay normalization of indeterminate diastolic function in 3 out of 6 patients with HT, who exhibited it at baseline (dysfunction persisted in 2). Conclusions PTX was shown to significantly reduce BP, LV hypertrophy and diastolic dysfunction parameters in PHPT patients with HT, and improve systolic function in all PHPT patients.
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Affiliation(s)
- Izabela Karwacka
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Kmieć
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Izabela Pisowodzka
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Fijałkowski
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof Sworczak
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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5
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Chandran M, Yeh LTL, de Jong MC, Bilezikian JP, Parameswaran R. Cognitive deficits in primary hyperparathyroidism - what we know and what we do not know: A narrative review. Rev Endocr Metab Disord 2022; 23:1079-1087. [PMID: 35994179 DOI: 10.1007/s11154-022-09750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
Classic symptoms of primary hyperparathyroidism (PHPT) are seen in approximately 20% of patients. While features such as kidney stones and skeletal disease are often highlighted as directly related to the disease, others can be even more prevalent. For example, cognitive dysfunction and reduced quality of life are common complaints in many patients, even among those who are classified as being asymptomatic. The pathophysiology of PHPT involves the impact of excess parathyroid hormone (PTH) on calcium metabolism. Referencing putative neurocognitive issues, many animal studies have illustrated the potential roles of PTH and PTH receptors in the brain. Functional imaging and pre-and post-parathyroidectomy studies have suggested a link between the neuronal impact of elevated PTH levels on specific functional aspects of the central nervous system, such as cognition. Confounding a direct role for PTH are hypercalcemia and vitamin D deficiency, both of which could conceivably alter CNS function in PHPT. The lack of strong evidence that parathyroidectomy improves cognition in patients with PHPT raises the question as to whether parathyroid surgery should be recommended on this basis alone. This narrative review summarizes the available literature on neurocognitive function in PHPT.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
- DUKE-NUS Medical School, Singapore, Singapore.
| | - Lydia Tan Li Yeh
- Division of Endocrine Surgery, National University Health System, Singapore, Singapore
| | - Mechteld C de Jong
- Division of Endocrine Surgery, National University Health System, Singapore, Singapore
| | - John P Bilezikian
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Rajeev Parameswaran
- Division of Endocrine Surgery, National University Health System, Singapore, Singapore
- Division of Endocrine Surgery, National University Hospital System, Singapore, Singapore
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Walker M, Silverberg SJ. Nontraditional Aspects of Sporadic Primary Hyperparathyroidism. Endocrinol Metab Clin North Am 2021; 50:629-647. [PMID: 34774238 DOI: 10.1016/j.ecl.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nontraditional aspects of primary hyperparathyroidism refer to the condition's rheumatic, gastrointestinal, cardiovascular, and neuropsychological effects. Although gastrointestinal and rheumatic symptomatology were features of classical primary hyperparathyroidism, they do not seem to be a part of the modern presentation of primary hyperparathyroidism. In contrast, neuropsychological symptoms such as altered mood and cognition, as well as cardiovascular disease, have been associated with the form of primary hyperparathyroidism seen today, but the relationship is not clearly causal. Evidence does not support reversibility after parathyroidectomy and therefore none of the nontraditional manifestations are considered sole indications for recommending surgery at this time.
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Affiliation(s)
- Marcella Walker
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Shonni J Silverberg
- Division of Endocrinology, Department of Medicine, Columbia University, Columbia University Irving Medical Center, New York, NY 10032, USA.
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7
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Zaki HM, Sliem HA, Ibrahim HR, Yassine IA. Silent neurological lesions detected by magnetic resonance imaging: Relationship to hyperparathyroidism among end-stage renal disease young patients on haemodialysis. Int J Clin Pract 2021; 75:e14569. [PMID: 34165847 DOI: 10.1111/ijcp.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/23/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) patients on haemodialysis (HD) suffer from several peripheral and central neurological complications. They are at high risk for developing silent neurological lesions (SNL) that may be detected accidentally by magnetic resonance imaging (MRI). Many factors are implicated in the development of neurological deficits in ESRD patients on HD. AIM OF THE WORK Evaluation of SNL in young ESRD patients by using MRI and assessing its correlation with hyperparathyroidism. METHODS The study involved 48 young ESRD patients (mean age of 19.6 ± 6 years) with HD and do not have any apparent abnormalities in the neurological examination. Laboratory investigations and conventional brain MRI were done on all. RESULTS 79.2% have SBI and 45.8% have white matter lesions. Regression analysis revealed that calcium level and duration of dialysis were independent predictor factors for the presence of silent brain MRI lesions (P = .034 & 0.045 respectively). ROC curve showed that parathyroid hormone (PTH) level >585 pg/mL, duration of dialysis >2 years, and calcium level >7.5 mg/dL predicted the presence of SNL. CONCLUSION The duration of HD and hyperparathyroidism (HPT) were independent predictors for the presence of SNL. MRI brain is considered as a mandatory affordable tool for HD patients >2 years and has HPT for early detection of SNL to help early intervention and avoid neurological complications and disabilities.
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Affiliation(s)
- Heba M Zaki
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hamdy A Sliem
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Heba R Ibrahim
- Department of Diagnostic Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Imane A Yassine
- Department of Neurology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Marques P, de Vries F, Dekkers OM, Korbonits M, Biermasz NR, Pereira AM. Serum Inflammation-based Scores in Endocrine Tumors. J Clin Endocrinol Metab 2021; 106:e3796-e3819. [PMID: 33837783 PMCID: PMC8475227 DOI: 10.1210/clinem/dgab238] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 12/13/2022]
Abstract
CONTEXT Serum inflammation-based scores reflect systemic inflammatory response and/or patients' nutritional status, and may predict clinical outcomes in cancer. While these are well-described and increasingly used in different cancers, their clinical usefulness in the management of patients with endocrine tumors is less known. EVIDENCE ACQUISITION A comprehensive PubMed search was performed using the terms "endocrine tumor," "inflammation," "serum inflammation-based score," "inflammatory-based score," "inflammatory response-related scoring," "systemic inflammatory response markers," "neutrophil-to-lymphocyte ratio," "neutrophil-to-platelet ratio," "lymphocyte-to-monocyte ratio," "Glasgow prognostic score," "neutrophil-platelet score," "Systemic Immune-Inflammation Index," and "Prognostic Nutrition Index" in clinical studies. EVIDENCE SYNTHESIS The neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio are the ones most extensively investigated in patients with endocrine tumors. Other scores have also been considered in some studies. Several studies focused in finding whether serum inflammatory biomarkers may stratify the endocrine tumor patients' risk and detect those at risk for developing more aggressive and/or refractory disease, particularly after endocrine surgery. CONCLUSIONS In this review, we summarize the current knowledge on the different serum inflammation-based scores and their usefulness in predicting the phenotype, clinical aggressiveness, and disease outcomes and prognosis in patients with endocrine tumors. The value of such serum inflammation-based scores in the management of patients with endocrine tumors has been emerging over the last decade. However, further research is necessary to establish useful markers and their cut-offs for routine clinical practice for individual diseases.
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Affiliation(s)
- Pedro Marques
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
- Correspondence: Pedro Marques, Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center. Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail:
| | - Friso de Vries
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
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Liu CT, Hsu SC, Hsieh HL, Chen CH, Chen CY, Sue YM, Lin FY, Shih CM, Shiu YT, Huang PH. Parathyroid Hormone Induces Transition of Myofibroblasts in Arteriovenous Fistula and Increases Maturation Failure. Endocrinology 2021; 162:6153466. [PMID: 33640969 DOI: 10.1210/endocr/bqab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Arteriovenous fistula (AVF) maturation failure remains a clinical dilemma, and its pathobiology is largely unclear. Secondary hyperparathyroidism is a complication of chronic renal failure that is associated with cardiovascular disease. While parathyroid hormone (PTH) has a prosclerotic effect on vascular smooth muscle cells (VSMCs), its role in AVF maturation failure remained unknown. OBJECTIVE This work aimed to investigate the association between plasma PTH and AVF maturation. METHODS Patients receiving AVF creation were enrolled retrospectively. A mouse model of secondary hyperparathyroidism and aortocaval AVF was used to investigate the effect of PTH on an AVF lesion. A cell model of VSMCs treated with PTH in a pressurized culture system was used to disclose the signaling pathway underlying the effect of PTH on an AVF lesion. RESULTS In patients receiving AVF creation, higher PTH was associated with an increased risk for maturation failure. In a mouse model, vascular wall thickness and myofibroblasts of AVF significantly increased with higher PTH. When the same mice were treated with cinacalcet, AVF lesions were attenuated by suppression of PTH. A cell model showed that PTH increased the marker of myofibroblasts, integrin β6 subunit (ITGB6), via the phosphorylated protein kinase B pathway. Finally, in the same model of mice AVF, higher PTH also increased the expression of ITGB6 in the smooth muscle layer of AVF, suggesting the transition to myofibroblast. CONCLUSION Overall, our results suggest that higher PTH increased the risk of AVF maturation failure through increasing the transition of VSMCs to myofibroblasts. Lowering PTH may be a strategy to enhance AVF maturation.
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Affiliation(s)
- Chung-Te Liu
- Division of Nephrology, Department of Internal Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei City 110, Taiwan
| | - Shih-Chang Hsu
- Emergency Department, Department of Emergency and Critical Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
| | - Hui-Ling Hsieh
- Division of Nephrology, Department of Internal Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Cheng-Hsien Chen
- Division of Nephrology, Department of Internal Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei City 110, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
| | - Chun-You Chen
- Department of Radiation Oncology, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
| | - Yuh-Mou Sue
- Division of Nephrology, Department of Internal Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City 116, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei City 110, Taiwan
| | - Feng-Yen Lin
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City 110, Taiwan
| | - Chun-Ming Shih
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City 110, Taiwan
| | - Yan-Ting Shiu
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah 84132, USA
- Veterans Affairs Medical Center, Salt Lake City, Utah 84148, USA
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei City 112, Taiwan
- Cardiovascular Research Center, National Yang-Ming University, Taipei City 112, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei City 112, Taiwan
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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.
