Abstract
ContextMild primary hyperparathyroidism has been associated with increased body fat mass and unfavorable cardiovascular risk factors.ObjectiveTo assess the effect of parathyroidectomy on fat mass, glucose and lipid metabolism.Design, patients, interventions, main outcome measures119 patients previously randomized to observation (OBS; n = 58) or parathyroidectomy (PTX; n = 61) within the Scandinavian Investigation of Primary Hyperparathyroidism (SIPH) trial, an open randomized multicenter study, were included. Main outcome measures for this study were the differences in fat mass, markers for lipid and glucose metabolism between OBS and PTX 5 years after randomization.ResultsIn the OBS group, total cholesterol (Total-C) decreased from mean 5.9 (±1.1) to 5.6 (±1.0) mmol/L (P = 0.037) and LDL cholesterol (LDL-C) decreased from 3.7 (±1.0) to 3.3 (±0.9) mmol/L (P = 0.010). In the PTX group, the Total-C and LDL-C remained unchanged resulting in a significant between-group difference over time (P = 0.013 and P = 0.026, respectively). This difference was driven by patients who started with lipid-lowering medication during the study period (OBS: 5; PTX: 1). There was an increase in trunk fat mass in the OBS group, but no between-group differences over time. Mean 25(OH) vitamin D increased in the PTX group (P < 0.001), but did not change in the OBS group. No difference in parameters of glucose metabolism was detected.ConclusionIn mild PHPT, the measured metabolic and cardiovascular risk factors were not modified by PTX. Observation seems safe and cardiovascular risk reduction should not be regarded as a separate indication for parathyroidectomy based on the results from this study.
Highlights
Primary hyperparathyroidism (PHPT) is a common endocrine disease [1] and is characterized by hyperactivity in one or several parathyroid glands, raised levels of parathyroid hormone (PTH) and altered calcium homeostasis with increased calcium levels in the circulation
In the PTX group, the total cholesterol (Total-C) and low-density lipoprotein cholesterol (LDL-C) remained unchanged resulting in a significant between-group difference over time (P = 0.013 and P = 0.026, respectively)
There was an increase in trunk fat mass in the OBS group, but no between-group differences over time
Summary
Primary hyperparathyroidism (PHPT) is a common endocrine disease [1] and is characterized by hyperactivity in one or several parathyroid glands, raised levels of parathyroid hormone (PTH) and altered calcium homeostasis with increased calcium levels in the circulation. Mild PHPT is the predominant clinical phenotype in the western world. It is characterized by biochemical evidence of PHPT and absence of typical target organ involvement, such as nephrolithiasis and skeletal disease. Observational studies have demonstrated an association of increased calcium levels and PHPT to cardiovascular disease [2, 3]. PTH is a metabolically active hormone and elevated levels of PTH are associated with alterations in cardiac structure and function, cardiovascular risk factors and overweight [4, 5, 6, 7]. But not all, have demonstrated improvement of cardiovascular disease or risk factors after surgery [3, 8, 9]
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