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Non classical complications of primary hyperparathyroidism.
I Chiodini1, E Cairoli1, S Palmieri2
1Unit for Bone Metabolism Diseases and Diabetes & Lab. of Endocrine and Metabolic Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Best Practice & Research. Clinical Endocrinology & Metabolism
|January 23, 2019
Summary
Primary hyperparathyroidism (PHPT) may affect multiple organ systems, but parathyroidectomy benefits are limited. Only left ventricular hypertrophy and some neuropsychological issues consistently improve after surgery for PHPT.
Area of Science:
- Endocrinology
- Internal Medicine
- Nephrology
Background:
- Primary hyperparathyroidism (PHPT) is linked to bone, kidney, and gastrointestinal issues.
- Emerging evidence suggests associations with cardiovascular, neuromuscular, articular complications, reduced quality of life, and increased cancer risk.
Purpose of the Study:
- To review the evidence on systemic complications of PHPT.
- To evaluate the impact of parathyroidectomy on these complications.
Main Methods:
- Systematic review of existing literature.
- Analysis of studies investigating PHPT and its sequelae.
- Assessment of outcomes following parathyroidectomy.
Main Results:
- Left ventricular hypertrophy is the only cardiovascular complication consistently improving post-parathyroidectomy; data on hypertension and vascular stiffness are inconsistent.
- Parathyroidectomy may improve neuropsychological and cognitive issues in moderate-severe PHPT, but evidence for mild PHPT is less clear.
- Effects on neuromuscular and articular complications remain unknown, and no studies show reduced cancer risk after surgery.
Conclusions:
- Cardiovascular and neuropsychological evaluations are not routinely recommended solely for PHPT.
- Cardiovascular disease, muscle weakness, or neuropsychological issues are not primary indications for parathyroidectomy.
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