Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism.
BACKGROUND
Mild primary hyperparathyroidism (pHPT) seems to have a good prognosis, and indications for active treatment (surgery) are widely discussed. The extraskeletal effects of PTH, such as insulin resistance, arterial hypertension, and cardiovascular (CV) risk, may however be reversible by operation.


OBJECTIVE
Our aim was to study biochemical markers of bone turnover, indices of the metabolic syndrome, and various risk markers for CV disease in patients with mild pHPT randomized to observation without surgery or operative treatment and followed for 2 yr.


METHODS
A total of 116 patients (mean age, 63 +/- 8 yr; 19 men and 97 women) who on May 1, 2008, had performed the 2-yr visit in a randomized study on mild pHPT (serum calcium at baseline, 2.69 +/- 0.11 mmol/liter) and where frozen samples were available from baseline and follow-up participated in the study.


RESULTS
Calcium and PTH levels were normalized after surgery, and biochemical markers of bone turnover decreased by 35%, followed by a significant increase in BMD in the spine (2.7%; P < 0.01) and femoral neck (1.1%; P < 0.02) compared with the observation group. No significant differences were observed between the groups for blood pressure, markers of insulin resistance, detailed cholesterol metabolism, adipokines, or parameters of inflammation and CV surrogate markers.


CONCLUSIONS
We observed expected effects on biochemical markers of bone turnover and bone mass after surgical treatment of mild pHPT, with stable values in the group randomized to observation. For a variety of measures of the metabolic syndrome, adipokines, and CV risk factors, no benefit of operative treatment could be demonstrated. Neither did we observe any deleterious effects of conservative management in the 2-yr perspective.
Bollerslev
Jens
J
Section of Endocrinology, Department of Medicine, Rikshospitalet, Oslo University Hospital, and University of Oslo, 0027 Oslo, Norway. jens.bollerslev@medisine.uio.no
Rosen
Thord
T
Mollerup
Charlotte L
CL
Nordenström
Jörgen
J
Baranowski
Marek
M
Franco
Celina
C
Pernow
Ylva
Y
Isaksen
Gunhild A
GA
Godang
Kristin
K
Ueland
Thor
T
Jansson
Svante
S
D054392:Adipokines / Q000097:blood; D000368:Aged; D015519:Bone Density; D001842:Bone and Bones / Q000473:pathology; D002118:Calcium / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology*; D016207:Cytokines / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010281:Parathyroid Hormone / Q000097:blood; D012307:Risk Factors; D014807:Vitamin D / Q000097:blood
D054392:Adipokines; D016207:Cytokines; D010281:Parathyroid Hormone; D014807:Vitamin D; D002118:Calcium