Early parathyroidectomy in mild primary hyperparathyroidism: Effects on heart and bones

Erik Almqvist

Early parathyroidectomy in mild primary hyperparathyroidism: Effects on heart and bones

Erik Almqvist

Surgery

Research output: Thesis › Doctoral Thesis (compilation)

Abstract

There is an ongoing controversy regarding how to take care of patients with mild primary hyperparathyroidism (PHPT). Some recommend surgical treatment at diagnosis, others just follow-up as long as there is no evidence of disease progression. The aim of this thesis was to evaluate cardiac and skeletal risk factors related to the duration of mild PHPT.

Fifty patients with mild PHPT were randomized to parathyroidectomy (PTX) either at diagnosis or 1 year later. The skeleton was examined using dual-energy X-ray absorptiometry and biochemical markers. Echocardiography, equilibrium radionuclide angiography (ERNA) and plasma NT-proBNP were used to evaluate cardiac structure and function.

Whereas bone mineral density (BMD) in the lumbar spine increased equally after PTX in both groups of patients, the group with an extra year of exposure to mild PHPT showed impaired ability to regain BMD in the hip. Surprisingly, the most important determinant of the increase in BMD after PTX in postmenopausal women was not the normalized serum level of parathyroid hormone or calcium, but a concomitant increase in circulating bioavailable testosterone.

At baseline, myocardial hypertrophy (a strong risk factor of premature death) was correlated to the serum concentration of parathyroid hormone but not to the level of serum calcium. At the end of the study, the patients who had delayed PTX showed significant increase of left ventricular hypertrophy, in contrast to the group treated immediately. After PTX, a transient dip occurred in heart function parameters measured by ERNA. This dip was subclinical and had no influence on exercise capacity. Abnormal cardiac secretion of NT-proBNP substantiated the observations made by ERNA.

In conclusion, these results obtained by a prospective and randomized study design, show that early PTX has favourable effects on heart and bones in patients with mild PHPT. Thus, PHPT should be treated surgically without delay irrespective of serum calcium level.

Original language	English
Qualification	Doctor
Awarding Institution	Surgery
Supervisors/Advisors	Bondeson, Anne-Greth, Supervisor
Award date	2006 Oct 12
Publisher	Department of Surgery, Malmö University Hospital, Lund University
ISBN (Print)	91-85559-34-2
Publication status	Published - 2006

Bibliographical note

Defence details

Date: 2006-10-12
Time: 14:00
Place: Föreläsningssalen, Kirurgiska kliniken, Universitetsjukhuset MAS, Malmö

External reviewer(s)

Name: Smeds, Staffan
Title: Professor
Affiliation: Sergelkliniken, Linköping

---

<div class="article_info">Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson and Johan Svensson. 2004. Early parathyroidectomy increases bone mineral density in patients with mild primary hyperparathyroidism. A prospective and randomized study. Surgery, vol 136 pp 1281-1288. Elesevier Inc.</div>
<div class="article_info">Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson and Johan Svensson. 2006. Increase of bioavailable testosterone is associated with gain in bone mineral density after cure of primary hyperparathyroidism in postmenopausal women. Clinical Endocrinology, vol 64 pp 58-62. Blackwell Publishing Ltd</div>
<div class="article_info">Erik Almqvist, Anne-Greth Bondeson, Lennart Bondeson, Anders Nissborg, Peter Smedgård and Sven-Eric Svensson. 2002. Cardiac dysfunction in mild primary hyperparathyroidism assessed by radionuclide angiography and echocardiography before and after parathyroidectomy. Surgery, vol 132 pp 1126-1132. Mosby Inc,</div>
<div class="article_info">Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson, Johan Svensson and Sven-Eric Svensson. 2006. Increased plasma concentrations of N-terminal pro-B-type natriuretic peptide in patients with mild primary hyperparathyroidism. Clinical Endocrinology, Blackwell Publishing Ltd (inpress)</div>

Subject classification (UKÄ)

Surgery

Free keywords

parathyroidectomy
hyperparathyroidism
bone metabolism
testosterone
myocardial hypertrophy
cardiac function
echocardiography
radionuclide angiography
natriuretic peptide
Surgery
orthopaedics
traumatologi
ortopedi
traumatology
Kirurgi

2 Article

Increased plasma concentrations of N-terminal pro-B-type natriuretic peptide in patients with mild primary hyperparathyroidism
Almqvist, E., Becker, C., Bondeson, A.-G., Bondeson, L., Svensson, J. & Svensson, S.-E., 2006, In: Clinical Endocrinology. 65, 6, p. 760-766
Research output: Contribution to journal › Article › peer-review
Increase of bioavailable testosterone is associated with gain in bone mineral density after cure of primary hyperparathyroidism in postmenopausal women
Almqvist, E., Becker, C., Bondeson, A.-G., Bondeson, L. & Svensson, J., 2006, In: Clinical Endocrinology. 64, 1, p. 58-62
Research output: Contribution to journal › Article › peer-review

