<p>Cardiovascular risk in primary hyperparathyroidism (HPT) is controversial, and studies mainly from Europe associate HPT with increased cardiovascular morbidity and mortality. Cardiovascular morphology and function were evaluated prospectively in 31 consecutive HPT patients (mean serum calcium 2.97±0.04) and randomly enrolled controls matched for age and sex. Patients were re-examined at normocalcemia about one year after parathyroidectomy. </p><p>HPT patients showed an operatively reversible disturbance in endothelial vasodilatory function that seemed unrelated to an early sign of atherosclerosis, i.e. thickness of carotid artery intima-media complex. Acute hypercalcemia in healthy subjects induced a similar impairment in endothelial function, which suggests a dependence on biochemical rather than structural vascular changes in HPT. Echocardiography showed left ventricular diastolic dysfunction and supernormal systolic performance being reversed after operation. Left ventricular mass tended to be irreversibly increased. During exercise HPT patients exhibited greater rise in systolic blood pressure compared to controls and an increased number of premature ventricular beats. This indicated increased work load and a propensity for fatal cardiac events. Following surgery, an improvement with less pronounced ST-segment depression was seen. 24-hour ambulatory blood pressure monitoring showed irreversibly increased levels despite maintained diurnal rhythm, while 24-hour heart rate variability analysis displayed blunted nocturnal increase of low and very low frequency bands that was corrected postoperatively. </p><p>Parathyroidectomy seems to alleviate most of the cardiovascular disturbances in HPT, except for hypertension. This is consistent with the normalised longevity in HPT treated with parathyroidectomy and supports active treatment of HPT. </p>

Cardiovascular risk in primary hyperparathyroidism (HPT) is controversial, and studies mainly from Europe associate HPT with increased cardiovascular morbidity and mortality. Cardiovascular morphology and function were evaluated prospectively in 31 consecutive HPT patients (mean serum calcium 2.97±0.04) and randomly enrolled controls matched for age and sex. Patients were re-examined at normocalcemia about one year after parathyroidectomy. HPT patients showed an operatively reversible disturbance in endothelial vasodilatory function that seemed unrelated to an early sign of atherosclerosis, i.e. thickness of carotid artery intima-media complex. Acute hypercalcemia in healthy subjects induced a similar impairment in endothelial function, which suggests a dependence on biochemical rather than structural vascular changes in HPT. Echocardiography showed left ventricular diastolic dysfunction and supernormal systolic performance being reversed after operation. Left ventricular mass tended to be irreversibly increased. During exercise HPT patients exhibited greater rise in systolic blood pressure compared to controls and an increased number of premature ventricular beats. This indicated increased work load and a propensity for fatal cardiac events. Following surgery, an improvement with less pronounced ST-segment depression was seen. 24-hour ambulatory blood pressure monitoring showed irreversibly increased levels despite maintained diurnal rhythm, while 24-hour heart rate variability analysis displayed blunted nocturnal increase of low and very low frequency bands that was corrected postoperatively. Parathyroidectomy seems to alleviate most of the cardiovascular disturbances in HPT, except for hypertension. This is consistent with the normalised longevity in HPT treated with parathyroidectomy and supports active treatment of HPT.

INTRODUÇÃO: Hiperparatireoidismo primário (HPT) é uma doença endócrina relativamente comum, caracterizada por hipercalcemia associada a concentrações de PTH elevadas ou inapropriadamente normais. A maioria dos pacientes (90%-95%) apresenta a forma esporádica da doença, enquanto a forma familiar pode ocorrer associada à neoplasia endócrina múltipla tipo 1 (NEM1) e tipo 2, HPT-tumor de mandíbula, HPT neonatal severo e HPT isolada familiar. HPT associado com NEM1 (HPT/NEM1) difere da forma esporádica em vários aspectos, entre eles: acometimento multiglandular das paratireóides (hiperplasia x adenoma); início da doença mais precoce (20 x 40 anos); afeta homens e mulheres em proporção semelhante (1:1), em contraste a 1:3 no HPT esporádico; diferentes tratamentos cirúrgicos (paratireoidectomia total ou subtotal x adenomectomia); maior taxa de recorrência após paratireoidectomia (PTx); e tende a ser menos agressivo que o HPT esporádico. No HPT esporádico, o perfil da perda mineral óssea e o impacto do tratamento cirúrgico na densidade mineral óssea (DMO) estão bem definidos. Por outro lado, dados sobre perda óssea no HPT/NEM1 e sua potencial