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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Manyalich-Blasi M, Domínguez-Garijo P, Saavedra-Pérez D, Sánchez-Izquierdo N, Casanueva Eliceiry S, Perissinotti A, Mora Porta M, de Hollanda A, Hanzu FA, López-Boado Serrat MA, Rull Ortuño AR, Ardid J, Vidal-Sicart S, Vidal Pérez Ò. Comparison of [ 18F]fluorocholine PET/CT with [ 99mTc]sestamibi and ultrasonography to detect parathyroid lesions in primary hyperparathyroidism: a prospective study. Gland Surg 2022; 11:1764-1771. [PMID: 36518798 PMCID: PMC9742049 DOI: 10.21037/gs-22-198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/31/2022] [Indexed: 03/07/2024]
Abstract
BACKGROUND Primary hyperparathyroidism is a common endocrine disorder produced by the increase of parathyroid hormone (PTH) due to a benign adenoma of a single parathyroid gland, or as multiple gland hyperplasia, or as a rare malignant tumor. Preoperative imaging scans are frequently necessary for the minimally invasive parathyroidectomies to identify the location of enlarged parathyroid glands and to design the procedure. METHODS The diagnostic reliability of [18F]fluorocholine positron emission tomography/computed tomography (FCH PET/CT), [99mTc]sestamibi [multiplexed ion beam imaging (MIBI)] and cervical ultrasonography was analyzed in 37 patients diagnosed with primary hyperparathyroidism undergoing minimally invasive parathyroidectomy. The three preoperative imaging techniques were correlated with intraoperative and histopathological findings as well as changes in biochemical parameters (serum PTH and calcium levels). Statistical analysis was carried out with SPSS version 24.0. RESULTS In 30 of 37 patients (81.1%), FCH PET/CT correctly localized the pathological gland. In 3 cases of ectopic adenomas, the accuracy of the techniques was 100% (3/3) for FCH PET/CT, 66.7% (2/3) for MIBI, and 33.3% (1/3) for neck ultrasonography. Neither neck ultrasonography nor MIBI were able to locate pathological parathyroid glands in those patients with multiglandular disease, while FCH PET/CT correctly located one patient (1/3, 33.3%) with two adenomas and 3 patients (3/6, 50.0%) with hyperplasia. The three imaging techniques, FCH PET/CT, MIBI and neck ultrasound yielded a sensitivity of 92.1%, 57.9% and 32.4%, a positive predictive value of 94.6%, 84.6% and 78.6%, and a diagnostic accuracy of 96.4%, 85.7% and 79.0%, respectively. CONCLUSIONS In this group of patients diagnosed with primary hyperparathyroidism, FCH PET/CT was superior to MIBI and neck ultrasound in detecting adenomas, particularly in the presence of ectopic glands or multiglandular disease.
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Affiliation(s)
- Marti Manyalich-Blasi
- Service of General and Digestive Surgery, Institute Clinic of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Paula Domínguez-Garijo
- Service of General and Digestive Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - David Saavedra-Pérez
- Service of General and Digestive Surgery, Consorci Sanitari Alt Penedès-Garraf, Alt Penedès, Spain
| | | | | | - Andrés Perissinotti
- Nuclear Medicine Department, Hospital Clínic Barcelona & Biomedical Research Networking Center of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Mireia Mora Porta
- Department of Endocrinology and Nutrition, Hospital Clinic de Barcelona, Group of Endocrine Disorders, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedad Metabólicas Asociadas (CIBERDEM), Universitat de, Barcelona, Spain
| | - Ana de Hollanda
- Department of Endocrinology and Nutrition, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Barcelona, Spain
| | - Felicia A. Hanzu
- Department of Endocrinology and Nutrition, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Diabetes y Enfermedad Metabólicas Asociadas (CIBERDEM), Universitat de Barcelona, Barcelona, Spain
| | - Miquel A. López-Boado Serrat
- Service of General and Digestive Surgery, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Antonio R. Rull Ortuño
- Service of General and Digestive Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Ardid
- Service of General and Digestive Surgery, Institute Clinic of Digestive and Metabolic Diseases (ICMDM), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Òscar Vidal Pérez
- Service of General and Digestive Surgery, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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