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Carnevale V, Pugliese F, Eller-Vainicher C, Salcuni AS, Nieddu L, Chiodini I, Scillitani A. Carotid Intima-Media Thickness in Surgically or Conservatively Managed Patients With Primary Hyperparathyroidism. J Clin Endocrinol Metab 2024; 109:e2342-e2347. [PMID: 38345411 PMCID: PMC11570369 DOI: 10.1210/clinem/dgae053] [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: 12/04/2023] [Indexed: 11/19/2024]
Abstract
CONTEXT Current evidence of cardiovascular (CV) risk in primary hyperparathyroidism (PHPT) is still inconsistent. OBJECTIVE To prospectively investigate changes of early atherosclerosis in patients with PHPT undergoing parathyroidectomy (PTx) or conservative management, according to consensus criteria. METHODS Biochemical parameters of PHPT, CV risk factors (systolic and diastolic blood pressure, cholesterol [total, high-density, and low-density], triglyceride, HbA1c, HOMA-IR), and carotid intima-media thickness (IMT) and plaque were assessed in 52 consecutive postmenopausal PHPT patients both at baseline and ≥ 24 months after surgery (PTx, n = 22) or conservative management (non-PTx, n = 30). RESULTS At baseline, PTx and non-PTx showed comparable age, BMI, renal function, and 25(OH)D levels, and did not differ for CV risk factors, IMT and plaques, or for prevalence of smoking, diabetes mellitus, or antihypertensive or statin therapy, while all parameters characterizing PHPT differed. Follow-up duration in PTx was longer than in non-PTx (P = .004). Parameters characterizing PHPT significantly improved ≥ 24 months after surgery, whereas in non-PTx serum phosphate slightly decreased and parathyroid hormone increased. Systolic and diastolic blood pressure increased at follow-up in both groups, while other CV risk factors did not significantly vary. In PTx, IMT did not significantly vary after surgery (0.85 ± 0.14 to 0.89 ± 0.22 mm, P = .366), whereas it significantly increased in non-PTx (0.80 ± 0.18 to 0.93 ± 0.23 mm, P = .008), even adjusting for blood pressure. Plaque prevalence and incidence did not significantly differ in the 2 groups. CONCLUSION Our results suggest that in postmenopausal patients with PHPT, subclinical atherosclerosis could be halted by PTx, whereas it worsens over time in nonoperated patients with milder disease.
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Affiliation(s)
- Vincenzo Carnevale
- Unit of Internal Medicine, “Casa Sollievo della Sofferenza” Hospital, IRCCS, 71013 San Giovanni Rotondo, FG, Italy
| | - Flavia Pugliese
- Unit of Endocrinology, “Casa Sollievo della Sofferenza” Hospital, IRCCS, 71013 San Giovanni Rotondo, FG, Italy
| | - Cristina Eller-Vainicher
- Endocrinology Unit, Fondazione IRCCS “Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Antonio S Salcuni
- Unit of Endocrinology and Metabolism, University-Hospital S. Maria Della Misericordia, 33100 Udine, Italy
| | - Luciano Nieddu
- Department of Humanistic and International Social Sciences, UNINT University, 00147 Rome, Italy
| | - Iacopo Chiodini
- Unit of Endocrinology, Ospedale Niguarda Cà Granda, 20112 Milan, Italy
| | - Alfredo Scillitani
- Unit of Endocrinology, “Casa Sollievo della Sofferenza” Hospital, IRCCS, 71013 San Giovanni Rotondo, FG, Italy
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Gheorghe AM, Nistor C, Ranetti AE, Ciuche A, Ciobica ML, Stanciu M, Tanasescu D, Popa FL, Carsote M. Osteoporosis and Normocalcemic Primary Hyperparathyroidism (Conservatively or Surgically Managed). J Clin Med 2024; 13:6325. [PMID: 39518465 PMCID: PMC11545940 DOI: 10.3390/jcm13216325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 10/14/2024] [Accepted: 10/21/2024] [Indexed: 11/16/2024] Open
Abstract
Asymptomatic primary hyperparathyroidism (PHPT) involves 80-90% of the parathyroid tumor-associated cases of PHPT in the modern medical era, while normocalcemic PHPT (NPHPT) has a prevalence of 0.1-11%. We aimed to analyze the bone status and mineral metabolism in NPHPT amid conservative or surgical management. In this narrative review, we searched PubMed (between January 2020 and July 2024) via different keywords. Fourteen studies from the final analysis (388 patients with NPHPT; 1188 with PHPT; and 803 controls) showed that mean serum calcium levels varied between 2.57 and 2.26 mmol/L in NPHPT. Ten studies identified a similar 24 h urinary calcium in NPHPT versus hypercalcemic PHPT (HPHPT). Except for one study, a mandatory vitamin D analysis was performed, but the 25-hydroxyvitamin D cut-offs varied. Osteoporosis (n = 6 studies; N = 172 with NPHPT) was confirmed in 41.7-100% of NPHPT subjects. In surgery candidates, this rate