title: FGF23, metabolic risk factors, and blood pressure in patients with primary hyperparathyroidism undergoing parathyroid adenomectomy.
abstract: BACKGROUND
  Fibroblast growth factor-23 (FGF23), a regulator of secretion of parathyroid hormone (PTH), is implicated in the development of cardiovascular disease. The role of FGF23 in primary hyperparathyroidism (pHPT) is unclear.
  
  
  METHODS
  A total of 150 consecutive patients with pHPT were examined with ambulatory blood pressure monitoring ((24h)ABP) before parathyroid adenomectomy (PTX). Blood samples were collected 6 ± 2 weeks before and 6 ± 2 weeks after PTX.
  
  
  RESULTS
  Plasma FGF23 levels decreased after PTX from a median of 45.2 pg/mL (interquartile range 37.6-54.8) to 36.8 pg/mL (26.7-48.7); P < .001. This postoperative decrease correlated with the decrease in ionized calcium (r = 0.24; P < .01). Greater FGF23 concentrations at baseline were associated with a greater weight of the adenoma and PTH levels, as well as with body mass index, triglycerides, and insulin levels and greater postoperative decreases in FGF23, ionized calcium, insulin growth-like factor 1, and insulin. FGF23 and PTH both correlated with greater blood pressures on (24h)ABP, especially at nighttime (r = 0.31 and r = 0.28; P ≤ .01), whereas after multivariate adjustment, only PTH remained independently associated with (24)ABP.
  
  
  CONCLUSIONS
  Circulating FGF23 is increased in pHPT and is associated independently with the metabolic risk profile. The long-term benefit of decreasing FGF23 in pHPT after PTX remains to be established.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Section of Endocrine Surgery, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden. Electronic address: inga-lena.nilsson@ki.se.
authors.forename: Inga-Lena
authors.initials: IL
authors.lastname: Nilsson
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sophie
authors.initials: S
authors.lastname: Norenstedt
authors.affiliation: Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Granath
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Zedenius
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Endocrinology, Metabolism and Diabetes, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Ylva
authors.initials: Y
authors.lastname: Pernow
authors.affiliation: Department of Clinical Science, Intervention and Technology, Renal Unit, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Tobias E
authors.initials: TE
authors.lastname: Larsson
mesh_terms: D000236:Adenoma / Q000097:blood / Q000601:surgery*; D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002118:Calcium / Q000097:blood; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D012307:Risk Factors
chemical_list: C000717427:FGF23 protein, human; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D002118:Calcium