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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
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11
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Frey S, Mirallié É, Cariou B, Blanchard C. Impact of parathyroidectomy on cardiovascular risk in primary hyperparathyroidism: A narrative review. Nutr Metab Cardiovasc Dis 2021; 31:981-996. [PMID: 33612382 DOI: 10.1016/j.numecd.2020.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/23/2020] [Accepted: 12/27/2020] [Indexed: 12/22/2022]
Abstract
AIMS Primary hyperparathyroidism (PHPT), one of the most frequent endocrine disorders, is not only associated with bone and kidney disorders but also with increased cardiovascular risk. This cardiovascular risk is not part of the indication for surgery owing to discordant evidence of the effects of parathyroidectomy (PTX), especially in mild PHPT which is the most common presentation of PHPT. This literature review focuses on the effects of PTX on the cardiovascular risk in PHPT. The MEDLINE database was searched via the PubMed interface, selecting relevant articles published after 1990 in English. DATA SYNTHESIS In the most recent series, PTX appeared to have a positive impact on cardiovascular morbidity and mortality. Surgery improves arterial hypertension, markers of glucose homeostasis, vascular and cardiac remodeling and electrocardiographic impairments due to classical PHPT. However, the results of surgery on mild PHPT are conflicting. CONCLUSIONS PTX seems to improve cardiovascular risk in patients presenting the classical form of PHPT. This improvement is correlated with preoperative serum calcium and/or PTH level, depending on the cardiovascular risk factor. However, many aspects of this improvement are not fully understood. Future studies should assess the effects of PTX on nocturnal hypertension, cardiac morphology and functions. The results for mild PHPT are conflicting owing to the limited size of the cohorts included in studies and the lack of randomized trials. Surgery is not currently recommended for patients presenting mild PHPT based on the cardiovascular risk and more studies are needed to better understand the interest of PTX on cardiovascular outcomes.
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Affiliation(s)
- Samuel Frey
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, Nantes, France; Université de Nantes, Quai de Tourville, 44000, Nantes, France
| | - Éric Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, Nantes, France; Université de Nantes, Quai de Tourville, 44000, Nantes, France
| | - Bertrand Cariou
- Université de Nantes, Quai de Tourville, 44000, Nantes, France; L'institut du Thorax, UNIV NANTES, CNRS, INSERM, CHU de Nantes, Nantes, France; Service d'Endocrinologie et Maladies Métaboliques, l'Institut du Thorax, CHU de Nantes, Nantes, France.
| | - Claire Blanchard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, Nantes, France; Université de Nantes, Quai de Tourville, 44000, Nantes, France; L'institut du Thorax, UNIV NANTES, CNRS, INSERM, CHU de Nantes, Nantes, France.
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12
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Dandurand K, Ali DS, Khan AA. Primary Hyperparathyroidism: A Narrative Review of Diagnosis and Medical Management. J Clin Med 2021; 10:jcm10081604. [PMID: 33918966 PMCID: PMC8068862 DOI: 10.3390/jcm10081604] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia in the outpatient setting. Symptomatic presentation includes non-specific signs and symptoms of hypercalcemia, skeletal fragility, nephrolithiasis and nephrocalcinosis. The majority of individuals present at an asymptomatic stage following routine biochemical screening, without any signs or symptoms of calcium or parathyroid hormone (PTH) excess or target organ damage. Indications for surgery have recently been revised as published in recent guidelines and consensus statements. Parathyroidectomy is advised in patients younger than 50 years old and in the presence of either significant hypercalcemia, impaired renal function, renal stones or osteoporosis. Surgery is always appropriate in suitable surgical candidates, however, medical management may be considered in those with mild asymptomatic disease, contraindications to surgery or failed previous surgical intervention. We summarized the optimal medical interventions available in the care of PHPT patients not undergoing parathyroidectomy. Calcium and vitamin D intake should be optimized. Antiresorptive therapy may be used for skeletal protection in patients with an increased fracture risk. Cinacalcet, a calcimimetic agent, has been shown to effectively lower serum calcium and PTH levels. The effect of medical treatment on the reduction in fracture risk is unknown and should be the focus of future research.
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13
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Alakuş H, Göksu M. Does Parathyroidectomy Affect the Neutrophil/Lymphocyte Ratio, a Systemic Inflammatory Marker? Cureus 2021; 13:e13708. [PMID: 33833922 PMCID: PMC8019483 DOI: 10.7759/cureus.13708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction Primary hyperparathyroidism (PHPT) is an endocrinological disorder associated with increased systemic inflammation. This study aimed to examine the changes in the neutrophil/lymphocyte ratio (NLR), serum parathormone, serum corrected calcium, serum phosphate, and white blood cell (WBC) count in patients with PHPT before and after parathyroidectomy. Methods A total of 37 patients who underwent successful parathyroidectomy for PHPT were included in the study. NLR, serum parathormone, serum corrected calcium, serum phosphate, and WBC count were compared before parathyroidectomy and at the sixth postoperative month. Results The difference in the NLR, serum parathormone, serum corrected calcium, and serum phosphate values before and after parathyroidectomy was statistically significant (p=0.019, p<0.001, p<0.001, and p<0.001, respectively), but there was no significant difference in the WBC count (p=0.314). The correlation analysis performed before parathyroidectomy revealed a significant positive correlation between NLR and serum parathormone (r=0.519, p=0.001), serum corrected calcium (r=0.390, p=0.017) and WBC count (r=0.531, p=0.001), and a significant negative correlation between NLR and serum phosphate (r=-0.331). Conclusion In patients with PHPT, successful parathyroidectomy results in a decrease in NLR. Increased systemic inflammation in patients with PHPT can be reduced following parathyroidectomy.
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Affiliation(s)
- Hüseyin Alakuş
- Department of Surgical Oncology, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Mustafa Göksu
- Department of General Surgery, Adiyaman University Faculty of Medicine, Adiyaman, TUR
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14
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Brandtner EM, Muendlein A, Leiherer A, Armbruster FP, Dschietzig TB, Geiger K, Fraunberger P, Saely CH, Drexel H. Serum Parathyroid Hormone Predicts Mortality in Coronary Angiography Patients with Type 2 Diabetes. J Clin Endocrinol Metab 2020; 105:5891791. [PMID: 32785694 DOI: 10.1210/clinem/dgaa512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Elevated serum levels of parathyroid hormone (PTH), one of the main regulators of calcium homeostasis and vitamin D metabolism, have been proposed as predictors of mortality. The impact of type 2 diabetes mellitus (T2DM) on the putative association between PTH and mortality has not been investigated thus far. AIM The aim of our study was to investigate the impact of T2DM on the power of PTH to predict mortality risk. METHODS Serum PTH levels were determined in 904 consecutive Caucasian patients referred to coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD), including 235 patients with T2DM. Prospectively, deaths were recorded over a mean follow-up period of 6.3 years. RESULTS PTH at baseline did not differ significantly between patients with and without T2DM (P = .307). Cox regression analysis revealed that the serum PTH level strongly predicted all-cause mortality in patients with T2DM (hazard ratio [HR] = 2.35 [1.37-4.03]; P = .002), whereas PTH did not predict all-cause mortality in patients without T2DM (HR = 1.04 [0.81-1.32]; P = .766). The interaction term PTH × T2DM was significant (P = .006), indicating a significantly stronger impact of PTH on mortality risk in patients with T2DM than in individuals without diabetes. The impact of PTH on mortality risk in patients with T2DM remained significant after adjustment for glycated hemoglobin A1c, diabetes duration, classical cardiovascular risk factors, serum levels of vitamin D, and kidney function (HR = 2.10 [1.10-4.10]; P = .030). CONCLUSION We conclude that PTH is a significantly stronger predictor of all-cause mortality in patients with T2DM than in those without T2DM.
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Affiliation(s)
- Eva Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Medical Central Laboratories, Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | | | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Medical Central Laboratories, Feldkirch, Austria
| | | | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
- Drexel University College of Medicine, Philadelphia, Pennsylvania
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15
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Liu M, Sum M, Cong E, Colon I, Bucovsky M, Williams J, Kepley A, Kuo J, Lee JA, Lazar RM, Marshall R, Silverberg S, Walker MD. Cognition and cerebrovascular function in primary hyperparathyroidism before and after parathyroidectomy. J Endocrinol Invest 2020; 43:369-379. [PMID: 31621051 PMCID: PMC7275118 DOI: 10.1007/s40618-019-01128-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE There are cognitive changes in primary hyperparathyroidism (PHPT) that improve with parathyroidectomy, but the mechanism of cognitive dysfunction has not been delineated. We assessed if cerebrovascular function is impaired in PHPT, improves post-parathyroidectomy and is associated with PTH level and cognitive dysfunction. METHODS This is an observational study of 43 patients with mild hypercalcemic or normocalcemic PHPT or goiter. At baseline, cerebrovascular function (dynamic cerebral autoregulation and vasomotor reactivity) by transcranial Doppler and neuropsychological function were compared between all three groups. A subset underwent parathyroidectomy or thyroidectomy, and was compared 6 months post-operatively. RESULTS Mean cerebrovascular and neuropsychological function was normal and no worse in PHPT compared to controls preoperatively. Higher PTH was associated with worse intracerebral autoregulation (r = - 0.43, p = 0.02) and worse cognitive performance on some tests. Post-parathyroidectomy, mood improved significantly, but changes did not differ compared to those having thyroidectomy (p = 0.84). There was no consistent improvement in cognition or change in vascular function in either surgical group. CONCLUSIONS Although higher PTH was associated with worse intracerebral autoregulation, cerebrovascular function, cognition and mood were normal in mild PHPT. PTX did not improve vascular or cognitive function. The observed improvement in mood cannot be clearly attributed to PTX. Notwithstanding the small sample size, the results do not support changing current criteria for parathyroidectomy to include cognitive complaints. However, the associations between PTH, cognition and cerebral autoregulation merit future studies in those with more severe hyperparathyroidism.
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Affiliation(s)
- M Liu
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - M Sum
- Division of Endocrinology, Department of Medicine, New York University Langone Medical Center, New York, NY, 10016, USA
| | - E Cong
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - I Colon
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - M Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - J Williams
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - A Kepley
- Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - J Kuo
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - J A Lee
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - R M Lazar
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - R Marshall
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - S Silverberg
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA
| | - M D Walker
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.
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16
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Nelson JA, Alsayed M, Milas M. The role of parathyroidectomy in treating hypertension and other cardiac manifestations of primary hyperparathyroidism. Gland Surg 2020; 9:136-141. [PMID: 32206605 DOI: 10.21037/gs.2019.12.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Among many recognized sequelae of primary hyperparathyroidism (PHPT), cardiovascular disease remains incompletely understood as a consequence of disordered calcium and parathyroid hormone (PTH) metabolism. While population studies have identified trends that associate PHPT with hypertension, metabolic syndrome, and vascular system calcifications, the fundamental pathophysiology, natural history, and opportunity to reverse or cure the cardiovascular effects with parathyroidectomy are not well established. This chapter reviews the current knowledge of this field of interest within PHPT and summarizes key findings from dedicated investigations that have addressed the impact of parathyroid surgery on the cardiovascular system.