might be overestimated. A DXA analysis was performed in eight studies (235 subjects with NPHPT, and 455 patients with HPHPT); two studies identified a lower BMD in HPHPT < NPHPT, but the results were not homogenous. A single study analyzed the TBS and found similar results in NPHPT. The prevalence of fractures (n = 9) varied between 7.4% and 42.8% in NPHPT. Bone turnover markers (N = 262 patients, n = 8 studies) showed lower bone formation markers in NPHPT versus PHPT (n = 3). Two studies analyzed the BMD and bone turnover markers following parathyroidectomy (161 patients, including 30 patients with NPHPT; mean ages over 60 years). To conclude, given the wide spectrum of complications associated with PHPT, an early diagnosis and proper management is essential. A more extensive screening in patients with osteoporosis and kidney stones might lead to the discovery of NPHPT, a more recently described form of PHPT. While it is still unclear whether NPHPT is an early stage of HPHPT or a separate entity, recent findings show similar osteoporosis and fracture occurrence, and an improvement in bone metabolism, following parathyroidectomy. More extensive prospective studies are crucial to understand the natural course of the disease, to reach a consensus regarding parathyroidectomy indications and surgery candidates' selection, and to ensure proper personalized management for these patients. With the evolving diagnosis methods, PHPT has become a condition with a changing clinical presentation, which now requires modern evaluation and treatment approaches.
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Affiliation(s)
- Ana-Maria Gheorghe
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 0505474 Bucharest, Romania;
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 011863 Bucharest, Romania;
| | - Claudiu Nistor
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 0505474 Bucharest, Romania
- Thoracic Surgery Department, “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Aurelian-Emil Ranetti
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Endocrinology Department, “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Adrian Ciuche
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 0505474 Bucharest, Romania
- Thoracic Surgery Department, “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Denisa Tanasescu
- Medical Clinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania;
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
| | - Mara Carsote
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 011863 Bucharest, Romania;
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Astor MC, Løvås K, Methlie P, Simunkova K, Assmus J, Husebye ES. Corticosteroid rhythms in hypoparathyroid patients. Eur J Endocrinol 2024; 191:271-278. [PMID: 39167533 DOI: 10.1093/ejendo/lvae102] [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: 04/30/2024] [Revised: 06/16/2024] [Accepted: 08/19/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Previous studies indicate a possible bidirectional stimulatory relationship between parathyroid hormone (PTH) and adrenocortical hormones, but the pattern of adrenocortical secretion in hypoparathyroidism is unknown. We aimed to characterize the adrenocortical secretion in patients with postsurgical hypoparathyroidism, and whether continuous subcutaneous PTH (1-34) infusion alters secretion patterns. DESIGN Crossover interventional study. METHODS We recruited 10 patients with postsurgical hypoparathyroidism with very low PTH levels on stable treatment with active vitamin D and calcium. Cortisol, cortisone, and aldosterone levels were measured in microdialysate from subcutaneous tissue over 24 h, before and during continuous subcutaneous PTH (1-34) infusion. Cortisol was also assayed in serum, saliva, and urine, and aldosterone and ACTH in serum and plasma, respectively. Ten patients with primary hyperparathyroidism and 10 healthy volunteers matched for sex and age served as controls. RESULTS Hypoparathyroid patients displayed both ultradian and circadian rhythmicity for tissue cortisol, cortisone, and aldosterone. Tissue aldosterone and cortisone levels were significantly lower in hypoparathyroid patients than in healthy controls, with no difference in tissue cortisol, but a higher cortisol to cortisone ratio. Treatment with PTH (1-34) increased tissue levels of aldosterone, cortisol, and cortisone and reduced the ratio of cortisol to cortisone. CONCLUSION Adrenocortical hormone levels are reduced in postsurgical hypoparathyroidism, and partly restored by short-term continuous subcutaneous PTH (1-34) therapy. CLINICAL TRIAL REGISTRATION NUMBER NCT02986607.
