Parathyroid gland disorders and cardiovascular disease

The review provides systematic information on the relation between pathology of parathyroid glands and cardiovascular disease (CVD). Recent studies have shown that actions of parathyroid hormone (PTH) and calcium affect the heart and vasculature through downstream actions of their receptors in the myocardium and endothelial cells, which lead to higher incidence of CVD among patients with parathyroid gland disorders (PGD). The mechanisms underlying this association also include insulin resistance and altered renin-angiotensinaldosterone axis among patients with primary hyperparathyroidism. However, low calcium and PTH level in hypoparathyroid patients are characterized by higher values of arterial stiffness, electrocardiogram abnormalities, vascular atherosclerosis and remodeling. These factors contribute to low quality of life among those patients. Knowledge of cardiovascular disease pathogenesis in patients with hyper- or hypoparathyroidism could help to improve quality of diagnostic and treatment and decrease the burden of cardiac risk factors. This review will be of interest to endocrinologists and cardiologists, and other specialists.

[Dynamic changes of renin-angiotensin-aldosterone system parameters after surgery of primary hyperparathyroidism]

AIM

To study an activity of the Renin-Angiotensin-Aldosterone System (RAAS) components in patients with primary hyperparathyroidism (PHPT) before and after parathyroidectomy (PTE).

MATERIALS AND METHODS

A comparative study of patients with PHPT and control group. The first stage of the study included 56 patients with PHPT (group 1) before and on the third day after PTE. The second stage was carried out in 27 patients with remission of PHPT (group 2). All patients and healthy volunteers were tested for the main parameters of phosphorus-calcium metabolism and the RAAS parameters (plasma renin activity PRA, serum aldosterone, angiotensin II AT II).

RESULTS

Patients with active PHPT demonstrated changes in RAAS activity (lower PRA, higher AT II level) comparing to control group, that have statistical significance in group 1 (p0.001 for both parameters). There were no significant differences in aldosterone levels (p1=0.090;p2=0.140). On the third day after PTE (group 1), a decrease in aldosterone level (p=0.009) and a tendency to decrease in PRA (p=0.030) were detected. However, an increase in PRA (p=0.018), a decrease in AT II concentration (p=0.032) comparing to the initial values and their normalization were observed 12 months after surgery when permanent normal serum calcium and PTH levels had been achieved. There were controversial correlations between the parameters of phosphorus-calcium metabolism and RAAS. The influence of angiotensin-converting-enzyme inhibitors and AT II receptor blockers on phosphorus-calcium metabolism in patients with PHPT was not observed.

CONCLUSION

In patients with PHPT, there were no сlear correlations of phosphorus-calcium metabolism parameters with RAAS, however an increase of AT II concentration was noted, that can take part in a development of hypertension for this endocrinopathy. PTE can have a positive effect on AT II level.