recuperação após PTx são escassamente relatados. O objetivo deste estudo é avaliar o perfil densitométrico e o impacto do tratamento cirúrgico na DMO em pacientes com HPT/NEM1. MÉTODOS: Neste estudo, avaliamos inicialmente 36 pacientes (18 homens e 18 mulheres) com diagnóstico de HPT/NEM1 (média de idade ao diagnóstico de HPT de 38,99 ± 14.46 anos, 20-74 anos). Estes pacientes pertenciam a oito famílias não relacionadas previamente caracterizadas clinicamente e portadoras de mutações germinativas MEN1. Avaliamos a DMO no terço proximal do rádio distal (1/3 RD), fêmur (colo do fêmur e fêmur total) e coluna lombar (L1-L4) destes 36 pacientes. A DMO foi medida pela densitometria óssea de dupla emissão com fonte de raios X (DXA) e os valores expressos em índice T, índice Z e em valores absolutos (g/cm2). Após esta avaliação da DMO, vinte e quatro pacientes foram submetidos à paratireoidectomia total seguida por auto-implante em antebraço não dominante. Em um grupo selecionado de 16 pacientes foi avaliada a densidade mineral óssea antes e após (período médio de 15 meses) o tratamento cirúrgico. RESULTADOS: Desmineralização óssea (osteoporose/osteopenia) foi observada no 1/3 RD (28/34, 79,4%); colo do fêmur (26/36, 72,7%) e na coluna lombar (25/36, 69,4%). Osteopenia foi principalmente observada no colo do fêmur (19/36, 52,8%), seguida pelo 1/3 RD (14/34, 41,2%) e coluna lombar (11/36, 30,5%). Osteoporose foi observada principalmente na coluna lombar (14/36, 38,9%) e 1/3 RD (14/34, 41,2%); enquanto no colo do fêmur (7/36, 19,4%) a prevalência foi menor . Valores médios de índice T estavam severamente reduzidos no 1/3 RD (- 2,46±1,436 DP), seguido pela coluna lombar (-2,05±1,539 DP). O colo do fêmur foi o menos afetado (-1,60±1,138 DP). Nos 16 pacientes submetidos ao tratamento cirúrgico, no período médio de 15 meses após PTx, a DMO (g/cm2) aumentou significativamente na coluna lombar de 0,843 para 0,909 g/cm2 (+ 8,4%; p=0,001). A DMO (g/cm2) no colo do fêmur também aumentou significativamente de 0,745 para 0,798 g/cm2 (+ 7,7%; p=0.0001). No 1/3 RD não houve modificação estatisticamente significante da DMO (0,627 ± 0,089 para 0,622 ± 0,075; p=0,76). CONCLUSÃO: Nossos dados demonstraram que o rádio distal é o sítio ósseo preferencial para desmineralização óssea e que a coluna lombar pode não estar relativamente protegida na HPT/MEN1, como descrito no HPT esporádico. Um aumento significante foi observado na coluna lombar e no colo do fêmur em pacientes com HPT/NEM1, em um período médio de 15 meses após paratireoidectomia; enquanto no terço proximal do radio distal, não houve melhora significativa durante este estudo / INTRODUTION: Primary hyperparathyroidism (HPT) is a relatively common endocrine disorder, which is characterized by hypercalcemia and elevated or inappropriately normal levels of PTH. Most patients (90-95%) present with the sporadic form of the disease, whereas familial cases may occur associated with multiple endocrine neoplasias type 1 (MEN1) and type 2, jaw tumours, as well as severe neonatal form and familial isolated HPT. HPT associated with MEN1 (HPT/MEN1) differs from sporadic primary HPT (s- HPT) in the following aspects: it presents as a multiglandular parathyroid neoplasia (hyperplasia vs adenoma); it has an earlier disease onset (20 vs. 40 years of age); there is a sex ratio of 1:1 in contrast to the 1:3 ratio for s- HPT; different surgical treatment (total or subtotal parathyroidectomy x adenomectomy); there are higher recurrence rates after a parathyroidectomy (PTx); and it frequently tends to be less aggressive than s-HPT. In s-HPT, the bone loss profile and the impact of parathyroid surgery are well defined. In contrast, data on bone losses in HPT/MEN1 and the potential bone recovery after PTx have been scarcely reported. The aim of this study is to evaluate the bone mineral status and the impact of surgical treatment on bone mineral density (BMD) in HPT/MEN1 patients. METHODS: We studied 36 cases (18 males and 18 females) diagnosed with HPT/MEN1 (average age at the HPT diagnosis of 38.9 ± 14.46 years; range, 20-74 years). These patients belonged to eight unrelated MEN1 families previously clinically characterized and harboring germline MEN1 mutations. We have assessed the values of BMD in the proximal one third distal radius (1/3 distal radius), femoral (femoral neck and total) and lumbar spine (L1-L4) of these 36 HPT/MEN1 cases. BMD values were measured by dual-energy X-ray absorptiometry and the values expressed in T, Z-score and in absolute values. After BMD analyses, twenty four out of them were submitted to total parathyroidectomy followed by autoimplant in the non-dominant forearm. BMD measurements were evaluated before and in a mean period of 15 months after surgery, in a subset of 16 patients. RESULTS: Bone demineralization (osteoporosis/osteopenia) was seen at the proximal third of distal radius (28/34, 79.4%); femoral neck (26/36, 72.7%) and in the lumbar spine (25/36, 69.4%). Osteopenia was mostly found in femoral neck (19/36, 52.8%), whereas 1/3 distal radius (14/34, 41.2%) and lumbar spine (11/36, 30.5%) were also represented. Osteoporosis was mostly marked at lumbar spine (14/36, 38.9%) and 1/3 DR (14/34, 41.2%), but femoral neck (7/36, 19.4%) was also affected. Mean T score values at the 1/3 DR were severely reduced (-2.46±1.436 SD), followed by lumbar spine (-2.05 ± 1.539 SD). The femoral neck was the least affected site (-1. 