Abstract
Background
Primary hyperparathyroidism (pHPT) is associated with an increased mortality attributable to cardiovascular disease (CVD), suggested to be alleviated by surgery. The exact mechanism of the beneficial influence of parathyroidectomy on survival is unknown. Furthermore, studies suggest that there is no increased mortality compared to the mortality rate in the general population during recent years. This study therefore investigated relative survival (RS), as well overall mortality associated with the clinical and biochemical variables in patients undergoing operation for sporadic pHPT. Furthermore, the influence of surgery on biochemical variables associated with pHPT was analyzed.
Methods
A group of 323 patients with sporadic pHPT operated between September 1989 and July 2003 were followed from surgery over a 10-year period. The median and mean follow-up time was 69 and 70 months, respectively (range: 1–120 months). Relative survival (RS) was calculated, and the impact of clinical and biochemical variables on overall death were evaluated.
Results
Postoperatively, serum levels of triglycerides and uric acid decreased. Glucose levels and glomerular filtration rate remained unchanged. A decreased RS was evident during the latter part of the 10 year follow-up period. In the multivariate Cox-analysis, diabetes mellitus (hazard ratio [HR] = 2.8, 95%; confidence interval [CI] 1.2–6.7), and the combination of an increased level of serum uric acid and cardiovascular disease (CVD) (HR = 8.6, 95%; CI 1.5–49.7) was associated with a higher mortality. The increased risk of death was evident for patients with persistently increased levels of uric acid postoperatively (HR = 4.8, 95%; CI = 1.4–16.01)
Conclusions
Patients undergoing operation for pHPT had a decreased RS during a 10-year follow-up compared to the general population. This decrease in RS is associated with diabetes mellitus and increased levels of uric acid pre-and postoperatively.
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References
Nilsson IL, Yin L, Lundgren E, et al. (2002) Clinical presentation of primary hyperparathyroidism in Europe—nationwide cohort analysis on mortality from nonmalignant causes. J Bone Miner Res 17 Suppl 2:N68–74
Nilsson IL, Wadsten C, Brandt L, et al. (2004) Mortality in sporadic primary hyperparathyroidism: nationwide cohort study of multiple parathyroid gland disease. Surgery 136:981–987
Ogard CG, Engholm G, Almdal TP, et al. (2004) Increased mortality in patients hospitalized with primary hyperparathyroidism during the period 1977–1993 in Denmark. World J Surg 28:108–111
Palmer M, Adami HO, Bergstrom R, et al. (1987) Mortality after surgery for primary hyperparathyroidism: a follow-up of 441 patients operated on from 1956 to 1979. Surgery 102:1–7
Vestergaard P, Mosekilde L (2003) Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism. BMJ 327:530–534
Vestergaard P, Mollerup CL, Frokjaer VG, et al. (2003) Cardiovascular events before and after surgery for primary hyperparathyroidism. World J Surg 27:216–222
Hedback G, Oden A (1998) Increased risk of death from primary hyperparathyroidism—an update. Eur J Clin Invest 28:271–276
Leifsson BG, Ahren B (1996) Serum calcium and survival in a large health screening program. J Clin Endocrinol Metab 81:2149–2153
Lundgren E, Lind L, Palmer M, et al. (2001) Increased cardiovascular mortality and normalized serum calcium in patients with mild hypercalcemia followed up for 25 years. Surgery 130:978–985
Hedback G, Oden A, Tisell LE (1991) The influence of surgery on the risk of death in patients with primary hyperparathyroidism. World J Surg 15:399–405; discussion 406–407
Hedback G, Oden A (1998) Death risk factor analysis in primary hypeparathyroidism. Eur J Clin Invest 28:1011–1018
Bergenfelz A, Isaksson A, Ahren B (1994) Intraoperative monitoring of intact PTH during surgery for primary hyperparathyroidism. Langenbecks Arch Chir 379:50–53
World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension (1999) Guidelines Subcommittee. J Hypertens 17:151–183
Krutzen E, Back SE, Nilsson-Ehle I, et al. (1984) Plasma clearance of a new contrast agent, iohexol: a method for the assessment of glomerular filtration rate. J Lab Clin Med 104:955–961
Hedback G, Oden A, Tisell LE (1995) Parathyroid adenoma weight and the risk of death after treatment for primary hyperparathyroidism. Surgery 117:134–139
Hedback G, Oden A (1995) Clinical evaluation of total serum calcium in primary hyperparathyroidism and the risk of death after surgery. Eur J Clin Invest 25:48– 52