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Affiliation(s)
- Marianne C Astor
- Department of Clinical Medicine and KG Jebsen-Center for Autoimmune Diseases, University of Bergen, 5020 Bergen, Norway
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Kristian Løvås
- Department of Clinical Medicine and KG Jebsen-Center for Autoimmune Diseases, University of Bergen, 5020 Bergen, Norway
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Paal Methlie
- Department of Clinical Medicine and KG Jebsen-Center for Autoimmune Diseases, University of Bergen, 5020 Bergen, Norway
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Katerina Simunkova
- Department of Clinical Medicine and KG Jebsen-Center for Autoimmune Diseases, University of Bergen, 5020 Bergen, Norway
| | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, 5021 Bergen, Norway
| | - Eystein S Husebye
- Department of Clinical Medicine and KG Jebsen-Center for Autoimmune Diseases, University of Bergen, 5020 Bergen, Norway
- Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
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Khattar G, Asmar S, Sanayeh EB, Keesari P, Rahi W, Sakr F, Khoury M, Cinelli M, Lee S, Weinberg M, Kowalski M, Parikh V. Unveiling the Hidden Stroke Threat in Patients With Atrial Fibrillation and Primary Hyperparathyroidism. Am J Cardiol 2024; 218:94-101. [PMID: 38452840 DOI: 10.1016/j.amjcard.2024.03.003] [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: 01/09/2024] [Revised: 02/17/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
Recent American College of Cardiology (ACC), American Heart Association (AHA), American College of Clinical Pharmacy (ACCP), and Heart Rhythm Society (HRS) guidelines suggest that patients with atrial fibrillation (AF) at intermediate to low annual risk of ischemic stroke can benefit from consideration of factors that might modify their risk of stroke. The role of nontraditional risk factors, such as primary hyperparathyroidism (PHPT), remains unexplored. In our study, we investigated the potential association between PHPT and the risk of ischemic stroke in patients with AF. Using data from the Nationwide Inpatient Sample Database, a retrospective cohort study focused on the adult population with AF, we stratified the participants based on PHPT presence. Demographic information, co-morbidities, and hospitalization details were extracted using International Classification of Diseases, Tenth revision codes. Propensity score matching was applied, encompassing over 20 confounding variables, including the risk factors outlined in the CHA2DS2-VASc (Congestive heart failure (C), Hypertension (H), Age ≥75 years (A₂), Diabetes Mellitus (D), Stroke/Transient Ischemic Attack (TIA)/Thromboembolism (S₂), Vascular disease (V), Age 65-74 years (A), Sex category [female] (Sc)) score. Multivariate logistic regression analysis was performed after matching to assess the independent impact of PHPT as an ischemic stroke risk factor. A total of 2,051 of the identified 395,249 patients with AF had PHPT. The PHPT group had an average age of 74 years and consisted of more women (66.1% vs 53.0%). After matching, it was observed that the PHPT group had longer hospital stays (5 vs 4 days) and higher hospitalization charges ($45,126 vs $36,644). This group exhibited higher rates of ischemic stroke (6.0% vs 4.4%) and mortality (6.3% vs 4.9%). The adjusted outcomes showed a 1.4-fold increased risk for ischemic stroke and a 1.32-fold increased risk for mortality in the PHPT cohort. The subgroup analysis showed a higher incidence of mortality in men with a high CHA2DS2-VASc score. In conclusion, this study highlights a marked association between PHPT and ischemic stroke in patients with AF, independent of the conventional CHA2DS2-VASc score. The potential mechanisms implicated include vascular changes, cardiac dysfunction, and coagulation cascade alterations. The presence of PHPT should be taken into consideration when deciding the assessment of thromboembolic risk.
