Is primary hyperparathyroidism a cause of endothelial dysfunction?

Summary

Objective

Symptomatic primary hyperparathyroidism (PHPT) is thought to be related to increased cardiovascular morbidity and mortality. In our study, we aimed to investigate endothelial dysfunction and markers of subclinical atherosclerosis in PHPT patients. Also we aimed to demonstrate the effect of vitamin D supplementation on these parameters.

Materials and methods

Twenty-nine patients followed by medical treatment (A), 25 preoperative (B) and 23 postoperative patients with PHPT (C), and 26 normocalcemic subjects (D) were included. Groups were assessed by measurements of flow-mediated dilation (FMD), carotid intima-media thickness (CIMT), serum levels of sCD40L, high-sensitivity CRP (hs-CRP), and interleukin-8 (IL-8). Thirteen patients with low levels of 25-hydroxy-vitamin D (25OHD) in the medical treatment group were assessed before and 3 months after vitamin D replacement.

Results

The median FMD was 5% in group A, 5.1% in group B, 7.6% in group C, and 7.7% in group D. The FMD measurement in group A was significantly lower than groups C and D (P = 0.02) and was similar to the FMD measurement in group B. FMD measurements of group B were not significantly lower than groups C and D. In 13 patients with low 25OHD in group A, the median FMD increased to 7.07% from 4.71% after vitamin D replacement (P = 0.02).

Conclusion

FMD was impaired in PHPT patients, particularly in the medically observed group. Vitamin D supplementation seems to provide improvements in FMD in medically observed PHPT patients with low 25OHD levels and this was the novel observation of our study.

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