Endocrine Abstracts

Introduction: Primary hyperparathyroidism is associated with numerous cardiovascular complications including hypertension, left ventricular hypertrophy and calcification of cardiac valves. However, guidelines from expert panels and NICE have not included cardiovascular complications as an indication of parathyroidectomy. This literature review will be focused on benefits of parathyroidectomy on cardiovascular complications of primary hyperparathyroidism.

Methodology: Literature search done through use of search engines goggle scholar, PubMed, Cochrane database, Medline and EmBase using PRISMA model. Initial database search revealed 79 studies. After applying exclusion and inclusion criterion, 43 studies were finalized for systemic review.

Results: Amongst the cardiovascular complications of 1HPT hypertension and LVH are most investigated in literature and evidence is relatively strong for hypertension and LVH compared to other cardiovascular complications. Evidence is relatively weak for coronary artery disease, serum lipid profile, endothelial vasodilatory dysfunction, calcification of cardiac valves, occurrence of cardiovascular events and cardiovascular mortality.

Conclusion: Although evidence for beneficial effects of parathyroidectomy on HTN and LVH is relatively strong, lack of well-designed multicenter randomized control trial seems to be the main obstacle for inclusion of this as part of parathyroidectomy criterion. However, there is a rationale on basis of evidence available to include Hypertension and LVH as possible indications. Consideration should be given for inclusion of echocardiogram at baseline and follow up of 1HPT patients managed conservatively.

References1. Jessica Mackenzie-Feder, Sandra Sirrs, Donald Anderson, Jibran Sharif, and Aneal Khan (2011)’ Primary Hyperparathyroidism: An Overview’ Internationl Journal of Endocrinolgy, available at hpp://dx.doi.org/101155/2011/251410

2. Hyperparathyroidism (primary): diagnosis, assessment and initial management NICe guideline [NG132] Published date: May 2019

3. Selvihan Beysel, Mustafa Caliskan, Muhammed Kizilgul, Mahmut Apaydin, Seyfullah Kan, Mustafa Ozbek & Erman Cakal (2019) ‘Parathyroidectomy improves cardiovascular risk factos in normocalcemic and hypercalcemic primay hyperparathyroidism’ BMC Caradiavascular Disorders Volume 19, Article number: 106

4. BJorn G. Leifsson and BO Ahern (1996) ‘Serum Calcium and Survival in a Large Health Screening Program’ Journmal of clinical endocrinology and metabolism S-205 02, vol81m no 6

5. Alessandro Piovesan, Nadia Molineri, Flavia Casasso, Ignazio Emmolo, Giuseppe Ugliengo, FLora Cesario and Giorgio Borretta (1999) ‘Let ventricular hypertrophy in primary hyper parathyroidism. Effects of successful parathyroide’ Clinical Endocrinology (1999) 50, 321-328.

6. Melanie Nana, Holly Morganb, Natasha Shrikrishnapalasuriyara, Atul Kalhan (2019) ‘Primary Hyperparathyroidism: Comparing Cardiovascular Morbidity and Mortality in Patients Treated With Parathyroidectomy Vs Conservative Management’ Jorunal of Endocrinology and Metabolism., 9(4): 95-107.