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Affiliation(s)
- J Alex Nelson
- Division of Endocrine Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mahmoud Alsayed
- Division of Endocrinology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,Diabetes and Endocrinology Institute, Banner - University Medical Center Phoenix, Phoenix, AZ, USA
| | - Mira Milas
- Diabetes and Endocrinology Institute, Banner - University Medical Center Phoenix, Phoenix, AZ, USA.,Division of Endocrine Surgery, University of Arizona College of Medicine - Phoenix, AZ, USA
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17
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Jiang W, Hu CY, Li FL, Hua XG, Huang K, Zhang XJ. Elevated parathyroid hormone levels and cognitive function: A systematic review. Arch Gerontol Geriatr 2019; 87:103985. [PMID: 31770681 DOI: 10.1016/j.archger.2019.103985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 10/30/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To systematically estimate the association between elevated parathyroid hormone (PTH) levels and cognitive function. METHODS This review was conducted on ten papers identified through database searches from inception to 31 October 2018. The quality of studies was assessed using the Downs and Black checklist. RESULTS There is a low volume of data reporting on the impact of elevated PTH levels on cognitive impairment. The quality of the identified studies ranged from poor (37 %) to good (76 %). Although the results from studies were mixed, one cross-sectional study and one prospective study suggested a link between elevated PTH levels and a decrease in the Mini-Mental State Examination (MMSE) score. Three cross-sectional studies that assessed other cognitive domain in specific domains, such as language, memory and executive function provided mixed results for an association between elevated PTH levels and cognitive function. Two studies showed mixed evidence for a link between elevated PTH levels and poor executive function. One prospective study, one cross-sectional study and three case-control studies provide mixed evidence for an association between higher PTH levels and Alzheimer´s disease (AD). Two studies showed limited evidence for an association between elevated PTH levels and vascular dementia. CONCLUSION This review presented that the level of evidence available to support an association between elevated PTH levels and cognitive function was generally weak and inconsistent. Future studies with more better methodological quality are needed.
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Affiliation(s)
- Wen Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Cheng-Yang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Feng-Li Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Xiao-Guo Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Kai Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China.
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Kızılgül M, Çalışkan M, Beysel S, Özbek M, Çakal E. Effect of parathyroidectomy on epicardial fat thickness as a cardiovascular risk factor in patients with primary hyperparathyroidism. Turk J Med Sci 2019; 49:1165-1169. [PMID: 31385484 PMCID: PMC7018295 DOI: 10.3906/sag-1902-40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background/aim Several studies demonstrated that primary hyperparathyroidism is related to increased risk for cardiovascular diseases (CVDs), and risk is decreased by parathyroidectomy. Epicardial fat thickness (EFT) has been postulated as a new marker of CVD risk. We evaluated the impact of parathyroidectomy on EFT in patients with primary hyperparathyroidism (PHPT). Materials and methods Thirty-four PHPT patients (29 female, 5 male) and 28 age- and sex-matched controls (19 female, 9 male) were included in the study. Demographic, anthropometric, and biochemical data were recorded both before parathyroidectomy and 6 months after the procedure. Epicardial fat thickness was measured by transthoracic echocardiography. Results Mean age was 53.15 ± 8.44 years. Mean preoperative EFT was higher than mean EFT in the control group (0.49 ± 0.07 cm to 0.46 ± 0.08 cm, P: 0.0005), and EFT decreased after parathyroidectomy (0.49 ± 0.07 cm to 0.44 ± 0.08 cm, P: 0.0005). Systolic blood pressure and calcium, parathormone, and hsCRP levels decreased after parathyroidectomy (P < 0.05). Vitamin D levels increased (P < 0.05). Diastolic blood pressure, body mass index, carotid intima-media thickness, and HOMA-IR, fasting plasma glucose, and phosphorus levels were unchanged after parathyroidectomy (P > 0.05). Preoperatively, EFT was correlated with SBP (r: 0.360, P: 0.0285) and age (r: 0.466, P: 0.0036). Multiple linear regression used to identify independent predictors of change in epicardial fat did not find any predictor of change in epicardial fat (P > 0.05). Conclusion EFT was decreased by parathyroidectomy in patients with primary hyperparathyroidism.However, the decrease in EFT was not correlated with any of the cardiovascular risk factors. More comprehensive studies evaluating the potential relation between PHPT and EFT need to be conducted.
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Affiliation(s)
- Muhammed Kızılgül
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Mustafa Çalışkan
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Selvihan Beysel
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Mustafa Özbek
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Erman Çakal
- Department of Endocrinology and Metabolism, University of Health Sciences, Dışkapı Training and Research Hospital, Ankara, Turkey
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Ejlsmark-Svensson H, Rolighed L, Rejnmark L. Effect of Parathyroidectomy on Cardiovascular Risk Factors in Primary Hyperparathyroidism: A Randomized Clinical Trial. J Clin Endocrinol Metab 2019; 104:3223-3232. [PMID: 30860588 DOI: 10.1210/jc.2018-02456] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/06/2019] [Indexed: 02/12/2023]
Abstract
CONTEXT It remains unclear whether risk of cardiovascular diseases is increased in patients with mild (<1.45 mmol/L) to moderate (≥1.45 to 1.60 mmol/L) primary hyperparathyroidism (PHPT). OBJECTIVE We aimed to determine the short-term effect of parathyroidectomy (PTX) on arterial stiffness, cholesterol levels, and blood pressure (BP). DESIGN This study was a clinical trial randomly allocating patients to either PTX or a control group (no surgery). Follow-up was performed 3 months after surgery in the PTX group and 3 months after baseline in the control group. SETTING University hospital. PARTICIPANTS We recruited 79 patients with PHPT; 69 participants completed the study. MAIN OUTCOMES Office and ambulatory 24-hour BP, pulse wave velocity (PWV), augmentation index, and fasting plasma cholesterol levels. RESULTS At baseline, participants had a median level of ionized calcium of 1.41 mmol/L (range, 1.33 to 1.60 mmol/L) and PTH of 10.4 pmol/L (4.5 to 30.4 pmol/L). Median age was 64 years (range, 18 to 81) and 72% were females. Following PTX, plasma total cholesterol levels decreased significantly compared with the controls (P = 0.04). Changes in PWV, augmentation index, and ambulatory 24-hour BP did not differ between groups, except for an increase in ambulatory diastolic BP following PTX. However, in patients with baseline levels of ionized calcium ≥1.45 mmol/L, PWV decreased significantly in response to PTX compared with the control group (P = 0.03). CONCLUSION PTX may decrease risk of cardiovascular diseases in PHPT by lowering total cholesterol levels, although ambulatory diastolic BP increases in response to surgery. Patients with moderate to severe hypercalcemia may benefit from PTX by a decrease in PWV.
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Affiliation(s)
- Henriette Ejlsmark-Svensson
- Department of Clinical Medicine, Aarhus University and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Clinical Medicine, Aarhus University and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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20
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Lam HB, Yang PS, Chien MN, Lee JJ, Chao LF, Cheng SP. Association between neutrophil-to-lymphocyte ratio and parathyroid hormone in patients with primary hyperparathyroidism. Arch Med Sci 2019; 15:880-886. [PMID: 31360183 PMCID: PMC6657247 DOI: 10.5114/aoms.2018.74758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/11/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is associated with adverse cardiovascular outcomes which may result from an increase in systemic inflammation. Previously we have shown that serum parathyroid hormone (PTH) levels are independently associated with inflammatory indicators. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive, widely available marker of inflammation. In the present study, we aimed to assess the longitudinal changes in NLR before and after parathyroidectomy. MATERIAL AND METHODS This retrospective study included 95 patients diagnosed with PHPT who underwent parathyroidectomy between 2006 and 2016. Follow-up complete blood counts were available in 31 patients. RESULTS At diagnosis, 43 (45%) patients presented with overt clinical symptoms and had higher serum calcium and PTH levels. Preoperative NLR was positively correlated with total white blood cell count (p = 0.001), serum calcium (p = 0.001), and PTH level (p = 0.013). The NLR was not associated with sex, age, comorbidities, or parathyroid weight. Among patients who were cured of PHPT, the median NLR decreased from 2.26 to 1.77 after parathyroidectomy (p = 0.037). There was no difference in hemoglobin, total white blood cells, or platelet count before and after surgery. CONCLUSIONS We found a positive correlation of preoperative NLR with calcium and PTH levels in PHPT patients. After curative parathyroidectomy, NLR modestly decreased without changes in other hematological parameters.
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Affiliation(s)
- Hung-Bun Lam
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Po-Sheng Yang
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Ming-Nan Chien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Jie-Jen Lee
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Graduate Institute of Medical Sciences and Department of Pharmacology, Taipei Medical University, Taipei, Taiwan
| | - Li-Fen Chao
- Department of Nursing, Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Graduate Institute of Medical Sciences and Department of Pharmacology, Taipei Medical University, Taipei, Taiwan
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Passeri E, Mazzaccaro D, Sansoni V, Perego S, Nano G, Verdelli C, Lombardi G, Corbetta S. Effects of 12-months treatment with zoledronate or teriparatide on intima-media thickness of carotid artery in women with postmenopausal osteoporosis: A pilot study. Int J Immunopathol Pharmacol 2019; 33:2058738418822439. [PMID: 30791743 PMCID: PMC6327329 DOI: 10.1177/2058738418822439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Atherosclerosis and osteoporosis are interrelated entities and share similar pathogenic mechanisms. Recent studies showed that key proteins of bone metabolism, such as osteoprotegerin (OPG) and osteopontin (OPN), are also involved in vascular atherosclerosis and calcifications. The carotid intima-media thickness (CA-IMT) is an early quantitative marker of generalized atherosclerosis. Aim of study was to investigate whether 12-months treatment with zoledronate (ZLN) or teriparatide (TPT) affects CA-IMT and circulating OPG and OPN levels. In this study, 11 postmenopausal osteoporotic women (aged 73, 70.5–74.5 years; median, range interquartile) treated with 5 mg/year iv ZLN; 9 postmenopausal osteoporotic women (aged 70, 62.5–73.5 years) treated with 20 µg/day sc TPT; and 10 aged-, body mass index (BMI)-, glycemic, and lipid profiles-matched, free from anti-osteoporotic and hypocholesterolemic drugs, controls were prospectively investigated at baseline and after 12 months. At baseline, median CA-IMT was similar in the three groups and increased after 12 months. CA-IMT increased significantly in TPT-treated patients (1.0, 0.8–1.2 vs 1.1, 0.9–15 mm, P = 0.04), though the change was minimal. After 12 months of treatment, CA-IMT positively correlated with alkaline phosphatase (ALP) levels (r = 0.767, P = 0.008) and negatively with high-density lipoprotein (HDL) cholesterol levels (r = −0.65, P = 0.03), suggesting interplay between active bone remodeling and lipid profile. At baseline and after 12 months, median serum OPG and OPN levels did not differ among the groups and did not correlate with changes in CA-IMT. In conclusion, ZLN and TPT treatments are safe on carotid walls in osteoporotic women with subclinical atherosclerosis; circulating OPG and OPN are not affected by long-term anti-osteoporotic treatments and do not correlate with CA-IMT.