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Affiliation(s)
- Georges Khattar
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York.
| | - Samer Asmar
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Elie Bou Sanayeh
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Praneeth Keesari
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Wissam Rahi
- Department of Internal Medicine, Lankeneau Medical Center, Wynnewood, Pennsylvania; Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Fouad Sakr
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Michel Khoury
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Michael Cinelli
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Samantha Lee
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Mitchell Weinberg
- Department of Interventional Cardiology and Vascular Medicine, Staten Island University Hospital/Northwell Health, Staten Island, New York; Chair of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York
| | - Marcin Kowalski
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York; Department of Cardiac Electrophysiology, Staten Island University Hospital/Northwell Health, Staten Island, New York; Zucker School of Medicine at Hofstra/Northwell, New York
| | - Valay Parikh
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, New York; Department of Cardiac Electrophysiology, Staten Island University Hospital/Northwell Health, Staten Island, New York; Zucker School of Medicine at Hofstra/Northwell, New York
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Khattar G, Siddiqui FS, Grovu R, Baker SA, Sanayeh EB, Wei C, El Gharib K, Sattar SBA, Elsayegh D, El-Hage H, Sayegh SE, Chalhoub M, Mustafa A. The calcium-clot connection: investigating the association between primary hyperparathyroidism and acute venous thromboembolism. J Thromb Thrombolysis 2024; 57:220-225. [PMID: 37848627 DOI: 10.1007/s11239-023-02906-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 10/19/2023]
Abstract
Primary hyperthyroidism (PHPT) is a relatively uncommon disease and leads to increased calcium levels. Ionized calcium, known as clotting Factor IV, may lead to overt coagulation cascade activation, increasing the risk of venous thromboembolism (VTE). National Inpatient Sample Database was used to sample individuals with primary hyperparathyroidism, and baseline demographics and comorbidities were collected using ICD-10 codes. Patients with missing data and age less than 18 were excluded. Moreover, patients with other types of hyperparathyroidism and risk factors for VTE, such as malignancy, thrombophilia, chronic kidney and liver disease, fractures, trauma, oral contraceptive/steroid use, and organ transplant, were excluded. Greedy propensity matching using R was performed to match patients with and without primary hyperparathyroidism on age, race, gender, and 10 other comorbidities, including chronic deep venous thromboembolism. Univariate analysis pre- and post-match were performed. Binary logistic regression was performed after matching to assess whether primary hyperparathyroidism was an independent risk factor for acute VTE. A p-value of < 0.05 was considered statistically significant. Out of 460,529 patients included in the study, 1114 (6.5%) had PHPT. Baseline comorbidities were more common in the PHPT group. On univariate analysis, patients with PHPT were more likely to have acute VTE (2.5% vs. 1.4%; p < 0.001). After 1:1 matching, PHPT patients were twice as likely to have Acute VTE. (OR: 2.1 [1.08-4.1]; p < 0.025). These findings suggest an association between PHPT and VTE, which should be further investigated to prevent the increasing incidence of VTE and its recurrence.
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Affiliation(s)
- Georges Khattar
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA.
| | - Fasih Sami Siddiqui
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Radu Grovu
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Saif Abu Baker
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Elie Bou Sanayeh
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Chapman Wei
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Khalil El Gharib
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - Saud Bin Abdul Sattar
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Dany Elsayegh
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Halim El-Hage
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Suzanne El Sayegh
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, 475 Seaview Ave, Staten Island, NY, 10305, USA
- Department of Nephrology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Michel Chalhoub
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Ahmad Mustafa
- Department of Cardiology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
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Romero-Velez G, Noureldine SI, Rahman M, Bena JF, Burneikis T, Jin J. Are 99mTC-Sestamibi Single Photon Emission Computed Tomography Scan Results Associated to the Parathyroid Cell Type in Primary Hyperparathyroidism? J Surg Res 2024; 293:517-524. [PMID: 37827030 DOI: 10.1016/j.jss.2023.08.043] [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: 02/09/2023] [Revised: 07/28/2023] [Accepted: 08/27/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION 99mTC-sestamibi scintigraphy (SPECT-CT) is a common imaging modality for parathyroid localization in primary hyperparathyroidism (PHPT). Prior studies have suggested that the cellular composition of parathyroid adenomas influences SPECT-CT imaging results. Other biochemical and anatomical factors may also play a role in false negative results. Therefore, after controlling for confounding variables, we sought to determine whether the histologic composition of parathyroid adenomas is associated to SPECT-CT results in patients with single gland disease causing PHPT. METHODS A retrospective review of patients with PHPT due to confirmed single gland disease was performed over a 2-y period. A 1:1 propensity score matching was done between patients with positive and negative SPECT-CT results with regard to demographical, biochemical, and anatomical characteristics followed by blinded pathologic examination of cell composition in the matched pairs. RESULTS Five hundred forty two patients underwent routine four gland exploration and 287 (53%) patients were found to have a single adenoma. Of those, 26% had a negative SPECT-CT result. There were significant differences between groups with regards to biochemical profile, gland location, and gland size. All of which became nonsignificant after propensity score matching. Adenomas were primarily composed of chief cells, with no difference between groups (95% versus 97%, P = 0.30). In the positive SPECT-CT group, chief cells were the dominant cell type in 68% of the cases, followed by mixed type (13%), oxyphil cells (12%), and clear cells (7%). This was similar to the negative SPECT-CT group (P = 0.22). CONCLUSIONS While certain patient's clinical characteristics are associated with SPECT-CT imaging results, histologic cell type is not significantly associated.
