Journal of Endocrinological Investigation

, Volume 31, Issue 10, pp 925–931 | Cite as

Cardiovascular aspects of primary hyperparathyroidism

Short Review


Data concerning the cardiovascular manifestations of primary hyperparathyroidism (PHPT) are inconsistent, which is due, in part, to the decrease in disease severity over the last several decades. In areas where patients tend to be more symptomatic, data support the presence of cardiovascular findings including myocardial and vascular calcification as well as increased cardiovascular mortality. Data from the cohorts in whom the disease is characterized by mild hypercalcemia, suggest that clinically overt cardiovascular manifestations are unusual in PHPT. Recent data, however, support the presence of subtle cardiovascular manifestations in mild disease, such as changes in endothelial function as well as increased vascular stiffness and perhaps diastolic dysfunction. Left ventricular hypertrophy is a more consistent finding across a spectrum of disease severity, though this finding may be related to hypertension, which has long been associated with PHPT.


Cardiovascular mortality primary hyperparathyroidism 


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  1. 1.
    Albright F, Aub J, Bauer W. Hyperparathyroidism: a common and polymorphic condition as illustrated by seventeen proved cases from one clinic. JAMA 1934, 102: 1276–87.CrossRefGoogle Scholar
  2. 2.
    Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 1999, 341: 1249–55.PubMedCrossRefGoogle Scholar
  3. 3.
    Catellier MJ, Chua GT, Youmans G, Waller BF. Calcific deposits in the heart. Clin Cardiol 1990, 13: 287–94.PubMedCrossRefGoogle Scholar
  4. 4.
    Roberts WC, Waller BF. Effect of chronic hypercalcemia on the heart. An analysis of 18 necropsy patients. Am J Med 1981, 71: 371–84.Google Scholar
  5. 5.
    Symons C, Fortune F, Greenbaum RA, Dandona P. Cardiac hypertrophy, hypertrophic cardiomyopathy, and hyperparathyroidism—an association. Br Heart J 1985, 54: 539–42.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Stefenelli T, Wikman-Coffelt J, Wu ST, Parmley WW. Calcium-dependent fluorescence transients during ventricular fibrillation. Am Heart J 1990, 120: 590–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Campese VM. Calcium, parathyroid hormone, and blood pressure. Am J Hypertens 1989, 2 (Pt 2): 34S–44S.PubMedCrossRefGoogle Scholar
  8. 8.
    Suzuki T, Aoki K. Hypertensive effects of calcium infusion in subjects with normotension and hypertension. J Hypertens 1988, 6: 1003–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Ogino K, Burkhoff D, Bilezikian JP. The hemodynamic basis for the cardiac effects of parathyroid hormone (PTH) and PTH-related protein. Endocrinology 1995, 136: 3024–30.PubMedGoogle Scholar
  10. 10.
    Schlüter KD, Piper HM. Trophic effects of catecholamines and parathyroid hormone on adult ventricular cardiomyocytes. Am J Physiol 1992, 263 (6 Pt 2): H1739–46.PubMedGoogle Scholar
  11. 11.
    Palmér M, Adami HO, Bergström R, Akerström G, Ljunghall S. Mortality after surgery for primary hyperparathyroidism: a follow-up of 441 patients operated on from 1956 to 1979. Surgery 1987, 102: 1–7.PubMedGoogle Scholar
  12. 12.
    Ronni-Sivula H. Causes of death in patients previously operated on for primary hyperparathyroidism. Ann Chir Gynaecol 1985, 74: 13–8.PubMedGoogle Scholar
  13. 13.
    Hedbäck G, Tisell LE, Bengtsson BA, Hedman I, Oden A. Premature death in patients operated on for primary hyperparathyroidism. World J Surg 1990, 14: 829–35; discussion 836.PubMedCrossRefGoogle Scholar
  14. 14.
    Ljunghall S, Jakobsson S, Joborn C, Palmér M, Rastad J, Akerström G. Longitudinal studies of mild primary hyperparathyroidism. J Bone Miner Res 1991, 6 (Suppl 2): S111–6; discussion S121-4.PubMedGoogle Scholar
  15. 15.
    Hedbäck G, Odén A, Tisell LE. The influence of surgery on the risk of death in patients with primary hyperparathyroidism. World J Surg 1991, 15: 399–405; discussion 406-7.PubMedCrossRefGoogle Scholar
  16. 16.