Ljunghall S, Palmer M, Akerstrom G, et al. (1983) Diabetes mellitus, glucose tolerance and insulin response to glucose in patients with primary hyperparathyroidism before and after parathyroidectomy. Eur J Clin Invest 13:373–377
Procopio M, Magro G, Cesario F, et al. (2002) The oral glucose tolerance test reveals a high frequency of both impaired glucose tolerance and undiagnosed type 2 diabetes mellitus in primary hyperparathyroidism. Diabet Med 19:958–961
Valdermarsson S, Leckstrom A, Westermark P, et al. (1996) Increased plasma levels of islet amyloid polypeptide in patients with primary hyperparathyroidism. Eur J Endocrinol 134:320–325
Hagstrom E, Lundgren E, Lithell H, et al. (2002) Normalized dyslipidaemia after parathyroidectomy in mild primary hyperparathyroidism: population-based study over five years. Clin Endocrinol (Oxf) 56:253–260
Lundgren E, Ljunghall S, Akerstrom G, et al. (1998) Case-control study on symptoms and signs of “asymptomatic” primary hyperparathyroidism. Surgery 124:980–985; discussion 985–986
Ljunghall S, Akerstrom G (1982) Urate metabolism in primary hyperparathyroidism. Urol Int 37:73–78
Pepersack T, Jabbour N, Fuss M, et al. (1989) Hyperuricemia and renal handling of urate in primary hyperparathyroidism. Nephron 53:349–352
Duh QY, Morris RC, Arnaud CD, et al. (1986) Decrease in serum uric acid level following parathyroidectomy in patients with primary hyperparathyroidism. World J Surg 10:729–736
Broulik PD, Stepan JJ, Pacovsky V (1987) Primary hyperparathyroidism and hyperuricaemia are associated but not correlated with indicators of bone turnover. Clin Chim Acta 170:195–200
Bolland MJ, Grey AB, Gamble GD, et al. (2005) Association between primary hyperparathyroidism and increased body weight: a meta-analysis. J Clin Endocrinol Metab 90:1525–1530
Prager R, Schernthaner G, Niederle B, et al. (1990) Evaluation of glucose tolerance, insulin secretion, and insulin action in patients with primary hyperparathyroidism before and after surgery. Calcif Tissue Int 46:1–4
Bannon MP, van Heerden JA, Palumbo PJ, et al. (1988) The relationship between primary hyperparathyroidism and diabetes mellitus. Ann Surg 207:430–433
Bickel C, Rupprecht HJ, Blankenberg S et al. (2002) Serum uric acid as an independent predictor of mortality in patients with angiographically proven coronary artery disease. Am J Cardiol 89:12–17
Fang J, Alderman MH (2000) Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971–1992. National Health and Nutrition Examination Survey. JAMA 283:2404–2410
Franse LV, Pahor M, Di Bari M, et al. (2000) Serum uric acid, diuretic treatment and risk of cardiovascular events in the Systolic Hypertension in the Elderly Program (SHEP). J Hypertens 18:1149–1154
Hoieggen A, Alderman MH, Kjeldsen SE, et al. (2004) The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney Int 65:1041–1049
Liese AD, Hense HW, Lowel H, et al. (1999) Association of serum uric acid with all-cause and cardiovascular disease mortality and incident myocardial infarction in the MONICA Augsburg cohort. World Health Organization Monitoring Trends and Determinants in Cardiovascular Diseases. Epidemiology 10:391–397
Verdecchia P, Schillaci G, Reboldi G, et al. (2000) Relation between serum uric acid and risk of cardiovascular disease in essential hypertension. The PIUMA study. Hypertension 36:1072–1078
Weir CJ, Muir SW, Walters MR, et al. (2003) Serum urate as an independent predictor of poor outcome and future vascular events after acute stroke. Stroke 34:1951–1956
Wong KY, MacWalter RS, Fraser HW, et al. (2002) Urate predicts subsequent cardiac death in stroke survivors. Eur Heart J 23:788–793
Baker JF, Krishnan E, Chen L, et al. (2005) Serum uric acid and cardiovascular disease: recent developments, and where do they leave us? Am J Med 118:816–826
Madsen TE, Muhlestein JB, Carlquist JF, et al. (2005) Serum uric acid independently predicts mortality in patients with significant, angiographically defined coronary disease. Am J Nephrol 25:45–49
Short RA, Johnson RJ, Tuttle KR (2005) Uric acid, microalbuminuria and cardiovascular events in high-risk patients. Am J Nephrol 25:36–44
Alderman M, Aiyer KJ (2004) Uric acid: role in cardiovascular disease and effects of losartan. Curr Med Res Opin 20:369–379
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Bergenfelz, A., Bladström, A., Their, M. et al. Serum Levels of Uric Acid and Diabetes Mellitus Influence Survival after Surgery for Primary Hyperparathyroidism: A Prospective Cohort Study. World J Surg 31, 1393–1400 (2007). https://doi.org/10.1007/s00268-007-9091-6
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DOI: https://doi.org/10.1007/s00268-007-9091-6