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Affiliation(s)
- Gustavo Romero-Velez
- Endocrinology and Metabolism Institute, Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Salem I Noureldine
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Mobeen Rahman
- Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - James F Bena
- Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Talia Burneikis
- Department of Endocrine and General Surgery, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Judy Jin
- Endocrinology and Metabolism Institute, Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio.
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Nomine-Criqui C, Bihain F, Nguyen-Thi PL, Scheyer N, Demarquet L, Klein M, Guerci B, Brunaud L. Patients with prediabetes improve insulin resistance after surgery for primary hyperparathyroidism. Surgery 2024; 175:180-186. [PMID: 37981555 DOI: 10.1016/j.surg.2023.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/14/2023] [Accepted: 04/05/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the evolution of insulin resistance at 12 months after parathyroidectomy for primary hyperparathyroidism according to the preoperative severity of glucose metabolism abnormalities. METHODS Observational study of patients who underwent parathyroidectomy between 2016 and 2021. Prediabetes and insulin resistance were defined as fasting glucose ≥1.00 g/L (American Diabetes Association) and homeostatic model assessment of insulin resistance >2.5, respectively. RESULTS A total of 231 patients were included. Preoperatively, 75 patients (32%) had prediabetes, and 108 patients (47%) had insulin resistance. At 12 months postoperative, homeostatic model assessment of insulin resistance values significantly decreased in patients with prediabetes (-0.69; P = .04) and in patients with insulin resistance (-0.85; P < .001). In patients with prediabetes, 48/75 (64%) decreased their insulin resistance, including 15/48 (31%) with normalization of fasting glucose. In multivariate analysis, preoperative prediabetes (1.82, 1.03-3.21; P = .037) or preoperative homeostatic model assessment of insulin resistance >2.5 (3.90, 2.23-6.75; P < .001) remained independent predictors for insulin resistance reduction observed between preoperative and 12 months postoperative. CONCLUSION Parathyroidectomy is more likely to reduce insulin resistance in patients with primary hyperparathyroidism and prediabetes or in patients with higher preoperative homeostatic model assessment of insulin resistance values. These data support the use of the preoperative prediabetes criterion in addition to the international workshop criteria for parathyroidectomy to better select patients for surgery.
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Affiliation(s)
- Claire Nomine-Criqui
- University of Lorraine, CHU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine and Metabolic Surgery (7ème étage), Nancy, France; University of Lorraine, INSERM NGERE / U1256, "Nutrition, Genetics, Environmental Risks," Faculty of Medicine, Nancy, France
| | - Florence Bihain
- University of Lorraine, CHU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine and Metabolic Surgery (7ème étage), Nancy, France; University of Lorraine, INSERM NGERE / U1256, "Nutrition, Genetics, Environmental Risks," Faculty of Medicine, Nancy, France
| | - Phi-Linh Nguyen-Thi
- University of Lorraine, CHU Nancy, Department of Medical Informatics and Evaluation, Nancy, France
| | - Nicolas Scheyer
- University of Lorraine, CHU Nancy, Department of Endocrinology, Diabetology and Nutrition (EDN), Nancy, France
| | - Léa Demarquet
- University of Lorraine, CHU Nancy, Department of Endocrinology, Diabetology and Nutrition (EDN), Nancy, France
| | - Marc Klein
- University of Lorraine, CHU Nancy, Department of Endocrinology, Diabetology and Nutrition (EDN), Nancy, France
| | - Bruno Guerci
- University of Lorraine, CHU Nancy, Department of Endocrinology, Diabetology and Nutrition (EDN), Nancy, France
| | - Laurent Brunaud
- University of Lorraine, CHU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine and Metabolic Surgery (7ème étage), Nancy, France; University of Lorraine, INSERM NGERE / U1256, "Nutrition, Genetics, Environmental Risks," Faculty of Medicine, Nancy, France.