    Söreide JA, van Heerden JA, Grant CS, Yau Lo C, Schleck C, Ilstrup DM. Survival after surgical treatment for primary hyperparathyroidism. Surgery 1997, 122: 1117–23.PubMedCrossRefGoogle Scholar
  17. 17.
    Wermers RA, Khosla S, Atkinson EJ, et al. Survival after the diagnosis of hyperparathyroidism: a population-based study. Am J Med 1998, 104: 115–22.PubMedCrossRefGoogle Scholar
  18. 18.
    Leifsson BG, Ahrén B. Serum calcium and survival in a large health screening program. J Clin Endocrinol Metab 1996, 81: 2149–53.PubMedGoogle Scholar
  19. 19.
    Nilsson IL, Yin L, Lundgren E, Rastad J, Ekbom A. Clinical presentation of primary hyperparathyroidism in Europe—nationwide cohort analysis on mortality from nonmalignant causes. J Bone Miner Res 2002, 17 (Suppl 2): N68–74.PubMedGoogle Scholar
  20. 20.
    Hedbäck G, Odén A. Increased risk of death from primary hyperparathyroidism—an update. Eur J Clin Invest 1998, 28: 271–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Lafferty FW. Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests. Arch Intern Med 1981, 141: 1761–6.Google Scholar
  22. 22.
    Nainby-Luxmoore JC, Langford HG, Nelson NC, Watson RL, Barnes TY. A case-comparison study of hypertension and hyperparathyroidism. J Clin Endocrinol Metab 1982, 55: 303–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Christensson T, Hellström K, Wengle B. Blood pressure in subjects with hypercalcaemia and primary hyperparathyroidism detected in a health screening programme. Eur J Clin Invest 1977, 7: 109–13.PubMedCrossRefGoogle Scholar
  24. 24.
    Ringe JD. Reversible hypertension in primary hyperparathyroidismpre- and posteroperative blood pressure in 75 cases. Klin Wochenschr 1984, 62: 465–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Rapado A. Arterial hypertension and primary hyperparathyroidism. Incidence and follow-up after parathyroidectomy. Am J Nephrol 1986, 6 (Suppl 1): 49–50.PubMedCrossRefGoogle Scholar
  26. 26.
    Sancho JJ, Rouco J, Riera-Vidal R, Sitges-Serra A. Long-term effects of parathyroidectomy for primary hyperparathyroidism on arterial hypertension. World J Surg 1992, 16: 732–5; discussion 736.PubMedCrossRefGoogle Scholar
  27. 27.
    Jones DB, Jones JH, Lloyd HJ, Lucas PA, Wilkins WE, Walker DA. Changes in blood pressure and renal function after parathyroidectomy in primary hyperparathyroidism. Postgrad Med J 1983, 59: 350–3.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Lind L, Jacobsson S, Palmér M, Lithell H, Wengle B, Ljunghall S. Cardiovascular risk factors in primary hyperparathyroidism: a 15-year follow-up of operated and unoperated cases. J Intern Med 1991, 230: 29–35.PubMedCrossRefGoogle Scholar
  29. 29.
    Sangal AK, Kevwitch M, Rao DS, Rival J. Hypomagnesemia and hypertension in primary hyperparathyroidism. South Med J 1989, 82: 1116–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Marone C, Beretta-Piccoli C, Weidmann P. Role of haemodynamics, catecholamines and renin in acute hypercalcaemic hypertension in man. Clin Sci (Lond) 1980, 59 (Suppl 6): 369s–71s.Google Scholar
  31. 31.
    Gennari C, Nami R, Gonnelli S. Hypertension and primary hyperparathyroidism: the role of adrenergic and renin-angiotensin-aldosterone systems. Miner Electrolyte Metab 1995, 21: 77–81.PubMedGoogle Scholar
  32. 32.
    Nilsson IL, Rastad J, Johansson K, Lind L. Endothelial vasodilatory function and blood pressure response to local and systemic hypercalcemia. Surgery 2001, 130: 986–90.PubMedCrossRefGoogle Scholar
  33. 33.
    Surawicz B. Role of electrolytes in etiology and management of cardiac arrhythmias. Prog Cardiovasc Dis 1966, 8: 364–86.PubMedCrossRefGoogle Scholar
  34. 34.
    Lind L, Ljunghall S. Serum calcium and the ECG in patients with primary hyperparathyroidism. J Electrocardiol 1994, 27: 99–103.PubMedCrossRefGoogle Scholar
  35. 35.
    Lind L, Ridefelt P, Rastad J, Akerström G, Ljunghall S. Cytoplasmic calcium regulation and the electrocardiogram in patients with primary hyperparathyroidism. Clin Physiol 1994, 14: 103–10.PubMedCrossRefGoogle Scholar
  36. 36.
