Elsevier

Surgery

Volume 128, Issue 6, December 2000, Pages 895-902
Surgery

American Association of Endocrine Surgeons
Left ventricular systolic and diastolic function and exercise testing in primary hyperparathyroidism—effects of parathyroidectomy*,**,

Presented at the 21st Annual Meeting of the American Association of Endocrine Surgeons (jointly hosted with the British Association of Endocrine Surgeons), London, United Kingdom, and Lille, France, May 22-25, 2000.
https://doi.org/10.1067/msy.2000.110240Get rights and content

Abstract

Background. Nontraditional manifestations of primary hyperparathyroidism (HPT) are controversial and may include morbidity, mortality, and risk factors for cardiovascular diseases. This study evaluates cardiovascular functions at rest and during exercise in HPT. Method. Thirty patients with HPT (mean serum calcium, 2.97 ± 0.24 mmol/L) and 30 control people with normocalcemia, matched for age and sex, underwent symptom-limited exercise testing and echocardiography before and 13 months (mean) after having a parathyroidectomy. Results. Despite similar maximal workload and blood pressures at rest in patients and healthy controls, HPT associated with higher systolic blood pressure during exercise (P =.03) and increased number of ventricular extrasystolic beats (P =.04). There was also an operatively reversible increase in ST-segment depression during exercise. Echocardiography showed an increased left ventricular (LV) isovolemic relaxation time (P =.02) and mitral deceleration time (P =.08), which indicate an LV diastolic dysfunction that could be partially reversed by operation. LV systolic function (ejection fraction and shortening fraction) tended to be elevated in HPT (P =.07 and.06, respectively) and diminished after parathyroidectomy. There was a trend toward higher LV mass, especially among the men with HPT (P =.06), which was unchanged postoperatively. Conclusions. HPT couples to reversible signs of myocardial ischemia and LV dysfunctions with a possible increased risk of life-threatening arrhythmia. (Surgery 2000;128:895-902.)

Section snippets

Materials and methods

Thirty consecutive patients with HPT were collected from the referrals for parathyroid operation at the County Hospital of Sundsvall, Sweden. They consisted of 23 women and 7 men, and the overall age range was 33 to 80 years (Table I).The total serum calcium concentration was 2.7 to 3.9 mmol/L (mean, 2.97 ± 0.04 mmol/L; normal range, 2.20 to 2.60 mmol/L) and the intact serum PTH was 5.4 to 48.9 pmol/L (mean, 15.7 ± 1.7 pmol/L; normal range, 1.2-5.7 pmol/L). With random sampling from the

Results

Patients had significantly higher blood calcium and PTH values than the controls at enrollment, while there were no such differences when compared with the controls in the other biochemical variables, body mass index, or body surface area (Table I). All the patients became normocalcemic (mean serum calcium, 2.35 ± 0.02 mmol/L) at the 1-year follow-up, when there were significant reductions in serum calcium, PTH, and alkaline phosphatase values. The total wet weight of the excised, abnormal

Discussion

The current study shows that sporadic primary HPT is associated with hitherto unrecognized cardiovascular abnormalities, which include exercise-related rises in blood pressure, an increased number of ventricular extrasystoles, ST-segment depression, and impaired diastolic LV functions at rest. It should be emphasized that the material consisted of consecutive patients recruited in the clinical routine, who generally had biochemically unequivocal signs of HPT, rather large parathyroid adenomas,

Acknowledgements

We thank Peter Wessman, Mid Sweden Research and Development Center, for statistical advice.

References (25)

  • G Hedbäck et al.

    Increased risk of death from primary hyperparathyroidism—an update

    Eur J Clin Invest

    (1998)
  • A Piovesan et al.

    Left ventricular hypertrophy in primary hyperparathyroidism: effects of successful parathyroidectomy

    Clin Endocrinol

    (1999)
  • Cited by (77)

    • The etiology of preeclampsia

      2022, American Journal of Obstetrics and Gynecology
    • Primary hyperparathyroidism predicts hypertension: Results from the National Inpatient Sample

      2017, International Journal of Cardiology
      Citation Excerpt :

      However, Kepez et al. reported no significant difference in coronary artery calcification scores between patients with pHPT and age-gender-matched controls [21]. Similarly, several studies assessing left ventricular ejection fraction found no significant difference between pHPT patients and the general population [22–25]. An increased incidence of left ventricular hypertrophy, on the other hand, has been reported among the pHPT population [26–30].

    • Primary Hyperparathyroidism

      2015, Endocrinology: Adult and Pediatric
    • Non-traditional Manifestations of Primary Hyperparathyroidism

      2015, The Parathyroids: Basic and Clinical Concepts: Third Edition
    View all citing articles on Scopus
    *

    Supported by the Swedish Medical Research Council.

    **

    Reprint requests: Inga-Lena Nilsson, MD, Department of Surgery, Sundsvall Hospital, S-851 86 Sundsvall, Sweden.

    Surgery 2000;128:895-902.

    View full text