Cite this

@phdthesis{3dee81d782554f46b36394ffab2f430c,

title = "Early parathyroidectomy in mild primary hyperparathyroidism: Effects on heart and bones",

abstract = "There is an ongoing controversy regarding how to take care of patients with mild primary hyperparathyroidism (PHPT). Some recommend surgical treatment at diagnosis, others just follow-up as long as there is no evidence of disease progression. The aim of this thesis was to evaluate cardiac and skeletal risk factors related to the duration of mild PHPT. Fifty patients with mild PHPT were randomized to parathyroidectomy (PTX) either at diagnosis or 1 year later. The skeleton was examined using dual-energy X-ray absorptiometry and biochemical markers. Echocardiography, equilibrium radionuclide angiography (ERNA) and plasma NT-proBNP were used to evaluate cardiac structure and function. Whereas bone mineral density (BMD) in the lumbar spine increased equally after PTX in both groups of patients, the group with an extra year of exposure to mild PHPT showed impaired ability to regain BMD in the hip. Surprisingly, the most important determinant of the increase in BMD after PTX in postmenopausal women was not the normalized serum level of parathyroid hormone or calcium, but a concomitant increase in circulating bioavailable testosterone. At baseline, myocardial hypertrophy (a strong risk factor of premature death) was correlated to the serum concentration of parathyroid hormone but not to the level of serum calcium. At the end of the study, the patients who had delayed PTX showed significant increase of left ventricular hypertrophy, in contrast to the group treated immediately. After PTX, a transient dip occurred in heart function parameters measured by ERNA. This dip was subclinical and had no influence on exercise capacity. Abnormal cardiac secretion of NT-proBNP substantiated the observations made by ERNA. In conclusion, these results obtained by a prospective and randomized study design, show that early PTX has favourable effects on heart and bones in patients with mild PHPT. Thus, PHPT should be treated surgically without delay irrespective of serum calcium level.",

keywords = "parathyroidectomy, hyperparathyroidism, bone metabolism, testosterone, myocardial hypertrophy, cardiac function, echocardiography, radionuclide angiography, natriuretic peptide, Surgery, orthopaedics, traumatologi, ortopedi, traumatology, Kirurgi",

author = "Erik Almqvist",

note = "Defence details Date: 2006-10-12 Time: 14:00 Place: F{\"o}rel{\"a}sningssalen, Kirurgiska kliniken, Universitetsjukhuset MAS, Malm{\"o} External reviewer(s) Name: Smeds, Staffan Title: Professor Affiliation: Sergelkliniken, Link{\"o}ping --- <div class={"}article_info{"}>Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson and Johan Svensson. 2004. Early parathyroidectomy increases bone mineral density in patients with mild primary hyperparathyroidism. A prospective and randomized study. Surgery, vol 136 pp 1281-1288. Elesevier Inc.</div> <div class={"}article_info{"}>Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson and Johan Svensson. 2006. Increase of bioavailable testosterone is associated with gain in bone mineral density after cure of primary hyperparathyroidism in postmenopausal women. Clinical Endocrinology, vol 64 pp 58-62. Blackwell Publishing Ltd</div> <div class={"}article_info{"}>Erik Almqvist, Anne-Greth Bondeson, Lennart Bondeson, Anders Nissborg, Peter Smedg{\aa}rd and Sven-Eric Svensson. 2002. Cardiac dysfunction in mild primary hyperparathyroidism assessed by radionuclide angiography and echocardiography before and after parathyroidectomy. Surgery, vol 132 pp 1126-1132. Mosby Inc,</div> <div class={"}article_info{"}>Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson, Johan Svensson and Sven-Eric Svensson. 2006. Increased plasma concentrations of N-terminal pro-B-type natriuretic peptide in patients with mild primary hyperparathyroidism. Clinical Endocrinology, Blackwell Publishing Ltd (inpress)</div>",

year = "2006",

language = "English",

isbn = "91-85559-34-2",

publisher = "Department of Surgery, Malm{\"o} University Hospital, Lund University",

type = "Doctoral Thesis (compilation)",

school = "Surgery",

}

TY - THES

T1 - Early parathyroidectomy in mild primary hyperparathyroidism: Effects on heart and bones

AU - Almqvist, Erik

N1 - Defence details Date: 2006-10-12 Time: 14:00 Place: Föreläsningssalen, Kirurgiska kliniken, Universitetsjukhuset MAS, Malmö External reviewer(s) Name: Smeds, Staffan Title: Professor Affiliation: Sergelkliniken, Linköping --- <div class="article_info">Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson and Johan Svensson. 2004. Early parathyroidectomy increases bone mineral density in patients with mild primary hyperparathyroidism. A prospective and randomized study. Surgery, vol 136 pp 1281-1288. Elesevier Inc.</div> <div class="article_info">Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson and Johan Svensson. 2006. Increase of bioavailable testosterone is associated with gain in bone mineral density after cure of primary hyperparathyroidism in postmenopausal women. Clinical Endocrinology, vol 64 pp 58-62. Blackwell Publishing Ltd</div> <div class="article_info">Erik Almqvist, Anne-Greth Bondeson, Lennart Bondeson, Anders Nissborg, Peter Smedgård and Sven-Eric Svensson. 2002. Cardiac dysfunction in mild primary hyperparathyroidism assessed by radionuclide angiography and echocardiography before and after parathyroidectomy. Surgery, vol 132 pp 1126-1132. Mosby Inc,</div> <div class="article_info">Erik Almqvist, Charlotte Becker, Anne-Greth Bondeson, Lennart Bondeson, Johan Svensson and Sven-Eric Svensson. 2006. Increased plasma concentrations of N-terminal pro-B-type natriuretic peptide in patients with mild primary hyperparathyroidism. Clinical Endocrinology, Blackwell Publishing Ltd (inpress)</div>