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Affiliation(s)
- Elena Passeri
- 1 Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Daniela Mazzaccaro
- 2 First Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Veronica Sansoni
- 3 Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Silvia Perego
- 3 Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giovanni Nano
- 2 First Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, Milan, Italy.,4 Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Chiara Verdelli
- 5 Laboratory of Experimental Endocrinology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giovanni Lombardi
- 3 Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Sabrina Corbetta
- 1 Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,4 Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Nilsson IL. Primary hyperparathyroidism: should surgery be performed on all patients? Current evidence and residual uncertainties. J Intern Med 2019; 285:149-164. [PMID: 30289185 DOI: 10.1111/joim.12840] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Primary hyperparathyroidism (pHPT) is the third most common endocrine disease and is characterized by hypercalcaemia and elevated or inappropriately 'normal' levels of the parathyroid hormone (PTH). The main target organs of PTH are the skeletal system and the kidneys. Before the 1970s, pHPT was a rarely detected disease associated with notable morbidity and premature mortality. Introduction of biochemical screening, allowing for a wide range of indications, has contributed to the detection of the full spectrum of the disease. A new entity with an isolated elevation of PTH, normocalcaemic HP, has emerged and is currently being explored. The highest incidence of pHPT, 3-5%, is observed amongst women, and the prevalence increases with age. The female-to-male ratio is 3-4 : 1 except in younger patients where distribution is equal and known hereditary causes account for approximately 10% of the cases. In the last few decades, it has become evident that fewer patients than previously believed are truly asymptomatic. The cause of pHPT is often a benign tumour, a parathyroid adenoma, and the only definite treatment is parathyroidectomy (PTX). No medical treatment, single or combined, can achieve a curing of pHPT. Recent data indicate that PTX, despite being proven to be cost-effective compared to conservative treatment, is underutilized, especially in elderly pHPT patients. The decision of PTX should always be based on a safe diagnosis, and the potential benefits of curative treatment should not be outweighed by the risks of surgery or anaesthesia.
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Affiliation(s)
- I-L Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department ofBreast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
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Chiodini I, Cairoli E, Palmieri S, Pepe J, Walker MD. Non classical complications of primary hyperparathyroidism. Best Pract Res Clin Endocrinol Metab 2018; 32:805-820. [PMID: 30665548 DOI: 10.1016/j.beem.2018.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Several studies suggested that the condition of primary hyperparathyroidism (PHPT) may be associated not only with the classical bone, kidney and gastrointestinal consequences, but also with cardiovascular, neuromuscular and articular complications, impaired quality of life and increased cancer risk. However, the only cardiovascular complications associated with PHPT, which seems to improve after parathyroidectomy, is left ventricular hypertrophy, while, data regarding the reversibility of hypertension, valve calcifications and increased vascular stiffness are inconsistent. Parathyroidectomy seems to ameliorate neuropsychological, cognitive disturbances and quality of life in moderate-severe PHPT, while data in mild PHPT are less clear. At variance, the effect of parathyroidectomy on neuromuscular and articular complications is still unknown, and no studies demonstrated a reduction of cancer risk after recovery from PHPT. Overall, to date, cardiovascular and neuropsychological evaluation are not recommended solely because of PHPT, nor cardiovascular disease, muscle weakness, and neuropsychological complications are indication for parathyroidectomy.
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Affiliation(s)
- I Chiodini
- Unit for Bone Metabolism Diseases and Diabetes & Lab. of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - E Cairoli
- Unit for Bone Metabolism Diseases and Diabetes & Lab. of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - S Palmieri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Unit of Endocrinology, Fondazione IRCCS Cà Granda, Milan, Italy
| | - J Pepe
- Department of Internal Medicine and Medical Disciplines, "Sapienza" University, Rome, Italy
| | - M D Walker
- Department of Medicine, Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Ma X, Zhang Y, Ma S, Li P, Ding D, Liu H, Liu J, Zhang M. Association between abnormal thalamic metabolites and sleep disturbance in patients with end-stage renal disease. Metab Brain Dis 2018; 33:1641-1648. [PMID: 29974312 DOI: 10.1007/s11011-018-0272-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
Sleep disturbances are common in end-stage renal disease (ESRD) patients. However, the underlying neuropathological mechanisms are largely unclear. Previous studies have revealed the important role of the thalamus in the potential mechanisms of sleep disorders. We hypothesized that the sleep disturbances in ESRD patients may correspond to metabolic changes of thalamus and the uremic factors may have a vital contribution on these changes. We performed multi-voxel 1H-MRS of bilateral thalami in 27 ESRD patients who currently receiving hemodialysis treatment and 21 age-matched healthy volunteers. ESRD patients underwent Pittsburgh Sleep Quality Index (PSQI) scale and restless legs syndrome (RLS) rating scale assessment. Laboratory blood tests including serum creatinine, serum urea, cystatin-C, serum parathyroid hormone (PTH), calcium and phosphorus levels, hemoglobin and hematocrit were performed in all ESRD patients close to the time of the MR examination. We found correlations among elevated PTH, higher PSQI score and RLS rating score in ESRD patients. ESRD patients displayed decreased N-acetylaspartate and creatine ratio (NAA/Cr) of thalami compared with controls. There were significantly negative correlation between NAA/Cr and serum PTH level or PSQI score. The metabolic changes of thalami played an important role in the neuropathological mechanisms of lower sleep quality in ESRD patients. Secondary hyperparathyroidism as one of the main uremia-related factors was closely related to abnormal metabolites of the thalamus in patients with ESRD, revealing the crosstalk procedure between renal impairment and brain function.
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Affiliation(s)
- Xueying Ma
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China
| | - Yan Zhang
- Department of Magnetic Resonance Imaging, Baoji Hospital of Traditional Chinese Medicine, Baoji, China
| | - Shaohui Ma
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China
| | - Peng Li
- Department of Medical Imaging, NO. 215 Hospital of Shaanxi Nuclear Industry, Xianyang, China
| | - Dun Ding
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China
| | - Hua Liu
- Department of Nephrology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, No. 2 South Taibai Road, Xi'an, 710071, Shaanxi-Province, People's Republic of China.
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China.
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Tay YKD, Liu M, Bandeira L, Bucovsky M, Lee JA, Silverberg SJ, Walker MD. Occult urolithiasis in asymptomatic primary hyperparathyroidism. Endocr Res 2018; 43:106-115. [PMID: 29400579 PMCID: PMC6042842 DOI: 10.1080/07435800.2018.1431275] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Recent international guidelines suggest renal imaging to detect occult urolithiasis in all patients with asymptomatic primary hyperparathyroidism (PHPT), but data regarding their prevalence and associated risk factors are limited. We evaluated the prevalence and risk factors for occult urolithiasis. METHODS Cross-sectional analysis of 96 asymptomatic PHPT patients from a university hospital in the United States with and without occult nephrolithiasis. RESULTS Occult urolithiasis was identified in 21% of patients. Stone formers had 47% higher 24-hour urinary calcium excretion (p = 0.002). Although available in only a subset of patients (n = 28), activated vitamin D [1,25(OH)2D] was 29% higher (p = 0.02) in stone formers. There was no difference in demographics, BMI, calcium or vitamin D intake, other biochemistries, renal function, BMD, or fractures. Receiver operating characteristic curves indicated that urinary calcium excretion and 1,25(OH)2D had an area under the curve of 0.724 (p = 0.003) and 0.750 (p = 0.04), respectively. A urinary calcium threshold of >211mg/day provided a sensitivity of 84.2% and a specificity of 55.3% while a 1,25(OH)2D threshold of >91pg/mL provided a sensitivity and specificity of 62.5% and 90.0% respectively for the presence of stones. CONCLUSION Occult urolithiasis is present in about one-fifth of patients with asymptomatic PHPT and is associated with higher urinary calcium and 1,25(OH)2D. Given that most patients will not have occult urolithiasis, targeted imaging in those most likely to have occult stones rather than screening all asymptomatic PHPT patients may be useful. The higher sensitivity of urinary calcium versus 1,25(OH)2D suggests screening those with higher urinary calcium may be an appropriate approach.
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Affiliation(s)
- Yu-Kwang Donovan Tay
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
- Department of Medicine, Sengkang Health, Singapore
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore
| | - Minghao Liu
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
| | - Leonardo Bandeira
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
| | - Mariana Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
| | - James A. Lee
- Department of Endocrine Surgery, Columbia University, New York, USA
| | - Shonni J. Silverberg
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
| | - Marcella D. Walker
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York
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Abstract
In this Review, we describe the pathogenesis, diagnosis and management of primary hyperparathyroidism (PHPT), with a focus on recent advances in the field. PHPT is a common endocrine disorder that is characterized by hypercalcaemia and elevated or inappropriately normal serum levels of parathyroid hormone. Most often, the presentation of PHPT is asymptomatic in regions of the world where serum levels of calcium are routinely measured. In addition to mild hypercalcaemia, PHPT can manifest with osteoporosis and hypercalciuria as well as with vertebral fractures and nephrolithiasis, both of which can be asymptomatic. Other clinical forms of PHPT, such as classical disease and normocalcaemic PHPT, are less common. Parathyroidectomy, the only curative treatment for PHPT, is recommended in patients with symptoms and those with asymptomatic disease who are at risk of progression or have subclinical evidence of end-organ sequelae. Parathyroidectomy results in an increase in BMD and a reduction in nephrolithiasis. Various medical therapies can increase BMD or reduce serum levels of calcium, but no single drug can do both. More data are needed regarding the neuropsychological manifestations of PHPT and the pathogenetic mechanisms leading to sporadic PHPT, as well as on risk factors for complications of the disorder. Future work that advances our knowledge in these areas will improve the management of the disorder.
