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World Journal of Surgery

, Volume 16, Issue 4, pp 732–735 | Cite as

Long-term effects of parathyroidectomy for primary hyperparathyroidism on arterial hypertension

  • J. J. Sancho
  • J. Rouco
  • R. Riera-Vidal
  • A. Sitges-Serra
Article

Abstract

The prevalence of arterial hypertension in primary hyperparathyroidism (PHPT) is higher than in the general population. With the aim of determining the evolution of hypertension associated with PHPT, we analyzed a group of 56 patients followed for a mean of 60 months (range 10–101 months) after successful parathyroidectomy for PHPT. The study group consisted of 16 men and 40 women. The mean age was 49±12 years (range 18–73 years). None of the patients had renal impairment. Two hypertensive patients died during the follow-up from complications related to their hypertension. Twelve (21.8%) patients were hypertensive before parathyroid surgery (systolic >160 mmHg and/or diastolic >90 mmHg). Pre-operative midregion serum parathyroid hormone concentration was higher in the hypertensive patients than in normotensive patients (2.7±2.4 vs 0.82±0.4 µiEq/l,p=0.018). Pre-operative creatinine clearance was lower in the hypertensive patients than in normotensive patients (65.4±27.5 vs 86.7±26 ml/min,p=0.002). There were no significant differences between normotensive and hypertensive patients in age, sex, body weight, clinical manifestations, weight of parathyroid tissue removed, and calcium metabolism, or in plasma concentrations of magnesium, uric acid, cholesterol, proteins, or albumin. During follow-up, none of the patients with pre-operative hypertension became normotensive, whereas 32% of the patients who were normotensive preoperatively developed clinical hypertension. The global prevalence of postoperative hypertension was thus 48%. The patients that developed hypertension after parathyroidectomy were followed for a longer period than the normotensive patients (76±17 vs 53±10 months,p=0.005), had a lower postoperative creatinine clearance (74±28 vs 90±25 mg/min,p=0.07), and higher cholesterol levels (6.2±1.5 vs 5.5±0.9 mmol/L,p=0.08). The pre-operative blood pressure recordings of patients who developed hypertension postoperatively were significantly higher than those of the patients who remained normotensive (131±11 vs 117±7 mmHg-systolic; 81±6 vs 73±5 mmHg-diastolic,p<0.001). The mechanism that raises blood pressure in some patients with PHPT appears to continue to exert its effect even long after parathyroidectomy. Hypertension seems to precede renal impairment in those patients.

Keywords

Primary Hyperparathyroidism Mese Parathyroid Tissue Raise Blood Pressure Calcio 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

La prévalence de l'hypertension artérielle (HT) est plus élevée lors d l'hyperparathyroïdie (PHPT) primaire que dans la population générale. Dans le but de déterminer l'évolution de l'HT au cours de la PHPT, nous avons analysé un groupe de 56 patients, suivis en moyenne pendant 60 mois (10–101 mois) après parathyroïdectomie efficace (PTX) pour hyperparathyroïdie primaire. Le groupe étudié comportait 16 hommes et 40 femmes. L'âge moyen PREOP était de 49±12 ans (18–73 ans). Aucun patient n'avait d'atteinte rénale. Deux patients hypertendus sont décédés de complications de leur HT pendant la période de suivi. Douze patients (21.8%, groupe HYPER-PRE) étaient hypertendus avant la PTX (systolique >160 mmHg et/ou diastolique >90 mmHg). La concentration sérique PREOP de parathormone était plus élevée dans le groupe HYPER-PRE que chez les patients hypertendus (2.7±2.4 vs 0.82±0.4 µiEq/ml,p=0.018). La clairance de la créatinine PREOP était plus basse dans le groupe HYPER-PRE que chez les patients normotendus (65.4±27.5 vs 86.7±26 ml/mn,p=0.002). Il n'y avait aucune différence PREOP entre les patients normo et hypertendus en ce qui concerne l'âge, le sexe, le poids, les signes cliniques, le poids des parathyroïdes enlevées, le métabolisme calcique aussi bien que les concentrations de magnésium, d'acide urique, de cholestérol, de protides ou d'albumine. Au cours du suivi, aucun patient du groupe HYPER-PRE n'est redevenu normotendu tanis que 32% des patients normotendus PREOP développèrent une HT clinique. La prévalence globale de l'HT POSTOP était donc de 48%. Les patients qui développèrent une HT après PTX (groupe HYPER-POST) ont été suivis penant une plus longue periode que le groupe NORMO-POST (76±17 vs 53±10 m,p=0.005), avaient une clairance de la créatinine POSTOP plus basse (74±28 vs 90±25 ml/mn,p=0.07) et un taux plus élevé de cholestérol (6.2±1.5 vs 5.5±0.9 mmol/l,p=0.08). La pression artérielle préopératoire du groupe HYPER-POST était significativement plus élevée que celle du groupe NORMO-POST (131±11 vs 117±7 mmHg-systolique; 81±6 vs 73±5 mmHg-diastolique,p<0.001). Le mécanisme qui élève la pression sanguine chez certains patients ayant une PHPT semble exercer son effet même longtemps après PTX. L'HT semble précéder l'atteinte rénale chez ces patients.