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Iglesias P, Arias J, López G, Romero I, Díez JJ. Primary Hyperparathyroidism and Cardiovascular Disease: An Association Study Using Clinical Natural Language Processing Systems and Big Data Analytics. J Clin Med 2023; 12:6718. [PMID: 37959184 PMCID: PMC10650925 DOI: 10.3390/jcm12216718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Primary hyperparathyroidism (PHPT) seems to be associated with different cardiovascular diseases (CVDs). We evaluated the association of PHPT with major CV risk factors (CVRFs) and CVDs by using artificial intelligence (AI) tools. An observational and retrospective study was conducted using data from the electronic health records (EHRs) of the Hospital Universitario Puerta de Hierro Majadahonda (Spain). Of a total of 699,157 patients over 18 years of age studied (54.7% females), 6515 patients (0.9%; 65.4% women; mean age 67.6 ± 15.9 years) had a diagnosis of PHPT. The overall frequencies of hypertension, dyslipidemia, diabetes mellitus, and smoking habit in the cohort of patients with PTHP were all significantly (p < 0.001) higher than those found in patients without a diagnosis of PTHP. The total frequency of stroke, ischemic heart disease, atrial fibrillation, deep vein thrombosis, and pulmonary embolism in the cohort of PHPT patients were significantly (p < 0.001) higher than that found in patients without the diagnosis of PHPT. A multivariate regression analysis showed that PHPT was significantly (p < 0.001) and independently associated with all the CVDs evaluated. Our data show that there is a significant association between the diagnosis of PHPT and the main CVRFs and CVDs in our hospital population.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de AranaMajadahonda, 28222 Madrid, Spain;
- Department of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Javier Arias
- MedSavana S.L., 28004 Madrid, Spain; (J.A.); (G.L.); (I.R.)
| | | | - Iago Romero
- MedSavana S.L., 28004 Madrid, Spain; (J.A.); (G.L.); (I.R.)
| | - Juan J. Díez
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de AranaMajadahonda, 28222 Madrid, Spain;
- Department of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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9
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Modica R, Liccardi A, Minotta R, Benevento E, Cannavale G, Colao A. Parathyroid diseases and metabolic syndrome. J Endocrinol Invest 2023; 46:1065-1077. [PMID: 36773188 DOI: 10.1007/s40618-023-02018-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Parathyroid diseases are related to parathyroid hormone (PTH) dysregulation by parathyroid cells or alteration of PTH function. They include hyperparathyroidism (PTH excess), hypoparathyroidism (PTH deficiency) and pseudohypoparathyroidism (PTH resistance). Little is known about correlation between parathyroid diseases and metabolic syndrome (MetS). METHODS An electronic-based search using PubMed was performed until October 2022 and articles were selected based on relevance of title, abstract, English language and publication in peer-reviewed journals. RESULTS Possible association between PTH alterations and the diverse manifestation of MetS have been proposed and it could be supposed that MetS may negatively influence parathyroid diseases. Available data show significant association for hyperparathyroidism and pseudohypoparathyroidism. CONCLUSIONS This review highlights the possible implications between MetS and parathyroid diseases. Given the increasing MetS global prevalence and the higher parathyroid diseases awareness and diagnosis, it may be interesting to further explore the possible role of alterations in parathyroid homeostasis in the development of MetS components with dedicated prospective studies.
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Affiliation(s)
- R Modica
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy.