PY - 2006

Y1 - 2006

N2 - There is an ongoing controversy regarding how to take care of patients with mild primary hyperparathyroidism (PHPT). Some recommend surgical treatment at diagnosis, others just follow-up as long as there is no evidence of disease progression. The aim of this thesis was to evaluate cardiac and skeletal risk factors related to the duration of mild PHPT. Fifty patients with mild PHPT were randomized to parathyroidectomy (PTX) either at diagnosis or 1 year later. The skeleton was examined using dual-energy X-ray absorptiometry and biochemical markers. Echocardiography, equilibrium radionuclide angiography (ERNA) and plasma NT-proBNP were used to evaluate cardiac structure and function. Whereas bone mineral density (BMD) in the lumbar spine increased equally after PTX in both groups of patients, the group with an extra year of exposure to mild PHPT showed impaired ability to regain BMD in the hip. Surprisingly, the most important determinant of the increase in BMD after PTX in postmenopausal women was not the normalized serum level of parathyroid hormone or calcium, but a concomitant increase in circulating bioavailable testosterone. At baseline, myocardial hypertrophy (a strong risk factor of premature death) was correlated to the serum concentration of parathyroid hormone but not to the level of serum calcium. At the end of the study, the patients who had delayed PTX showed significant increase of left ventricular hypertrophy, in contrast to the group treated immediately. After PTX, a transient dip occurred in heart function parameters measured by ERNA. This dip was subclinical and had no influence on exercise capacity. Abnormal cardiac secretion of NT-proBNP substantiated the observations made by ERNA. In conclusion, these results obtained by a prospective and randomized study design, show that early PTX has favourable effects on heart and bones in patients with mild PHPT. Thus, PHPT should be treated surgically without delay irrespective of serum calcium level.

AB - There is an ongoing controversy regarding how to take care of patients with mild primary hyperparathyroidism (PHPT). Some recommend surgical treatment at diagnosis, others just follow-up as long as there is no evidence of disease progression. The aim of this thesis was to evaluate cardiac and skeletal risk factors related to the duration of mild PHPT. Fifty patients with mild PHPT were randomized to parathyroidectomy (PTX) either at diagnosis or 1 year later. The skeleton was examined using dual-energy X-ray absorptiometry and biochemical markers. Echocardiography, equilibrium radionuclide angiography (ERNA) and plasma NT-proBNP were used to evaluate cardiac structure and function. Whereas bone mineral density (BMD) in the lumbar spine increased equally after PTX in both groups of patients, the group with an extra year of exposure to mild PHPT showed impaired ability to regain BMD in the hip. Surprisingly, the most important determinant of the increase in BMD after PTX in postmenopausal women was not the normalized serum level of parathyroid hormone or calcium, but a concomitant increase in circulating bioavailable testosterone. At baseline, myocardial hypertrophy (a strong risk factor of premature death) was correlated to the serum concentration of parathyroid hormone but not to the level of serum calcium. At the end of the study, the patients who had delayed PTX showed significant increase of left ventricular hypertrophy, in contrast to the group treated immediately. After PTX, a transient dip occurred in heart function parameters measured by ERNA. This dip was subclinical and had no influence on exercise capacity. Abnormal cardiac secretion of NT-proBNP substantiated the observations made by ERNA. In conclusion, these results obtained by a prospective and randomized study design, show that early PTX has favourable effects on heart and bones in patients with mild PHPT. Thus, PHPT should be treated surgically without delay irrespective of serum calcium level.

KW - parathyroidectomy

KW - hyperparathyroidism

KW - bone metabolism

KW - testosterone

KW - myocardial hypertrophy

KW - cardiac function

KW - echocardiography

KW - radionuclide angiography

KW - natriuretic peptide

KW - Surgery

KW - orthopaedics

KW - traumatologi

KW - ortopedi

KW - traumatology

KW - Kirurgi

M3 - Doctoral Thesis (compilation)

SN - 91-85559-34-2

PB - Department of Surgery, Malmö University Hospital, Lund University

ER -

Early parathyroidectomy in mild primary hyperparathyroidism: Effects on heart and bones

Abstract

Bibliographical note

Subject classification (UKÄ)

Free keywords

Fingerprint

Research output

Increased plasma concentrations of N-terminal pro-B-type natriuretic peptide in patients with mild primary hyperparathyroidism

Increase of bioavailable testosterone is associated with gain in bone mineral density after cure of primary hyperparathyroidism in postmenopausal women

Cite this