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Affiliation(s)
- Marcella D Walker
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA
| | - Shonni J Silverberg
- Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA
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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.
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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
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Colak S, Aydogan BI, Gokcay Canpolat A, Tulunay Kaya C, Sahin M, Corapcioglu D, Uysal AR, Emral R. Is primary hyperparathyroidism a cause of endothelial dysfunction? Clin Endocrinol (Oxf) 2017; 87:459-465. [PMID: 28686293 DOI: 10.1111/cen.13418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Symptomatic primary hyperparathyroidism (PHPT) is thought to be related to increased cardiovascular morbidity and mortality. In our study, we aimed to investigate endothelial dysfunction and markers of subclinical atherosclerosis in patients with PHPT. Also we aimed to demonstrate the effect of vitamin D supplementation on these parameters. MATERIALS AND METHODS Twenty-nine patients followed by medical treatment (A), 25 preoperative (B) and 23 postoperative patients with PHPT (C), and 26 normocalcaemic subjects (D) were included. Groups were assessed by measurements of flow-mediated dilation (FMD), carotid intima-media thickness (CIMT), serum levels of sCD40L, high-sensitivity CRP (hs-CRP) and interleukin-8 (IL-8). Thirteen patients with low levels of 25-hydroxy-vitamin D (25OHD) in the medical treatment group were assessed before and 3 months after vitamin D replacement. RESULTS The median FMD was 5% in group A, 5.1% in group B, 7.6% in group C and 7.7% in group D. The FMD measurement in group A was significantly lower than groups C and D (P=.02) and was similar to the FMD measurement in group B. FMD measurements of group B were not significantly lower than groups C and D. In 13 patients with low 25OHD in group A, the median FMD increased to 7.07% from 4.71% after vitamin D replacement (P=.02). CONCLUSION Flow-mediated dilation was impaired in patients with PHPT, particularly in the medically observed group. Vitamin D supplementation seems to provide improvements in FMD in medically observed PHPT patients with low 25OHD levels, and this was the novel observation of our study.
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Affiliation(s)
- Sevgi Colak
- Department of Internal Medicine, University of Ankara, İbni Sina Hospital, Ankara, Turkey
| | - Berna Imge Aydogan
- Department of Endocrinology and Metabolism, University of Ankara, İbni Sina Hospital, Ankara, Turkey
| | - Asena Gokcay Canpolat
- Department of Endocrinology and Metabolism, University of Ankara, İbni Sina Hospital, Ankara, Turkey
| | - Cansin Tulunay Kaya
- Department of Cardiology, University of Ankara, İbni Sina Hospital, Ankara, Turkey
| | - Mustafa Sahin
- Department of Endocrinology and Metabolism, University of Ankara, İbni Sina Hospital, Ankara, Turkey
| | - Demet Corapcioglu
- Department of Endocrinology and Metabolism, University of Ankara, İbni Sina Hospital, Ankara, Turkey
| | - Ali Riza Uysal
- Department of Endocrinology and Metabolism, University of Ankara, İbni Sina Hospital, Ankara, Turkey
| | - Rifat Emral
- Department of Endocrinology and Metabolism, University of Ankara, İbni Sina Hospital, Ankara, Turkey
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Best CA, Krishnan R, Malvankar-Mehta MS, MacNeil SD. Echocardiogram changes following parathyroidectomy for primary hyperparathyroidism: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7255. [PMID: 29068975 PMCID: PMC5671808 DOI: 10.1097/md.0000000000007255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The aim of the study is to systematically review the evidence on post parathyroidectomy (PTX) changes as measured by echocardiogram (ECHO) in patients with primary hyperparathyroidism (PHPT).PHPT may increase risk of cardiovascular morbidity/mortality. Conclusions of studies assessing ECHO changes, pre versus post PTX, are inconsistent.A systematic literature search was conducted to locate published and unpublished studies. Randomized control trials, nonrandomized control trials, and observational studies were included. Variables were reported as means and standard deviations. An inverse variance statistical method, with random-effects analysis model, was applied to continuous data. The effect measure was standardized mean difference, confidence interval of 95%. Primary outcome measure was left ventricular ejection fraction (LVEF). Secondary outcome measures were left ventricular mass index (LVMI), peak early over peak late diastolic velocity ratio (E/A ratio), isovolumetric relaxation time (IVRT), intraventricular septal thickness (IVST), and posterior wall thickness (PWT).Fourteen studies were included. Follow-up time ranged 3 to 67 months. No significant differences (P > .05) in primary outcome measure LVEF (SMD = -0.03, CI = -0.24, 0.19), or secondary outcome measures E/A Ratio (SMD = -0.05, CI = -0.24, 0.14), IVST (SMD = 0, CI = 0.31, 0.32), PWT (SMD = 0.01, CI = -0.38, 0.39), LVMI (SMD = -0.18, CI = -0.74, 0.38), and IVRT (SMD = -0.84, CI = -1.83, 0.14) were observed.There was no significant difference in LVEF pre to post PTX. Due to heterogeneity of current literature, we were unable to determine if other outcome measures of cardiac function are affected after PTX in patients with PHPT. We recommend a randomized control trial be conducted to make concrete conclusions.
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Affiliation(s)
| | - Rohin Krishnan
- Department of Epidemiology and Biostatistics, Western University, London
| | - Monali S. Malvankar-Mehta
- Department of Ophthalmology, Department of Epidemiology and Biostatistics, Western University, London
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Sedky NK, Hassanein SI, Gad MZ. Independent assortment of GC gene polymorphism (rs2282679) and 25-hydroxyvitamin D levels in coronary artery disease. Can J Physiol Pharmacol 2017; 96:345-351. [PMID: 28892641 DOI: 10.1139/cjpp-2017-0334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Coronary artery disease (CAD) remains a major public health burden. Emerging research has suggested an association between vitamin D insufficiency and CAD. Vitamin D binding protein (VDBP) is the primary vitamin D carrier and many of its genetic polymorphisms are able to induce the expression of proteins with different affinities for the vitamin, which in turn might affect its serum levels and CAD incidence. One hundred and twelve male patients, aged between 35 and 50 years, with verified CAD and 109 age- and sex-matched controls were recruited. Genotyping was performed by the TaqMan allelic discrimination assay and plasma 25(OH)D levels were assessed by HPLC-UV. Serum parathyroid hormone (s-PTH) and VDBP levels were measured using ELISA. s-25(OH)D levels in CAD patients were significantly lower than in the controls, whereas s-PTH levels were significantly higher in the CAD patients than in the controls. There was no significant difference in the distribution of GC genotypes among both groups. s-25(OH)D showed a weak inverse correlation with s-PTH levels. Serum levels of vitamin D and PTH are highly correlated with CAD incidence. However, the s-VDBP level is associated neither with disease outcome nor with vitamin D status. The GC gene variant has no effect on 25(OH)D levels.
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Affiliation(s)
- Nada K Sedky
- a Biomedical Sciences Program, Zewail City of Science and Technology, Giza, 12566, Egypt
| | - Sally I Hassanein
- b Clinical Biochemistry Unit, Biochemistry Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, New Cairo City, 11835, Egypt
| | - Mohamed Zakaria Gad
- b Clinical Biochemistry Unit, Biochemistry Department, Faculty of Pharmacy and Biotechnology, German University in Cairo, New Cairo City, 11835, Egypt
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Mesquita PN, Dornelas Leão Leite AP, Chagas Crisóstomo SD, Veras Filho E, da Cunha Xavier L, Bandeira F. Evaluation of coronary calcium score in patients with normocalcemic primary hyperparathyroidism. Vasc Health Risk Manag 2017; 13:225-229. [PMID: 28790836 PMCID: PMC5488767 DOI: 10.2147/vhrm.s128084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Given that the diagnosis of primary hyperparathyroidism (PHPT) is given at an increasingly less-symptomatic phase, and the literature data on the cardiovascular risk of patients with normocalcemic primary hyperparathyroidism (NPHPT) are controversial, the coronary calcium score (CCS), which is correlated with coronary artery disease, may be useful for clarifying the association between cardiovascular risk and NPHPT. OBJECTIVE This research aims to describe the CCS and the clinical and laboratory variables of patients with NPHPT compared with a control group and to verify the presence of an association between NPHPT and CCS. STUDY POPULATION AND METHODS A questionnaire on anthropometric data (weight, height, waist circumference, and blood pressure) was used, laboratory examinations (estimations of glucose, glycated hemoglobin [HbA1c], total cholesterol [TC] and its fractions, triglycerides, creatinine, calcium, parathyroid hormone, and 25-OH vitamin D) were conducted, and computerized tomography was carried out to measure the CCS in 13 patients diagnosed with NPHPT and 16 controls. RESULTS There was no association between NPHPT and altered CCS (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.05-1.26; p=0.095). Differences between the case and control groups were found in terms of body mass index (BMI) (26.97 kg/m2 vs 31.53 kg/m2, respectively; p=0.044), HbA1c (5.59% vs 6.62%; p=0.000), and TC (188.07 mg/dL vs 220.64 mg/dL; p=0.088). After adjustment for potential confounders, no statistical significance was observed for the association between changes in CCS and presence of NPHPT (adjusted OR: 1.64; 95% CI: 0.1-26.43; p=0.726). CONCLUSION No association was found between the CCS and the presence of NPHPT.
