Primary hyperparathyroidism: Incidence of cardiac abnormalities and partial reversibility after successful parathyroidectomy

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Abstract

purpose: This prospective study was designed to assess the effect of primary hyperparathyroidism on heart muscle, valves, and myocardial function. Echocardiography was used to evaluate changes in mechanical performance, the thickness of the left ventricular wall, myocardial calcific deposits, and valvular calcifications in patients with primary hyperparathyroidism.

methods: Echocardiography was performed in 54 patients with hyperparathyroidism prior to surgery and 12 ± 2 months after successful parathyroidectomy. A matched control group was followed for comparison.

results: In a blinded fashion, aortic and mitral valve calcifications were detected in 63% and 49% of patients with primary hyperparathyroidism (controls: 12% and 15%, respectively). Calcific deposits in the myocardium were found in 69% of patients with hyperparathyroidism and 17% of the control subjects. After parathyoidectomy and 12 months of normocalcemia, a significant regression of left ventricular hypertrophy (p <0.001) was observed.

conclusions: The present data show a high incidence of left ventricular hypertrophy, calcific deposits in the myocardium, and/or aortic and mitral valve calcification in patients with primary hyperparathyroidism. A 1-year follow-up after parathyroidectomy (and restoration of normocalcemia) discloses regression of hypertrophy, while calcifications persist without evidence of progression.

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      Commonly used medications in medical therapy include intravenous fluids, abundant hydration, loop diuretics, calcitonin, intravenous bisphosphonates (pamidronate), and calcimimetic agents such as cinacalcet [11]. A treatment plan must be swiftly made to avoid irreversible complications in the long term, such as nephrocalcinosis, cardiac abnormalities [12], bone resorption or central nervous system changes, and emergency surgery must be performed if medical therapy fails to stabilize clinical and laboratory parameters. Although subtotal parathyroidectomy (3 and a half gland) has been previously regarded as a valid surgical approach, total parathyroidectomy has become the main surgical option afterward.

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