Division of Oncological Endocrinology; Department of Medical Sciences, University of Turin, Turin, Italy.
Division of Endocrinology, Diabetes and Metabolism; Department of Medical Sciences, University of Turin, Turin, Italy.
Endocrine. 2024 Dec;86(3):1140-1147. doi: 10.1007/s12020-024-04063-0. Epub 2024 Oct 15.
Cardiometabolic disorders are non-classical complications of hypercalcemic primary hyperparathyroidism (HC-PHPT), but whether this risk connotes normocalcemic PHPT (NC-PHPT) remains to be elucidated. We investigated cardiometabolic alterations in both forms of PHPT, looking for their association with indices of disease activity.
Patients with HC-PHPT (n = 17), NC-PHPT (n = 17), and controls (n = 34) matched for age, sex, and BMI were assessed for glucose, lipid, blood pressure alterations, and history of cardiovascular events to perform a case-control study at an ambulatory referral center for Bone Metabolism Diseases.
NC-PHPT, in comparison to controls, showed similar glucose (mean ± SD, 88 ± 11 vs 95 ± 22 mg/dl), total cholesterol (199 ± 25 vs 207 ± 36 mg/dl), and systolic blood pressure levels (SBP, 132 ± 23 vs 132 ± 19 mmHg), together with a comparable frequency of glucose alterations (6% vs 9%), lipid disorders (41% vs 50%) and hypertension (53% vs 59%, p = NS for all comparisons). Conversely, all these abnormalities were more prevalent in HC-PHPT vs controls (p < 0.05). When compared to NC-PHPT, HC-PHPT showed higher glucose (113 ± 31 mg/dl), total cholesterol (238 ± 43 mg/dl), and SBP levels (147 ± 15 mmHg) as well as an increased frequency of glucose (41%) and lipid alterations (77%) and a higher number of cardiovascular events (18% vs 0%, p < 0.05 for all comparisons). Among indices of PHPT activity, calcium levels displayed a significant correlation with glucose (R = 0.46) and SBP values (R = 0.60, p < 0.05).
NC-PHPT is not associated with cardiovascular alterations. The predominant pathogenetic role of hypercalcemia in the development of cardiometabolic disorders could account for the absence of such alterations in NC-PHPT.
心脏代谢紊乱是非经典的甲状旁腺功能亢进（PHPT）的并发症，但这种风险是否与正常血钙性 PHPT（NC-PHPT）相关仍有待阐明。我们研究了两种 PHPT 形式的心脏代谢变化，寻找其与疾病活动指标的关联。
在一家骨代谢疾病门诊就诊中心，对 17 例 HC-PHPT 患者（n=17）、17 例 NC-PHPT 患者（n=17）和 34 名年龄、性别和 BMI 匹配的对照组进行了血糖、血脂、血压变化和心血管事件史的评估，以进行病例对照研究。
与对照组相比，NC-PHPT 显示出相似的血糖（平均值±标准差，88±11 与 95±22mg/dl）、总胆固醇（199±25 与 207±36mg/dl）和收缩压水平（SBP，132±23 与 132±19mmHg），且血糖变化（6%与 9%）、血脂异常（41%与 50%）和高血压（53%与 59%）的发生率相似（所有比较 p>0.05）。相反，所有这些异常在 HC-PHPT 与对照组之间更为常见（p<0.05）。与 NC-PHPT 相比，HC-PHPT 表现出更高的血糖（113±31mg/dl）、总胆固醇（238±43mg/dl）和 SBP 水平（147±15mmHg），以及更高的血糖（41%）和血脂异常（77%）发生率，以及更多的心血管事件（18%与 0%，所有比较 p<0.05）。在 PHPT 活动的指标中，钙水平与血糖（R=0.46）和 SBP 值（R=0.60，p<0.05）呈显著相关性。
NC-PHPT 与心血管改变无关。高钙血症在心脏代谢紊乱发展中的主要致病作用可能解释了 NC-PHPT 中不存在这种改变的原因。