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Affiliation(s)
| | - Ana Paula Dornelas Leão Leite
- Department of Radiology, University of Pernambuco, Cardiac Emergency Hospital of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Enio Veras Filho
- Unit of Endocrinology, Diabetes and Bone Diseases, Hospital Agamenon Magalhães
| | | | - Francisco Bandeira
- Unit of Endocrinology, Diabetes and Bone Diseases, Hospital Agamenon Magalhães
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Robinson-Cohen C, Lutsey PL, Kleber ME, Nielson CM, Mitchell BD, Bis JC, Eny KM, Portas L, Eriksson J, Lorentzon M, Koller DL, Milaneschi Y, Teumer A, Pilz S, Nethander M, Selvin E, Tang W, Weng LC, Wong HS, Lai D, Peacock M, Hannemann A, Völker U, Homuth G, Nauk M, Murgia F, Pattee JW, Orwoll E, Zmuda JM, Riancho JA, Wolf M, Williams F, Penninx B, Econs MJ, Ryan KA, Ohlsson C, Paterson AD, Psaty BM, Siscovick DS, Rotter JI, Pirastu M, Streeten E, März W, Fox C, Coresh J, Wallaschofski H, Pankow JS, de Boer IH, Kestenbaum B. Genetic Variants Associated with Circulating Parathyroid Hormone. J Am Soc Nephrol 2017; 28:1553-1565. [PMID: 27927781 PMCID: PMC5407713 DOI: 10.1681/asn.2016010069] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022] Open
Abstract
Parathyroid hormone (PTH) is a primary calcium regulatory hormone. Elevated serum PTH concentrations in primary and secondary hyperparathyroidism have been associated with bone disease, hypertension, and in some studies, cardiovascular mortality. Genetic causes of variation in circulating PTH concentrations are incompletely understood. We performed a genome-wide association study of serum PTH concentrations among 29,155 participants of European ancestry from 13 cohort studies (n=22,653 and n=6502 in discovery and replication analyses, respectively). We evaluated the association of single nucleotide polymorphisms (SNPs) with natural log-transformed PTH concentration adjusted for age, sex, season, study site, and principal components of ancestry. We discovered associations of SNPs from five independent regions with serum PTH concentration, including the strongest association with rs6127099 upstream of CYP24A1 (P=4.2 × 10-53), a gene that encodes the primary catabolic enzyme for 1,25-dihydroxyvitamin D and 25-dihydroxyvitamin D. Each additional copy of the minor allele at this SNP associated with 7% higher serum PTH concentration. The other SNPs associated with serum PTH concentration included rs4074995 within RGS14 (P=6.6 × 10-17), rs219779 adjacent to CLDN14 (P=3.5 × 10-16), rs4443100 near RTDR1 (P=8.7 × 10-9), and rs73186030 near CASR (P=4.8 × 10-8). Of these five SNPs, rs6127099, rs4074995, and rs219779 replicated. Thus, common genetic variants located near genes involved in vitamin D metabolism and calcium and renal phosphate transport associated with differences in circulating PTH concentrations. Future studies could identify the causal variants at these loci, and the clinical and functional relevance of these variants should be pursued.
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Affiliation(s)
- Cassianne Robinson-Cohen
- Division of Nephrology, Department of Medicine, Kidney Research Institute,
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | | | - Marcus E Kleber
- Vth Department of Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Carrie M Nielson
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon
| | - Braxton D Mitchell
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, Maryland
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, and
| | - Karen M Eny
- Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura Portas
- Institute of Population Genetics, National Research Council of Italy, Rome, Italy
| | - Joel Eriksson
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, and
| | - Mattias Lorentzon
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, and
| | | | - Yuri Milaneschi
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, Vrije Universiteit Medical Center/GGZ inGeest, Amsterdam, The Netherlands
| | - Alexander Teumer
- Institutes for Community Medicine, Department Study of Health in Pomerania - Klinisch-Epidemiologische Forschung (SHIP-KEF), and
| | - Stefan Pilz
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Endocrinology and Nuclear Medicine, and
| | - Maria Nethander
- Bioinformatics Core Facility, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elizabeth Selvin
- Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Weihong Tang
- Divisions of Epidemiology and Community Health and
| | - Lu-Chen Weng
- Divisions of Epidemiology and Community Health and
| | - Hoi Suen Wong
- Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dongbing Lai
- Departments of Medical and Molecular Genetics and
| | | | | | - Uwe Völker
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Georg Homuth
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | | | - Federico Murgia
- Institute of Population Genetics, National Research Council of Italy, Rome, Italy
| | - Jack W Pattee
- Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Eric Orwoll
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon
| | - Joseph M Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jose Antonio Riancho
- Department of Medicine, University of Cantabria, and Hospital Universitario Marques de Valdecilla, Insituto de Investigacion Sanitaria, Santander, Spain
| | - Myles Wolf
- Division of Nephrology and Hypertension, Department of Medicine and
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frances Williams
- Department of Twin Research and Genetic Epidemiology, Division of Genetics & Molecular Medicine, King's College, London, United Kingdom
| | - Brenda Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, Vrije Universiteit Medical Center/GGZ inGeest, Amsterdam, The Netherlands
| | - Michael J Econs
- Departments of Medical and Molecular Genetics and
- Medicine, Indiana University, Indianapolis, Indiana
| | - Kathleen A Ryan
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, and
| | - Andrew D Paterson
- Program in Genetics & Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bruce M Psaty
- Institutes for Community Medicine, Department Study of Health in Pomerania - Klinisch-Epidemiologische Forschung (SHIP-KEF), and
- Departments of Health Services and
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - David S Siscovick
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
- The New York Academy of Medicine, New York, New York
- Medicine, University of Washington, Seattle, Washington
| | - Jerome I Rotter
- Department of Pediatrics and Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles, Medical Center, Institute for Translational Genomics and Population Sciences, Torrance, California
| | - Mario Pirastu
- Institute of Population Genetics, National Research Council of Italy, Rome, Italy
| | - Elizabeth Streeten
- Department of Medicine and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Winfried März
- Vth Department of Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
- Synlab Academy, Synlab Services GmbH, Mannheim, Germany; and
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Caroline Fox
- Department of Genetics and Pharmacogenomics, Merck Research, Whitehouse Station, New Jersey
| | - Josef Coresh
- Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Ian H de Boer
- Division of Nephrology, Department of Medicine, Kidney Research Institute
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Bryan Kestenbaum
- Division of Nephrology, Department of Medicine, Kidney Research Institute
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
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Shen Z, Ruan Q, Yu Z, Sun Z. Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review. Geriatr Gerontol Int 2017; 17:529-544. [PMID: 27240548 DOI: 10.1111/ggi.12758] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/12/2016] [Indexed: 11/28/2022]
Abstract
AIM The objective of this review was to assess chronic kidney disease-related frailty and cognitive impairment, as well as their probable causes, mechanisms and the interventions. METHODS Studies from 1990 to 2015 were reviewed to evaluate the relationship between chronic kidney disease and physical frailty and cognitive impairment. Of the 1694 studies from the initial search, longitudinal studies (n = 22) with the keywords "Cognitive and CKD" and longitudinal or cross-sectional studies (n = 5) with the keywords "Frailty and CKD" were included in final analysis. RESULTS By pooling current research, we show clear evidence for a relationship between chronic kidney disease and frailty and cognitive impairment in major studies. Vascular disease is likely an important mediator, particularly for cognitive impairment. However, non-vascular factors also play an important role. Many of the other mechanisms that contribute to impaired cognitive function and increased frailty in CKD remain to be elucidated. In limited studies, medication therapy did not obtain the ideal effect. There are limited data on treatment strategies, but addressing the vascular disease risk factors earlier in life might decrease the subsequent burden of frailty and cognitive impairment in this population. Multidimensional interventions, which address both microvascular health and other factors, may have substantial benefits for both the cognitive impairments and physical frailty in this vulnerable population. CONCLUSIONS Chronic kidney disease is a potential cause of frailty and cognitive impairment. Vascular and non-vascular factors are the possible causes. The mechanism of chronic kidney disease-induced physical frailty and cognitive impairment suggests that multidimensional interventions may be effective therapeutic strategies in the early stage of chronic kidney disease. Geriatr Gerontol Int 2017; 17: 529-544.
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Affiliation(s)
- Zhiyuan Shen
- Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China
| | - Qingwei Ruan
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhuowei Yu
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhongquan Sun
- Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China
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Parathyroid Hormone Levels in the Prediction of Ischemic Stroke Risk. DISEASE MARKERS 2017; 2017:4343171. [PMID: 28115793 PMCID: PMC5237770 DOI: 10.1155/2017/4343171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/23/2016] [Indexed: 12/11/2022]
Abstract
Objective. It was examined whether PTH and 25-dihydroxyvitamin D (25(OH)D) levels, together or separately, are indicators of the risk of stroke. Materials and Methods. This prospective study was performed at two centers. In the study, 100 patients diagnosed with acute ischemic stroke and 100 control individuals in the same age range were examined. In addition to neurological examination, cranial imaging, extensive routine blood chemistry, PTH, and 25(OH)D levels were evaluated in all cases. Stroke risk factors were determined. Logistic regression was used for statistical analysis. Results. A total of 60 patients and 79 control individuals were included in the study. Different estimation models were designed in order to examine the relationship between PTH and 25(OH)D levels with stroke. According to modeling results, it was determined that the most effective predictor for risk of stroke was 25(OH)D levels, followed by hypertension and PTH levels, respectively. Conclusion. PTH and 25(OH)D levels together can make important contributions to determination of stroke risk, and further investigations are needed to understand this relationship more fully.
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Jalilian R, Binazar MJ, Mirza L. Familial Hypocalciuric Hypercalcemia and Benefits of Genetic Confirmation: A Case Report and Review. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161401.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Yorulmaz G, Akalın A, Akay OM, Şahin G, Bal C. The Effect of Hyperparathyroid State on Platelet Functions and Bone Loss. Turk J Haematol 2016; 33:293-298. [PMID: 26377856 PMCID: PMC5204183 DOI: 10.4274/tjh.2015.0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Coagulation and fibrinolysis defects were reported in primary hyperparathyroid patients. However, there are not enough data regarding platelet functions in this group of patients. Our aim was to evaluate the platelet functions in primary and secondary hyperparathyroid patients and to compare them with healthy subjects. Materials and Methods: In our study 25 subjects with primary hyperparathyroidism (PHPT), 25 subjects with secondary hyperparathyroidism (SHPT), and 25 healthy controls were included. Platelet functions of the subjects were evaluated by using platelet-rich plasma and platelet aggregation tests induced with epinephrine, adenosine diphosphate (ADP), collagen, and ristocetin. Serum P selectin levels, which indicate platelet activation level, were measured in all subjects. Bone mineral densitometry was performed for all patients. Results: There was no significant difference between the groups with PHPT and SHPT and the control group regarding the platelet aggregation tests and serum P selectin levels. There was also no significant correlation between parathormone levels and aggregation parameters (ristocetin, epinephrine, collagen, and ADP: respectively p=0.446, 0.537, 0.346, and 0.302) and between P selectin (p=0.516) levels. When we separated the patients according to serum calcium levels, there was also no significant difference between aggregation parameters and serum P selectin levels between the patients with hypercalcemia and the patients with normocalcemia. We could not find any significant correlation between aggregation parameters, P selectin levels, and serum calcium levels in this group of patients. Bone loss was greater in patients with PHPT. Conclusion: There is no significant effect of PHPT or SHPT and serum calcium levels on platelet functions when evaluated by aggregation tests.
