Table 2.
Studies evaluating hyperparathyroidism and metabolic syndrome
| Study | Year | Disease | Population | Age (years) | Variables | Results | |
|---|---|---|---|---|---|---|---|
| Lundgren et al. [20] | Prospective case–control study | 2001 | Hypercalcemic hyperparathyroidism | 172 hypercalcemic patients, 344 normocalcemic controls | 28–86 | Serum calcium, serum PTH, CV causes of death | CV diseases were significantly over-represented as causes of death in the hypercalcemic patients |
| Tran et al. [23] | Cross-sectional review of records | 2014 | Primary hyperparathyroidism | 247 patients with hyperparathyroidism (123 obese and 124 non obese) | 57 ± 10 | Serum PTH, obesity (BMI ≥ 30 kg/m2), nephrolithiasis and osteoporosis | Obesity is a risk factor for hypercalciuria and nephrolithiasis and is protective against osteoporosis in hyperparathyroidism patients |
| Yuan et al. [24] | Cross-sectional study | 2021 | Primary hyperparathyroidism | 192 patients with hyperparathyroidism, 202 controls | 55 (46–63) in hyperparathyroidism population, 49 (38–59) in controls | Serum calcium, 25OH-D, PTH, lipids profiles; bone mineral density; fat distribution | Inverted U-shape relationship between PTH and body weight and BMI |
| Khaleeli et al. [26] | Prospective observational study | 2006 | Primary hyperparathyroidism | 54 patients with hyperparathyroidism | 65 ± 11 | Serum calcium, PTH, 75 g OGTT before and after surgery | After successful parathyroidectomy fasting and 2-h plasma glucose fall significantly; DM and IGT/IFG often ameliorates to IGT or NGT |
| Kumar et al. [28] | Cross-sectional study | 1993 | Primary hyperparathyroidism | 19 patients with hyperparathyroidism, 11 age and BMI matched controls | 54 (41–59) in hyperparathyroidism population, 54 (42–61) in controls | Serum calcium, PTH, plasma glucose and C-peptide before and after glucose infusion | Insulin insensitivity is present in hyperparathyroidism and may be the cause of glucose intolerance and diabetes |
| Procopio et al | Observational case–control study | 2002 | Primary hyperparathyroidism | 59 patients with hyperparathyroidism and no DM, 60 controls | 59 (55.3–62.2) in hyperparathyroidism population, 57 (50.8–60.1) in controls | Serum calcium, PTH, 75 g OGTT | Increased insulin resistance and prevalence of IGT and undiagnosed diabetes in hyperparathyroidism patients |
| Ejlsmark-Svensson et al. [29] | Randomized clinical trial | 2019 | Primary hyperparathyroidism | 79 patients with hyperparathyroidism | 64 (56–69) | 24-h BP and fasting plasma cholesterol levels at baseline and 3 months after surgery | PTX may decrease risk of CV diseases in hyperparathyroidism by lowering total cholesterol levels; ambulatory diastolic BP increases in response to surgery |
| Norenstedt et al. [30] | Randomized double-blind clinical trial | 2013 | Primary hyperparathyroidism | 150 patients with hyperparathyroidism | 60 (30–80) | Metabolic profile, blood pressure and 25OH-D at baseline and 12 months after surgery | PTX proved effective in reducing insulin resistance |
| Hagström et al. [31] | Observational case–control study | 2001 | Primary hyperparathyroidism | 87 patients with hyperparathyroidism, 87 controls | 66.7 ± 5.74 in hyperparathyroidism population, 66.9 ± 5.66 in controls | Serum lipids, lipoprotein fractions and influences of treatment for the parathyroid disease | Proatherosclerotic dyslipidemia characterizes mild hyperparathyroidism and is effectively reversed by PTX |
| Heyliger et al. [33] | Retrospective observational study | 2009 | Primary hyperparathyroidism | 368 patients with hyperparathyroidism | 52 ± 13 | Serum calcium, PTH, BP | PTX in hypertensive patients reduces both systolic and diastolic BP |
| Broulik et al. [34] | Retrospective observational study | 2011 | Primary hyperparathyroidism | 1020 patients with hyperparathyroidism, 1020 controls | 58 ± 14 in hyperparathyroidism population, 60 ± 15 in controls | BP | PTX in hypertensive patients reduce systolic and diastolic BP |
| Graff-Baker et al. [35] | Cohort study | 2019 | Primary hyperparathyroidism | 2380 patients with hyperparathyroidism, 501 with PTX and 1879 with no surgery | 65.3 ± 9.7 in PTX population, 71.9 ± 10.4 in no surgery population | BP and antihypertensive medications use | PTX is associated with decreases in BP and with reduced requirements for antihypertensive medications |
| Parfrey et al. [37] | Global, multicenter, randomized placebo-controlled trial | 2015 | Primary hyperparathyroidism | 3883 patients in hemodialysis and treatment with cinacalcet in two arms (< and ≥ 65 years) | 50 (32–61) in < 65 years arm, 71 (66–80) in ≥ 65 years arm | Death, major CV events | Cinacalcet decreased the risk of death and of major CV events in older, but not younger, patients with moderate to severe hyperparathyroidism receiving hemodialysis |
| Purra et al. [22] | Prospective case–control study | 2021 | Primary hyperparathyroidism | 100 patients with primary hyperparathyroidism and 113 controls | 48 ± 14 in hyperparathyroidism population, 50 ± 14 in controls | Echocardiographic parameters | Symptomatic patients with hyperparathyroidism have substantial cardiac structural and functional abnormalities |
| Forman et al. [44] | Cross-sectional study | 2010 | 25OH-D deficit | 184 normotensive individuals | 42.2 ± 9.5 in ≥ 30 ng/ml of 25OH-D; 40.0 ± 12.2 in 30–15 ng/ml of 25OH-D; 38.2 ± 13.5 in < 15 ng/ml of 25OH-D |
Plasma renin activity and angiotensin II and the renal plasma flow response to infused angiotensin II; 25OH-D |
Low plasma 25OH-D levels may result in upregulation of the RAS in otherwise healthy humans |
| Vaidya et al. [45] | Observational study | 2011 | 25OH-D deficit and obesity | 97 patients with hypertension | 46.8 ± 1.2 in non obese arm, 46.1 ± 1.5 in obese arm | Plasma renin activity, 25OH-D, BP | Vascular RAS activity may progressively increase when 25OH-D deficiency occurs in obesity |
| McMullan et al | Randomized, double-blind, placebo-controlled trial | 2017 | 25OH-D deficit | 93 patients | 39.3 ± 12.3 in vitamin D arm, 34.7 ± 11.3 in placebo arm | 25OH-D, BP, RAS | No benefit from correcting vitamin D deficiency on RAS activity or BP after 8 weeks |
| El Hilali et al. [46] | Population-based cohort study | 2015 | Secondary hyperparathyroidism | 1317 patients | 75 (70–81) | 25OH-D, PTH, CV mortality | Low serum 25OH-D is associated with overall mortality in older persons. High serum PTH is associated with a higher risk of overall mortality and CV mortality in older men |
PHT parathormone, 25OH-D 25-hydroxyvitamin D, BMI body mass index, BP blood pressure, DM diabetes mellitus, IGT impaired glucose tolerance, IFG impaired fasting glucose, NGT normal glucose tolerance, PTX parathyroidectomy, CV cardiovascular, RAS Renin-Angiotensin system