Endocrine Abstracts

Background: PTH is a hormone with vascular and cardiovascular properties, involved in the expression of endothelial pro-atherosclerotic and pro-inflammatory parameters. Both hypercalcemic and normocalcemic primary hyperparathyroidism (PHPT) were associated with increased cardiovascular risk.

Patients and methods: 84 patients (6M/78F) with PHPT, aged 58.9±12.7 years, were retrospectively reviewed. Serum calcium levels, PTH and 25 OH vitamin D levels were measured. ECG was performed in all patients and echocardiography was performed in selected cases.

Results: Mean serum total calcium was 11.2±1.2 mg/dl (range: 9.3–18.4); median PTH level was 158.4 pg/ml (range: 64.2–1982) and mean serum 25 OH vitamin D levels was 18.3±9.1 ng/ml (range: 5.8–37.7). Mean body mass index was 27±5.1 kg/m². Arterial hypertension was present in 48 patients (57.1%) in whom plasma metanephrines and normetanephrines were normal; 2 additional patients were prior operated for an adrenal paraganglioma (pheochromocytoma) and for an extra-adrenal paraganglioma, respectively. Chronic stable angina or resting ECG ischemic features were present in 23 patients (27.4%), arrhythmias in 12 patients (14.3%); on transthoracic echocardiography, aortic and mitral valve calcifications were present in 9 patients (10.7%). Impaired glucose metabolism was present in 15 patients (17.8%): type 2 diabetes mellitus in 8 patients (9.5%) and impaired glucose tolerance in 7 patients (8.33%).

Conclusions: cardiovascular involvement is frequent in PHPT patients. A proper screening should be done both in patients with hypercalcemic PHPT who will be referred to surgery and in patients with normocalcemic PHPT to assess cardiovascular risk and to weight potential benefits of surgery.