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Affiliation(s)
- Göknur Yorulmaz
- Eskişehir State Hospital, Clinic of Endocrinology, Eskişehir, Turkey, Phone: +90 505 866 58 83, E-mail:
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Celer O, Akalın A, Oztunali C. Effect of teriparatide treatment on endothelial function, glucose metabolism and inflammation markers in patients with postmenopausal osteoporosis. Clin Endocrinol (Oxf) 2016; 85:556-60. [PMID: 27321876 DOI: 10.1111/cen.13139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Teriparatide, an anabolic agent used in the treatment of postmenopausal osteoporosis, can induce effects similar to primary hyperparathyroidism. Our objective was to evaluate the effects of teriparatide on endothelial functions, glucose metabolism and inflammation markers in patients diagnosed with postmenopausal osteoporosis. DESIGN, PATIENTS AND MEASUREMENTS This was a single-centre, single-arm, 6-month prospective study. Twenty-three postmenopausal women over 65 years old with a lumbar spine or femoral neck T-score of -4·0 or lower and having at least two compression fractures in thoracic or lumbar spine were studied. Low-dose intermittent teriparatide (20 μg/day) was supplemented with calcium carbonate (1000 mg elemental calcium) and 880 IU cholecalciferol for 6 months. The biochemical parameters for glucose metabolism, inflammation and atherosclerosis were determined. For the assessment of vascular endothelial function, carotid intima-media thickness (CIMT), brachial artery intima-media thickness (BIMT), per cent change in flow-mediated dilation (FMD%) and nitroglycerine-induced dilations (NID%) were measured on ultrasonography. RESULTS The fasting plasma glucose, homoeostatic model assessment of insulin resistance, fibrinogen, homocysteine and high-density lipoprotein cholesterol increased significantly with teriparatide treatment (P < 0·05 for all). Baseline CIMT and BIMT did not change significantly with 6 months of teriparatide treatment (P > 0·05); however, FMD% and NID% showed significant decrease after treatment (P < 0·01 for both). CONCLUSIONS Intermittent teriparatide treatment may adversely affect some parameters of glucose metabolism, inflammation and endothelial function. On the basis of our findings, further large-scale and controlled studies are needed to clarify the exact effect of teriparatide treatment on glucose metabolism, inflammation and endothelial function.
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Affiliation(s)
- Ozgen Celer
- Department of Endocrinology and Metabolism, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Aysen Akalın
- Department of Endocrinology and Metabolism, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Cigdem Oztunali
- Department of Radiology, Eskisehir Osmangazi University, Eskisehir, Turkey
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Pepe J, Diacinti D, Fratini E, Nofroni I, D'Angelo A, Pilotto R, Savoriti C, Colangelo L, Raimo O, Cilli M, Cipriani C, Minisola S. High prevalence of abdominal aortic calcification in patients with primary hyperparathyroidism as evaluated by Kauppila score. Eur J Endocrinol 2016; 175:95-100. [PMID: 27165861 DOI: 10.1530/eje-15-1152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/06/2016] [Indexed: 01/08/2023]
Abstract
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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Affiliation(s)
- Jessica Pepe
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology'Sapienza' University, Rome, Italy
| | - Emanuela Fratini
- Department of Radiological Sciences, Oncology and Pathology'Sapienza' University, Rome, Italy
| | - Italo Nofroni
- Department of Public Health and Infectious Diseases'Sapienza' University, Rome, Italy
| | - Antonella D'Angelo
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Roberta Pilotto
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Claudio Savoriti
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Luciano Colangelo
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Orlando Raimo
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Mirella Cilli
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Cristiana Cipriani
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
| | - Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines'Sapienza' University, Rome, Italy
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Antequera I, Cuende JI, Nieto López-Guerrero J, Valdivielso P. [Vascular risk in endocrine diseases other than diabetes]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28:197-201. [PMID: 26153542 DOI: 10.1016/j.arteri.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/05/2015] [Accepted: 05/14/2015] [Indexed: 06/04/2023]
Abstract
Endocrinological diseases directly affect the cardiovascular system. The deleterious effects on cardiovascular function can be direct, and linked to the increase or reduction of circulating hormones. Equally, the adverse effects may be indirect; for example following the rise in blood pressure, increase or redistribution of lean mass, or increased plasma lipoproteins. The best health care and the increasing availability of biochemical tests lead to the diagnosis of many endocrine diseases before the onset of clinical signs. This review will focus on presenting evidence of cardiovascular functional or structural impairment in cases of primary hyperparathyroidism, Cushing's syndrome, and hypothyroidism in their sub-clinical forms, as well as the reversibility of complications after appropriate treatment.
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Affiliation(s)
- Isabel Antequera
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España.
| | - José I Cuende
- Servicio de Medicina Interna, Complejo Asistencial Universitario de Palencia, Palencia, España
| | | | - Pedro Valdivielso
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
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Pathophysiologic and treatment strategies for cardiovascular disease in end-stage renal disease and kidney transplantations. Cardiol Rev 2016; 23:109-18. [PMID: 25420053 DOI: 10.1097/crd.0000000000000044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The inextricable link between the heart and the kidneys predestines that significant cardiovascular disease ensues in the face of end-stage renal disease (ESRD). As a point of fact, the leading cause of mortality of patients on dialysis is still from cardiovascular etiologies, albeit differing in particular types of disease from the general population. For example, sudden cardiac death outnumbers coronary artery disease in patients with ESRD, which is the reverse for the general population. In this review, we will focus on the pathophysiology and treatment options of important traditional and nontraditional risk factors for cardiovascular disease in ESRD patients such as hypertension, anemia, vascular calcification, hyperparathyroidism, uremia, and oxidative stress. The evidence of erythropoietin-stimulating agents, phosphate binders, calcimimetics, and dialysis modalities will be presented. We will then discuss how these risk factors may be changed and perhaps exacerbated after renal transplantation. This is largely due to the immunosuppressive agents that are both crucial yet potentially detrimental in the posttransplant state. Calcineurin inhibitors, corticosteroids, and mammalian target of rapamycin inhibitors, the mainstay of transplant immunosuppression, are all known to increase the risks of developing new onset diabetes as well as the metabolic syndrome. Thus, we need to carefully negotiate between patients' cardiovascular profile and their risks of rejection. Finally, we end by considering strategies by which we may minimize cardiovascular disease in the transplant population, as this modality still confers the highest chance of survival in patients with ESRD.
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McMahon DJ, Carrelli A, Palmeri N, Zhang C, DiTullio M, Silverberg SJ, Walker MD. Effect of Parathyroidectomy Upon Left Ventricular Mass in Primary Hyperparathyroidism: A Meta-Analysis. J Clin Endocrinol Metab 2015; 100:4399-407. [PMID: 26445115 PMCID: PMC4667168 DOI: 10.1210/jc.2015-3202] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) has been associated with increased left ventricular mass (LVM) in many studies. Most studies have been inadequately powered to assess the effect of parathyroidectomy (PTX) on LVM. OBJECTIVE The objective was to evaluate whether PTX has a benefit on LVM in patients with PHPT. DATA SOURCES Sources included PubMed, Medline, Cochrane Library, clinicaltrials.gov, review articles, and abstracts from meetings. STUDY SELECTION Eligible studies included prospective studies of PTX vs observation or PTX alone in patients with PHPT who had LVM measured by echocardiography. DATA EXTRACTION Two investigators independently identified eligible studies and extracted data. Random-effects models were used to obtain final pooled estimates. DATA SYNTHESIS Fifteen studies (four randomized controlled trials and 11 observational) of 457 participants undergoing PTX were included. PTX was associated with a reduction in LVM (crude Hedges gu -0.290 ± 0.070, 95% confidence interval [CI] -0.423 to -0.157) of 11.6 g/m(2) (12.5%) on average. Effect size estimates differed by study duration (P < .001), with improvements seen in shorter (≤ 6 mo) but not longer studies. There was a trend toward greater improvement in observational studies vs randomized controlled trials (P = .07), and both serum calcium and PTH were higher in the former. Using random-effects models, the estimated effect size remained significant (Hedges gu -0.250, 95% CI -0.450 to -0.050). Higher preoperative PTH but not calcium was associated with a greater decline in LVM (β = -.039, 95% CI -0.075 to -0.004). CONCLUSION PTX reduced LVM in PHPT, and higher preoperative PTH levels were associated with greater improvements. Because the benefit was limited to short-term studies and PHPT disease severity was not independent of study design, further work is needed to clarify the factors that influence the change in LVM and whether the benefit persists beyond 6 months after PTX. Although the clinical significance of the LVM improvement is unclear, these data indicate that PTH may underlie increased LVM in PHPT.