    Nilsson IL, Aberg J, Rastad J, Lind L. Maintained normalization of cardiovascular dysfunction 5 years after parathyroidectomy in primary hyperparathyroidism. Surgery 2005, 137: 632–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Rosenqvist M, Nordenström J, Andersson M, Edhag OK. Cardiac conduction in patients with hypercalcaemia due to primary hyperparathyroidism. Clin Endocrinol (Oxf) 1992, 37: 29–33.CrossRefGoogle Scholar
  38. 38.
    Barletta G, De Feo ML, Del Bene R, et al. Cardiovascular effects of parathyroid hormone: a study in healthy subjects and normotensive patients with mild primary hyperparathyroidism. J Clin Endocrinol Metab 2000, 85: 1815–21.PubMedGoogle Scholar
  39. 39.
    Curione M, Letizia C, Amato S, et al. Increased risk of cardiac death in primary hyperparathyroidism: what is a role of electrical instability? Int J Cardiol 2007, 121: 200–2.PubMedCrossRefGoogle Scholar
  40. 40.
    Almqvist EG, Bondeson AG, Bondeson L, Nissborg A, Smedgård P, Svensson SE. Cardiac dysfunction in mild primary hyperparathyroidism assessed by radionuclide angiographyand echocardiography before and after parathyroidectomy. Surgery 2002, 132: 1126–32; discussion 1132.PubMedCrossRefGoogle Scholar
  41. 41.
    Dalberg K, Brodin LA, Juhlin-Dannfelt A, Farnebo LO. Cardiac function in primary hyperparathyroidism before and after operation. An echocardiographic study. Eur J Surg 1996, 162: 171–6.Google Scholar
  42. 42.
    Näppi S, Saha H, Virtanen V, et al. Left ventricular structure and function in primary hyperparathyroidism before and after parathyroidectomy. Cardiology 2000, 93: 229–33.PubMedCrossRefGoogle Scholar
  43. 43.
    Piovesan A, Molineri N, Casasso F, et al. Left ventricular hypertrophy in primary hyperparathyroidism. Effects of successful parathyroidectomy. Clin Endocrinol (Oxf) 1999, 50: 321–8.CrossRefGoogle Scholar
  44. 44.
    Stefenelli T, Abela C, Frank H, et al. Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up. J Clin Endocrinol Metab 1997, 82: 106–12.PubMedCrossRefGoogle Scholar
  45. 45.
    Stefenelli T, Globits S, Bergler-Klein J, Woloszczuk W, Längle F, Niederle B. Cardiac changes in patients with hypercalcemia. Wien Klin Wochenschr 1993, 105: 339–41.PubMedGoogle Scholar
  46. 46.
    Nuzzo V, Tauchmanovà L, Fonderico F, et al. Increased intima-media thickness of the carotid artery wall, normal blood pressure profile and normal left ventricular mass in subjects with primary hyperparathyroidism. Eur J Endocrinol 2002, 147: 453–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Nilsson IL, Aberg J, Rastad J, Lind L. Left ventricular systolic and diastolic function and exercise testing in primary hyperparathyroidism-effects of parathyroidectomy. Surgery 2000, 128: 895–902.PubMedCrossRefGoogle Scholar
  48. 48.
    Smith JC, Page MD, John R, et al. Augmentation of central arterial pressure in mild primary hyperparathyroidism. J Clin Endocrinol Metab 2000, 85: 3515–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Längle F, Abela C, Koller-Strametz J, et al. Primary hyperparathyroidism and the heart: cardiac abnormalities correlated to clinical and biochemical data. World J Surg 1994, 18: 619–24.PubMedCrossRefGoogle Scholar
  50. 50.
    Stefenelli T, Mayr H, Bergler-Klein J, Globits S, Woloszczuk W, Niederle B. Primary hyperparathyroidism: incidence of cardiac abnormalities and partial reversibility after successful parathyroidectomy. Am J Med 1993, 95: 197–202.PubMedCrossRefGoogle Scholar
  51. 51.
    Lind L, Skarfors E, Berglund L, Lithell H, Ljunghall S. Serum calcium: a new, independent, prospective risk factor for myocardial infarction in middle-aged men followed for 18 years. J Clin Epidemiol 1997, 50: 967–73.PubMedCrossRefGoogle Scholar
  52. 52.
    Vestergaard P, Mollerup CL, Frøkjaer VG, Christiansen P, Blichert-Toft M, Mosekilde L. Cardiovascular events before and after surgery for primary hyperparathyroidism. World J Surg 2003, 27: 216–22.PubMedCrossRefGoogle Scholar
  53. 53.
    Kamycheva E, Sundsfjord J, Jorde R. Serum parathyroid hormone levels predict coronary heart disease: the Tromsø study. Eur J Cardiovasc Prev Rehabil 2004, 11: 69–74.PubMedCrossRefGoogle Scholar