| | - A Liccardi
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy
| | - R Minotta
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy
| | - E Benevento
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy
| | - G Cannavale
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy
| | - A Colao
- Department of Clinical Medicine and Surgery, Endocrinology Unit of Federico II University of Naples, 80131, Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, Federico II University of Naples, 80131, Naples, Italy
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10
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Frey S, Wargny M, Blanchard C, Caillard C, Hadjadj S, Cariou B, Figueres L, Mirallié E. Effects of parathyroidectomy on kidney function in patients with primary hyperparathyroidism: Results of a prospective study. Surgery 2023; 173:146-153. [PMID: 36167701 DOI: 10.1016/j.surg.2022.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Altered glomerular filtration rate is a controversial indication for parathyroidectomy in patients with primary hyperparathyroidism. The objective of this study was to evaluate the estimated glomerular filtration rate change 12 months after parathyroidectomy for primary hyperparathyroidism according to preoperative kidney function. METHOD Patients who underwent parathyroidectomy for primary hyperparathyroidism between 2016 and 2021 (n = 381) were enrolled in a monocentric prospective cohort. Patients without 1-year follow-up or with missing data were excluded (n = 135, 35%). Patients were dichotomized according to their baseline estimated glomerular filtration rate: <60 mL/min (group 1) and ≥60 mL/min (group 2). Parameters were measured before and then at 6 and 12 months after parathyroidectomy. RESULTS Out of 246 included patients, 27 (11%) were assigned to group 1 and 219 (89%) to group 2. The mean baseline estimated glomerular filtration rate was 46.8 ± 11.5 and 87.3 ± 14.7 mL/min in groups 1 and 2, respectively. Group 1 patients were older (P = .0006) and had a higher median serum parathyroid hormone level (P = .021). At 6 months postoperative, 224 patients (91%) were normocalcemic. The estimated glomerular filtration rate raw change after parathyroidectomy was significantly higher in group 1 than in group 2 (4.2 ± 7.8 vs -2.2 ± 9.1 mL/min, P = .0004). In group 1, 13/27 patients (48%) improved their chronic kidney disease stage after parathyroidectomy, including 6/13 (46%) with postoperative estimated glomerular filtration rate ≥60 mL/min, whereas 2/27 (7%) worsened. The baseline estimated glomerular filtration rate <60 mL/min and elevated serum calcium level were associated with postoperative estimated glomerular filtration rate improvement in multivariable analysis (P = .0023 and .039, respectively). CONCLUSION Parathyroidectomy for primary hyperparathyroidism is more likely to improve kidney function in patients with preoperative estimated glomerular filtration rate <60 mL/min. These results strengthen the current guidelines for surgery.
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Affiliation(s)
- Samuel Frey
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, France; Université de Nantes, France; Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France. https://twitter.com/samuelfrey13
| | - Matthieu Wargny
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Santé au Travail, Pharmacie, Stérilisation, Clinique des Données, France
| | - Claire Blanchard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, France; Université de Nantes, France; Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Cécile Caillard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, France
| | - Samy Hadjadj
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Lucile Figueres
- Université de Nantes, France; Service de Néphrologie-Immunologie Clinique, CHU de Nantes, France
| | - Eric Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, France; Université de Nantes, France.
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11
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Prediction Model of Postoperative Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism Based on Logistic Regression and XGBoost Algorithm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8752826. [PMID: 35924110 PMCID: PMC9343187 DOI: 10.1155/2022/8752826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/14/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
Objective A predictive model was established based on logistic regression and XGBoost algorithm to investigate the factors related to postoperative hypocalcemia in patients with secondary hyperparathyroidism (SHPT). Methods A total of 60 SHPT patients who underwent parathyroidectomy (PTX) in our hospital were retrospectively enrolled. All patients were randomly divided into a training set (n = 42) and a test set (n = 18). The clinical data of the patients were analyzed, including gender, age, dialysis time, body mass, and several preoperative biochemical indicators. The multivariate logistic regression and XGBoost algorithm models were used to analyze the independent risk factors for severe postoperative hypocalcemia (SH). The forecasting efficiency of the two prediction models is analyzed. Results Multivariate logistic regression analysis showed that body mass (OR = 1.203, P = 0.032), age (OR = 1.214, P = 0.035), preoperative PTH (OR = 1.026, P = 0.043), preoperative Ca (OR = 1.062, P = 0.025), and preoperative ALP (OR = 1.031, P = 0.027) were positively correlated with postoperative SH. The top three important features of XGBoost algorithm prediction model were preoperative Ca, preoperative PTH, and preoperative ALP. The area under the curve of the logistic regression and XGBoost algorithm model in the test set was 0.734 (95% CI: 0.595~0.872) and 0.827 (95% CI: 0.722~0.932), respectively. Conclusion The predictive models based on the logistic regression and XGBoost algorithm model can predict the occurrence of postoperative SH.
