Endocrine Abstracts

Background: Primary hyperparathyroidism (PHP) is associated with increased rates of cardiovascular (CV) risk. Moreover, it is not fully clear whether surgery can attenuate CV risk. The intima-media thickness (IMT) of carotid vessels is considered a marker of atherosclerosis and CV events.

Aim: Of the study was to evaluate IMT and some metabolic parameters in PHP patients.

Subjects: Of 56 subjects were studied. Patients were divided into two groups: those with normal calcium levels (Gr 1, n=31) and those with still elevated levels (Gr 2, n=25) after surgical or medical therapy. Surgery was performed in 60% and 71% of patients from Gr 1 and Gr. 2, respectively.

Protocol: In all subjects, we measured BMI, blood pressure (BP), IMT by color-duplex sonography, serum Ca, PTH, HOMA-IR, HbA1c, serum lipids, and osteoprotegerin.

Results: BP was similar in both groups. Gr 2 patients were significantly older (65±3 years) than Gr 1 patients (56±3 years; P=0.02). BMI > 30 kg/m² was found in almost five times as many patients in Gr 2 (47%) as in Gr 1 (10%). Serum Ca levels were 9.8±0.1 mg/dl in Gr 1 and 12.4±0.4 mg/dl in Gr 2 (P<0.0001). PTH levels were elevated in 68% and 52% of Gr 1 and 2 patients, respectively. Osteoprotegerin, total cholesterol, triglycerides, and HOMA-IR levels were higher and HDL-cholesterol was lower in Gr 2 than in Gr 1 patients, while HbA1c levels were similar in both groups. A significant increase in IMT was observed in 22% and 32% of Gr 1 and Gr 2 patients, respectively.

Conclusion: Age and BMI seem to be the best predictors of the increase in IMT, osteoprotegerin and some other factors involved in CV risk in PHP patients. These clinical and biochemical abnormalities persist after surgery and may explain the lower survival in PHP patients than in the general population.