  54. 54.
    Rubin MR, Rundek T, McMahon DJ, Lee HS, Sacco RL, Silverberg SJ. Carotid artery plaque thickness is associated with increased serum calcium levels: The Northern Manhattan study. Atherosclerosis 2007, 194: 426–32.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Nilsson IL, Aberg J, Rastad J, Lind L. Endothelial vasodilatory dysfunction in primary hyperparathyroidism is reversed after parathyroidectomy. Surgery 1999, 126: 1049–55.PubMedCrossRefGoogle Scholar
  56. 56.
    Kosch M, Hausberg M, Vormbrock K, Kisters K, Rahn KH, Barenbrock M. Studies on flow-mediated vasodilation and intimamedia thickness of the brachial artery in patients with primary hyperparathyroidism. Am J Hypertens 2000, 13: 759–64.PubMedCrossRefGoogle Scholar
  57. 57.
    Kosch M, Hausberg M, Barenbrock M, Posadzy-Malaczynska A, Kisters K, Rahn KH. Arterial distensibility and pulse wave velocity in patients with primary hyperparathyroidism before and after parathyroidectomy. Clin Nephrol 2001, 55: 303–8.PubMedGoogle Scholar
  58. 58.
    Lumachi F, Ermani M, Frego M, et al. Intima-media thickness measurement of the carotid artery in patients with primary hyperparathyroidism. A prospective case-control study and long-term follow-up. In Vivo 2006, 20: 887–90.Google Scholar
  59. 59.
    Fallo F, Camporese G, Capitelli E, Andreozzi GM, Mantero F, Lumachi F. Ultrasound evaluation of carotid artery in primary hyperparathyroidism. J Clin Endocrinol Metab 2003, 88: 2096–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Brutsaert DL, Sys SU, Gillebert TC. Diastolic dysfunction in post-cardiac surgical management. J Cardiothorac Vasc Anesth 1993, 7 (Suppl 1): 18–20.PubMedCrossRefGoogle Scholar
  61. 61.
    Baykan M, Erem C, Erdogan T, et al. Assessment of left ventricular diastolic function and the Tei index by tissue Doppler imaging in patients with primary hyperparathyroidism. Clin Endocrinol (Oxf) 2007, 66: 483–8.Google Scholar
  62. 62.
    Georgiannos SN, Jenkins BJ, Goode AW. Cardiac output in asymptomatic primary hyperparathyroidism: a stigma of early cardiovascular dysfunction? Int Surg 1996, 81: 171–3.PubMedGoogle Scholar
  63. 63.
    Neunteufl T, Katzenschlager R, Abela C, et al. Impairment of endothelium-independent vasodilation in patients with hypercalcemia. Cardiovasc Res 1998, 40: 396–401.PubMedCrossRefGoogle Scholar
  64. 64.
    Kosch M, Hausberg M, Vormbrock K, et al. Impaired flow-mediated vasodilation of the brachial artery in patients with primary hyperparathyroidism improves after parathyroidectomy. Cardiovasc Res 2000, 47: 813–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Baykan M, Erem C, Erdogan T, et al. Impairment of flow mediated vasodilatation of brachial artery in patients with primary hyperparathyroidism. Int J Cardiovasc Imaging 2007, 23: 323–8.PubMedCrossRefGoogle Scholar
  66. 66.
    Fardella C, Rodriguez-Portales JA. Intracellular calcium and blood pressure: comparison between primary hyperparathyroidism and essential hypertension. J Endocrinol Invest 1995, 18: 827–32.PubMedCrossRefGoogle Scholar
  67. 67.
    Arnett DK, Evans GW, Riley WA. Arterial stiffness: a new cardiovascular risk factor? Am J Epidemiol 1994, 140: 669–82.PubMedGoogle Scholar
  68. 68.
    Rubin MR, Maurer MS, McMahon DJ, Bilezikian JP, Silverberg SJ. Arterial stiffness in mild primary hyperparathyroidism. J Clin Endocrinol Metab 2005, 90: 3326–30.PubMedCrossRefGoogle Scholar
  69. 69.
    Niederle B, Stefenelli T, Glogar D, Woloszczuk W, Roka R, Mayr H. Cardiac calcific deposits in patients with primary hyperparathyroidism: preliminary results of a prospective echocardiographic study. Surgery 1990, 108: 1052–6; discussion 1056-7.PubMedGoogle Scholar

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© Italian Society of Endocrinology (SIE) 2008

Authors and Affiliations

  1. 1.Division of EndocrinologyColumbia University College of Physicians & Surgeons New YorkNew YorkUSA

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