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Generation of Hypoparathyroid Rats via Carbon-Nanoparticle-Assisted Parathyroidectomy
Published on: July 14, 2023
Improvement of hypertension control and left-ventricular function after cure of primary hyperparathyroidism
Izabela Karwacka1, Piotr Kmieć1, Sonia Kaniuka-Jakubowska1
1Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Insights
Parathyroidectomy significantly lowers blood pressure and improves heart function in primary hyperparathyroidism patients. This surgery reduces hypertension and left-ventricular issues, enhancing overall cardiovascular health.
Area of Science:
- Endocrinology
- Cardiology
- Nephrology
Background:
- Primary hyperparathyroidism (PHPT) is linked to higher cardiovascular mortality.
- The impact of the renin-angiotensin-aldosterone system (RAAS) in PHPT's cardiovascular pathology is not fully understood.
- It remains unclear if parathyroidectomy (PTX) can alleviate hypertension (HT) and left-ventricular (LV) dysfunction in PHPT patients.
Purpose of the Study:
- To investigate the effects of successful PTX on blood pressure, LV structure, and function in PHPT patients.
- To assess changes in RAAS components and B-type natriuretic peptide following PTX.
- To determine if PTX mitigates hypertension and LV dysfunction in PHPT.
Main Methods:
- 45 hypercalcemic PHPT patients underwent laboratory tests and 24-hour ambulatory blood pressure monitoring (ABPM) before and after PTX.
- Transthoracic echocardiography (TTE) was performed pre- and six months post-PTX.
- Analysis included biochemical markers, BP, and echocardiographic parameters.
Main Results:
- Post-PTX, PHPT patients showed reduced calcemia and parathyroid hormone (PTH), with higher phosphatemia.
- In hypertensive patients, PTX led to significant reductions in 24-hour systolic and diastolic blood pressure (SBP/DBP) by 12/6 mmHg.
- TTE revealed decreased LV mass index and end-diastolic dimension, improved global longitudinal strain, and reduced left-atrium volume index in hypertensive patients post-PTX.
Conclusions:
- Successful PTX significantly reduces blood pressure in PHPT patients with hypertension.
- Parathyroidectomy mitigates left-ventricular hypertrophy and diastolic dysfunction in PHPT patients with HT.
- PTX improves systolic function in all PHPT patients, regardless of baseline blood pressure status.
Introduction:
Cardiovascular mortality is significantly higher in patients with primary hyperparathyroidism (PHPT) compared to the general population. The role of the renin-angiotensin-aldosterone system (RAAS) as a mediator of cardiovascular pathology in PHPT is unclear, as is the question whether successful parathyroidectomy (PTX) mitigates hypertension (HT), and left-ventricular (LV) dysfunction.
Methods:
In 45 consecutive, hypercalcemic PHPT patients (91% female, 20 normotensive, mean age 54.6 ± 14.6), laboratory examinations, and 24 h ambulatory blood pressure monitoring (ABPM) were performed before, one and six months after successful PTX, while transthoracic echocardiography (TTE) pre- and six months post-PTX.
Results:
Both in patients with normotension (NT) and HT, lower calcemia and parathyroid hormone (PTH) as well as higher phosphatemia were observed on follow-up, while B-type natriuretic peptide, aldosterone, plasma renin activity, and aldosterone-to-renin ratios were comparable. Six months post-PTX, only in patients with HT, median 24-hour SBP/DBP decreased by 12/6 mmHg, daytime SBP by 10, and nighttime DBP by 5 mmHg. Improvement in BP was observed in approximately 78% of patients with HT. Six months post-PTX, TTE revealed: 1) decrease in median LV mass index (by 2 g/m2) and end-diastolic dimension (by 3 mm) among patients with HT; 2) normalization of global longitudinal strain in 22% of patients (comparable between those with NT and HT); 3) a mean 12.7% reduction in left-atrium volume index among patients with HT, which underlay normalization of indeterminate diastolic function in 3 out of 6 patients with HT, who exhibited it at baseline (dysfunction persisted in 2).
Conclusions:
PTX was shown to significantly reduce BP, LV hypertrophy and diastolic dysfunction parameters in PHPT patients with HT, and improve systolic function in all PHPT patients.
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