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12
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Al-Jehani A, Al-Ahmed F, Nguyen-Thi PL, Bihain F, Nomine-Criqui C, Demarquet L, Guerci B, Ziegler O, Brunaud L. Insulin resistance is more severe in patients with primary hyperparathyroidism. Surgery 2022; 172:552-558. [DOI: 10.1016/j.surg.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/05/2021] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
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13
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Effect of Parathyroidectomy on Metabolic Homeostasis in Primary Hyperparathyroidism. J Clin Med 2022; 11:jcm11051373. [PMID: 35268464 PMCID: PMC8911089 DOI: 10.3390/jcm11051373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/20/2022] [Accepted: 02/28/2022] [Indexed: 12/10/2022] Open
Abstract
Background: The benefits of parathyroidectomy on cardiovascular risk in primary hyperparathyroidism (PHPT) are controversial. This monocentric, observational, prospective study aimed to assess the effects of parathyroidectomy on glucose and lipid metabolism in classic or mild PHPT. Methods: Patients who underwent parathyroidectomy for classic (calcemia >2.85 mmol/L) or mild PHPT (calcemia ≤2.85 mmol/L) between 2016 and 2019 were included. A metabolic assessment was performed before and 1 year after parathyroidectomy. Patients with a history of diabetes were excluded. Results: Nineteen patients had classic and 120 had mild PHPT. Ninety-five percent were normocalcemic 6 months after surgery. Fasting plasma glucose and insulin levels decreased after parathyroidectomy in patients with mild PHPT (p < 0.001). HOMA-IR decreased after surgery in the overall population (p < 0.001), while plasma adiponectin concentrations increased in patients with both classic (p = 0.005) and mild PHPT (p < 0.001). Plasma triglyceride levels decreased significantly only in patients with classic PHPT (p = 0.021). Plasma PCSK9 levels decreased in patients with mild PHPT (p < 0.001). Conclusions: Parathyroidectomy for PHPT improves insulin resistance and decreases plasma triglyceride levels in classic PHPT and plasma PCSK9 levels in mild PHPT. Further studies are needed to better characterize the consequences of such metabolic risk factors’ improvements on cardiovascular events.
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14
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Sankpal S, Scott B, Drysdale HRE, Kotowicz M, Nagra S, Watters DA. Resolution of hypertension following water-clear cell parathyroid adenoma excision. ANZ J Surg 2021; 92:1958-1959. [PMID: 34918858 DOI: 10.1111/ans.17427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Shipra Sankpal
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,Department of Surgery - University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Benjamin Scott
- Department of Surgery - University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Henry R E Drysdale
- Department of Surgery - University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Mark Kotowicz
- IMPACT - Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia.,Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sonal Nagra
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,Department of Surgery - University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - David A Watters
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,Department of Surgery - University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
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15
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Castellano E, Pellegrino M, Tardivo V, Attanasio R, Boriano A, Borretta G. Aldosterone Secretion in Patients With Primary Hyperparathyroidism Without Arterial Hypertension. Endocr Pract 2021; 27:1072-1076. [PMID: 33965584 DOI: 10.1016/j.eprac.2021.04.886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a direct bidirectional link between parathyroid hormone (PTH) and the renin-angiotensin-aldosterone system (RAAS), but few studies evaluated the RAAS in patients with primary hyperparathyroidism (PHPT), mainly biased from concomitant antihypertensive treatment. METHODS We retrospectively evaluated a consecutive series of 130 normotensive patients with PHPT comparing aldosterone (ALD) levels and plasma renin activity (PRA) with the demographic, biochemical, or clinical features of PHPT. RESULTS No correlation was found between ALD and PRA, and the demographic, biochemical, and bone densitometry parameters in patients with PHPT without hypertension, with the exception of a negative correlation between age and serum PRA. Moreover, there was no significant correlation between PTH and ALD levels even in patients whose PTH level was >100 ng/L (P = .088). CONCLUSION In our normotensive patients with PHPT, the ALD, PRA, and aldosterone/renin ratio were not correlated to PTH and calcium levels. In addition, they were neither related to PHPT clinical presentation nor renal function, vitamin D status, bone mass loss, or the presence of comorbidities such as diabetes and obesity. Further studies are needed to clarify the complex interplay between PTH and the RAAS in the modern PHPT presentation.
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Affiliation(s)
- Elena Castellano
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy.
| | - Micaela Pellegrino
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Valentina Tardivo
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Roberto Attanasio
- IRCCS Orthopedic Institute Galeazzi, Endocrinology Service, Milan, Italy
| | - Alberto Boriano
- Medical Physics Department, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Giorgio Borretta
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
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