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Affiliation(s)
- Donald J McMahon
- Division of Endocrinology (D.J.M., A.C., C.Z., S.J.S., M.D.W.), Department of Medicine, and Division of Cardiology (M.D.), Department of Medicine, Columbia University, College of Physicians and Surgeons, and Department of Medicine (N.P.), New York Presbyterian/Columbia University Medical Center, New York, New York 10032
| | - Angela Carrelli
- Division of Endocrinology (D.J.M., A.C., C.Z., S.J.S., M.D.W.), Department of Medicine, and Division of Cardiology (M.D.), Department of Medicine, Columbia University, College of Physicians and Surgeons, and Department of Medicine (N.P.), New York Presbyterian/Columbia University Medical Center, New York, New York 10032
| | - Nick Palmeri
- Division of Endocrinology (D.J.M., A.C., C.Z., S.J.S., M.D.W.), Department of Medicine, and Division of Cardiology (M.D.), Department of Medicine, Columbia University, College of Physicians and Surgeons, and Department of Medicine (N.P.), New York Presbyterian/Columbia University Medical Center, New York, New York 10032
| | - Chiyuan Zhang
- Division of Endocrinology (D.J.M., A.C., C.Z., S.J.S., M.D.W.), Department of Medicine, and Division of Cardiology (M.D.), Department of Medicine, Columbia University, College of Physicians and Surgeons, and Department of Medicine (N.P.), New York Presbyterian/Columbia University Medical Center, New York, New York 10032
| | - Marco DiTullio
- Division of Endocrinology (D.J.M., A.C., C.Z., S.J.S., M.D.W.), Department of Medicine, and Division of Cardiology (M.D.), Department of Medicine, Columbia University, College of Physicians and Surgeons, and Department of Medicine (N.P.), New York Presbyterian/Columbia University Medical Center, New York, New York 10032
| | - Shonni J Silverberg
- Division of Endocrinology (D.J.M., A.C., C.Z., S.J.S., M.D.W.), Department of Medicine, and Division of Cardiology (M.D.), Department of Medicine, Columbia University, College of Physicians and Surgeons, and Department of Medicine (N.P.), New York Presbyterian/Columbia University Medical Center, New York, New York 10032
| | - Marcella D Walker
- Division of Endocrinology (D.J.M., A.C., C.Z., S.J.S., M.D.W.), Department of Medicine, and Division of Cardiology (M.D.), Department of Medicine, Columbia University, College of Physicians and Surgeons, and Department of Medicine (N.P.), New York Presbyterian/Columbia University Medical Center, New York, New York 10032
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Lourida I, Thompson-Coon J, Dickens CM, Soni M, Kuźma E, Kos K, Llewellyn DJ. Parathyroid hormone, cognitive function and dementia: a systematic review. PLoS One 2015; 10:e0127574. [PMID: 26010883 PMCID: PMC4444118 DOI: 10.1371/journal.pone.0127574] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/16/2015] [Indexed: 01/18/2023] Open
Abstract
Background Metabolic factors are increasingly recognized to play an important role in the pathogenesis of Alzheimer’s disease and dementia. Abnormal parathyroid hormone (PTH) levels play a role in neuronal calcium dysregulation, hypoperfusion and disrupted neuronal signaling. Some studies support a significant link between PTH levels and dementia whereas others do not. Methods We conducted a systematic review through January 2014 to evaluate the association between PTH and parathyroid conditions, cognitive function and dementia. Eleven electronic databases and citation indexes were searched including Medline, Embase and the Cochrane Library. Hand searches of selected journals, reference lists of primary studies and reviews were also conducted along with websites of key organizations. Two reviewers independently screened titles and abstracts of identified studies. Data extraction and study quality were performed by one and checked by a second reviewer using predefined criteria. A narrative synthesis was performed due to the heterogeneity of included studies. Results The twenty-seven studies identified were of low and moderate quality, and challenging to synthesize due to inadequate reporting. Findings from six observational studies were mixed but suggest a link between higher serum PTH levels and increased odds of poor cognition or dementia. Two case-control studies of hypoparathyroidism provide limited evidence for a link with poorer cognitive function. Thirteen pre-post surgery studies for primary hyperparathyroidism show mixed evidence for improvements in memory though limited agreement in other cognitive domains. There was some degree of cognitive impairment and improvement postoperatively in observational studies of secondary hyperparathyroidism but no evident pattern of associations with specific cognitive domains. Conclusions Mixed evidence offers weak support for a link between PTH, cognition and dementia due to the paucity of high quality research in this area.
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Affiliation(s)
- Ilianna Lourida
- The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Jo Thompson-Coon
- The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Chris M. Dickens
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Maya Soni
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Elżbieta Kuźma
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Katarina Kos
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - David J. Llewellyn
- The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- * E-mail:
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Hagström E, Ahlström T, Ärnlöv J, Larsson A, Melhus H, Hellman P, Lind L. Parathyroid hormone and calcium are independently associated with subclinical vascular disease in a community-based cohort. Atherosclerosis 2015; 238:420-6. [DOI: 10.1016/j.atherosclerosis.2014.12.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 11/16/2014] [Accepted: 12/14/2014] [Indexed: 11/17/2022]
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Watari E, Taketani Y, Kitamura T, Tanaka T, Ohminami H, Abuduli M, Harada N, Yamanaka-Okumura H, Yamamoto H, Takeda E. Fluctuating plasma phosphorus level by changes in dietary phosphorus intake induces endothelial dysfunction. J Clin Biochem Nutr 2014; 56:35-42. [PMID: 25678749 PMCID: PMC4306666 DOI: 10.3164/jcbn.14-96] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/03/2014] [Indexed: 12/21/2022] Open
Abstract
High serum phosphorus (P) impairs endothelial function by increasing oxidative stress and decreasing nitric oxide production. Serum P levels fluctuate due to circadian rhythms or dietary P intake in healthy people and due to dialysis in end-stage chronic kidney disease patients. Here we examined whether fluctuating plasma P caused by changes in dietary P intake may be involved in endothelial dysfunction, resulting in increased cardiovascular risk. Rats were fed a diet containing 0.6% P for 16 days (control group), or a diet alternating between 0.02% P and 1.2% P (LH group) or between 1.2% P and 0.02% P (HL group) every 2 days; the total amount of P intake among the groups during the feeding period was similar. In the LH and HL groups, endothelial-dependent vasodilation significantly decreased plasma 8-(OH)dG level significantly increased, and the expression of inflammatory factors such as MCP-1 increased in the endothelium as compared with the control group. These data indicate that repetitive fluctuations of plasma P caused by varying dietary P intake can impair endothelial function via increased oxidative stress and inflammatory response. Taken together, these results suggest that habitual fluctuation of dietary P intake might be a cause of cardiovascular disease through endothelial dysfunction, especially in chronic kidney disease patients.
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Affiliation(s)
- Eriko Watari
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Yutaka Taketani
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Tomoyo Kitamura
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Terumi Tanaka
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Hirokazu Ohminami
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Maerjianghan Abuduli
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Nagakatsu Harada
- Department of Nutrition and Metabolism, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Hisami Yamanaka-Okumura
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Hironori Yamamoto
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Eiji Takeda
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan
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Aliabadi-Wahle S, Kelly TL, Rozenfeld Y, Carlisle JR, Naeole LK, Negreanu FA, Schuman E, Hammill CW. Treatment Strategies for Primary Hyperparathyroidism: What is the Cost? Am Surg 2014. [DOI: 10.1177/000313481408001132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary hyperparathyroidism (HPT) contributes to the onset of many chronic conditions. Although parathyroidectomy is the only definitive treatment, observation remains a valid option. Over a 3-year span, a major health plan was queried for HPT and benign parathyroid neoplasm. Patients with secondary and tertiary HPT, Stage III to V kidney disease, and prior renal transplant were excluded. Patients were divided into: observation (Group 1), parathyroidectomy during the study period (Group 2), and parathyroidectomy before the study group (Group 3), and were compared with a control group of 27,092 adult members without HPT using analysis of variance. The 3-year mean total allowed expenditure for Group One (n = 559), Group Two (n = 93), and Group Three (n = 48) were $21,267, $37,043, and $14,702, respectively. Groups One and Two had significantly higher use than the nonparathyroid group ( P < 0.0001), whereas that of Group Three was comparable. Group Two had the highest cost, whereas Group Three had a significantly lower cost than Group One ( P 0.0001). Primary hyperparathyroidism is associated with a higher use of healthcare resources. Patients observed incurred a higher allowed expenditure than those with prior parathyroidectomy. Surgical treatment may represent a cost-effective strategy for treatment of hyperparathyroidism, although more comprehensive studies are needed to confirm these findings.
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Affiliation(s)
- Shaghayegh Aliabadi-Wahle
- The Oregon Clinic, Portland, Oregon
- Providence Cancer Center, Portland, Oregon; and
- Legacy Health System, Portland, Oregon
| | | | | | | | | | | | | | - Chet W. Hammill
- The Oregon Clinic, Portland, Oregon
- Providence Cancer Center, Portland, Oregon; and
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Abstract
Secondary hypertension (SH) often implies a correctable form of nonessential hypertension. Often certain clinical clues prompt a more extensive evaluation of the causes of the hypertension. Renovascular disease, intrinsic renal disease, primary hyperaldosteronism, and obstructive sleep apnea represent the most common causes of SH. This article defines the disorder and details its epidemiology, prevalence, pathophysiology, physical findings, and treatment strategies.
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Affiliation(s)
- Raghavesh Pullalarevu
- Division of Nephrology, Department of Medicine, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
| | - Ghulam Akbar
- Division of Nephrology, Department of Medicine, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA
| | - Geoffrey Teehan
- Division of Nephrology, Department of Medicine, Lankenau Institute of Medical Research, Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA.
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Silverberg SJ, Clarke BL, Peacock M, Bandeira F, Boutroy S, Cusano NE, Dempster D, Lewiecki EM, Liu JM, Minisola S, Rejnmark L, Silva BC, Walker MD, Bilezikian JP. Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99:3580-94. [PMID: 25162667 PMCID: PMC5393491 DOI: 10.1210/jc.2014-1415] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This report summarizes data on traditional and nontraditional manifestations of primary hyperparathyroidism (PHPT) that have been published since the last International Workshop on PHPT. PARTICIPANTS This subgroup was constituted by the Steering Committee to address key questions related to the presentation of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed. EVIDENCE Data from the 5-year period between 2008 and 2013 were presented and discussed to determine whether they support changes in recommendations for surgery or nonsurgical follow-up. CONSENSUS PROCESS Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was undertaken. After extensive review and discussion, the subgroup came to agreement on what changes in the recommendations for surgery or nonsurgical follow-up of asymptomatic PHPT should be made to the Expert Panel. CONCLUSIONS 1) There are limited new data available on the natural history of asymptomatic PHPT. Although recognition of normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism) is increasing, data on the clinical presentation and natural history of this phenotype are limited. 2) Although there are geographic differences in the predominant phenotypes of PHPT (symptomatic, asymptomatic, normocalcemic), they do not justify geography-specific management guidelines. 3) Recent data using newer, higher resolution imaging and analytic methods have revealed that in asymptomatic PHPT, both trabecular bone and cortical bone are affected. 4) Clinically silent nephrolithiasis and nephrocalcinosis can be detected by renal imaging and should be listed as a new criterion for surgery. 5) Current data do not support a cardiovascular evaluation or surgery for the purpose of improving cardiovascular markers, anatomical or functional abnormalities. 6) Some patients with mild PHPT have neuropsychological complaints and cognitive abnormalities, and some of these patients may benefit from surgical intervention. However, it is not possible at this time to predict which patients with neuropsychological complaints or cognitive issues will improve after successful parathyroid surgery.
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Affiliation(s)
- Shonni J Silverberg
- Columbia University College of Physicians & Surgeons (S.J.S., N.E.C., D.D., M.D.W., J.P.B.) New York, New York 10032; Mayo Clinic (B.L.C.), Rochester, Minnesota 55902; Indiana University School of Medicine (M.P.), Indianapolis, Indiana 46202; University of Pernambuco School of Medicine (F.B.), 52050-450 Recife, Brazil; INSERM UMR 1033, Université de Lyon (S.B.), 69437 Lyon, France; New Mexico Clinical Research and Osteoporosis Center (E.M.L.), University of New Mexico School of Medicine, Albuquerque, New Mexico 87106; Shanghai Jiao-tong University School of Medicine (L.J.-M.), Shanghai 200025, People's Republic of China; Sapienza University of Rome (S.M.), 00161 Rome, Italy; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; and Federal University of Minas Gerais (B.C.S.), Belo Horizonte 30.130-100, Brazil
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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.
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