Resumen

La incidencia de hipertensión arterial (HT) en el hiperparatiroidismo primario (HPTP) es mayor que en la población general. Con el propósito de definir la evolución de la HT asociada con HPTP nos propusimos analizar un grupo de 56 pacientes seguidos durante un periodo de 60 meses (10–101 m) después de paratiroidectomía exitosa (PTX) realizada por HPTP. El grupo de pacientes estuvo formado por 16 hombres y 40 mujeres. La edad PREOP promedio fue 49±12 años (18–73 años). Ninguno de los pacientes presentaba alteración renal. Dos pacientes hipertensos murieron en el curso del seguimiento debido a complicaciones de su HT. Doce pacientes (21.8%, grupo HIPER-PRE) aparecían hipertensos antes de la PTX (Sistólica >160 mmHg y/o Diastdica >90 mmHg). La concentración sérica de parathormona apareció más alta en el grupo HIPER-PRE que en los pacientes normotensos (2.7±2.4 vs 0.82±0.4 µiEq/l,p=0.018). La depuración de creatinina PREOP apareció más baja en el grupo HIPER-PRE que en los pacientes normotensos (65.4±27.5 vs 86.7±26 ml/min,p=0.002). No se hallaron diferencias PREOP significativas entre los pacientes normotensos y los hipertensos en cuanto a edad, sexo, peso corporal, manifestaciones clínicas, peso de las paratiroides resecadas, metabolismo del calcio, y tampoco en cuanto a magnesio, ácido úrico, colesterol, proteínas o albúmina. En el curso del seguimiento ninguno de los pacientes con HT PREOP normalizó su tensión, en tanto que 32% de los pacientes PREOP normotensos desarrollaron HT clínica. La prevalencia global de la HT POSTOP fue pues de 48%. Los pacientes que desarrollaron HT después de PTX (grupo HIPER-POST) fueron seguidos por un periodo más largo que los NORMO-POST (76±17 vs 53±10 m,p=0.005), exhibieron una depuración de creatinina POSTOP más baja (74±28 vs 90±25 mg/min,p=0.07) y niveles de colesterol más elevados (6.2±1.5 vs 5.5±0.9 mmol/L,p=0.08). Los registros preoperatorios de la presión arterial en el grupo HIPER-POST aprarecieron significativamente más altos que los del grupo NORMO-POST (113±11 vs 117±7 mmHg-Sistólica; 816±6 vs 73±5 mmHg-Diastólica,p=<0.001). El mecanismo que produce la elevación de la presión arterial en algunos pacientes con HPTP parece ejercer su efecto en forma continua aún largo tiempo después de PTX. La HT parece preceder la alteración renal en tales pacientes.

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Copyright information

© the Société Internationale de Chirurgie 1992

Authors and Affiliations

  • J. J. Sancho
    • 1
    • 2
  • J. Rouco
    • 1
    • 2
  • R. Riera-Vidal
    • 1
    • 2
  • A. Sitges-Serra
    • 1
    • 2
  1. 1.Hospital Universitari del MarUniversitat Autònoma de BarcelonaBarcelonaSpain
  2. 2.Centro Médico PovisaVigoSpain

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