60 ± 1.138 SD). In the 16 cases submitted to surgical treatment, in a mean period of 15 months after PTX, BMD (g/cm2) significantly increased at the lumbar spine from 0.843 to 0.909 g/cm2 (+ 8.4%; p=0.001). Femoral neck BMD (g/cm2) also increased significantly from 0.745 to 0.798 g/cm2 (+ 7.7%; p=0.0001). In the proximal one third of distal radius, BMD (g/cm2) remained unchanged (baseline, 0.627 ± 0.089 to 0.622 ± 0.075; p=0.76). CONCLUSION: Our data confirmed distal radius as the preferential site of bone demineralization and that lumbar spine may not be relatively protected in HPT/MEN1, as related in the s-HPT. A significant increase in the BMD has been verified in the lumbar spine and femoral neck BMD in 16 patients with HPT/MEN1, in a mean period of 15 months after parathyroidectomy. However, the proximal one third of distal radius BMD did not present significant improvement during this study

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-17T22:00:57Z No. of bitstreams: 1 SabrinaDamianse.pdf: 871013 bytes, checksum: 1d5fef56ed73d762fa195bbdb1500bab (MD5) / Made available in DSpace on 2017-05-17T22:00:57Z (GMT). No. of bitstreams: 1 SabrinaDamianse.pdf: 871013 bytes, checksum: 1d5fef56ed73d762fa195bbdb1500bab (MD5) Previous issue date: 2016-07-15 / The multiple endocrine neoplasia type 1 (MEN1) is a genetic syndrome with autosomal dominant transmission, characterized by tumors of the parathyroid, anterior pituitary and pancreas. Primary hyperparathyroidism is the most common clinical presentation in MEN1 and evaluation of patients with pituitary adenomas for the presence of hyperparathyroidism could identify patients with this syndrome. The aim of this study was to identify the frequency of MEN1 by serum calcium and parathyroid hormone measurement in patients with pituitary adenomas followed at the Endocrinology Service of the Hospital Universitário da Universidade Federal do Maranhão (HUUFMA). This is a descriptive study with data collected from the patients' medical charts in june 2015 to may 2016. We evaluated 300 patients with pituitary adenoma subtypes (128 prolactinomas, 67 acromegaly, 22 corticotropinomas, 3 gonadotropinomas and 80 adenomas clinically nonfunctioning) finding a frequency of 1.3% of MEN1 patients among patients with adenomas pituitary. Patients with MEN1 were mostly female and the average age at diagnosis of pituitary adenoma was 42.7 years, ranging between 24 and 57 years old. Pituitary tumors of these patients were more often macroadenoma and the predominant subtype was somatotropinoma. At initial diagnosis, our patients had apparently sporadic pituitary lesions, however, or were confirmed with MEN1 early because they already have signs and/or symptoms of hyperparathyroidism, or have been diagnosed very late caused mild symptoms of parathyroid disease. Therefore, screening measures serum calcium and PTH in patients with pituitary adenomas are recommended, primarily, because these tests are necessary to identify the most common disease in MEN1, primary hyperparathyroidism. The study contributed to the identification of new patients with MEN 1 in those patients with pituitary adenomas with the benefit of early diagnosis, appropriate therapeutic approach and genetic counseling in family forms. / A neoplasia endócrina múltipla tipo 1 (NEM1) é uma síndrome genética, com transmissão autossômica dominante, caracterizada por tumores da paratireóide, da hipófise anterior e do pâncreas. O hiperparatireoidismo primário é apresentação clínica mais frequente na NEM1 e a avaliação dos pacientes com diagnóstico de adenomas hipofisários quanto à presença de hiperparatireoidismo poderia identificar pacientes com esta síndrome. O objetivo deste estudo foi identificar a frequência de NEM1 a partir das dosagens séricas de cálcio e paratormônio em pacientes portadores de adenomas hipofisários acompanhados no Serviço de Endocrinologia do Hospital Universitário da Universidade Federal do Maranhão (HUUFMA). Trata-se de um estudo descritivo com dados coletados a partir dos prontuários de atendimento dos pacientes no período de junho de 2015 a maio de 2016. Foram avaliados 300 pacientes com diagnóstico de adenoma hipofisário de diferentes subtipos (128 prolactinomas, 67 acromegálicos, 22 corticotropinomas, 3 gonadotropinomas e 80 adenomas clinicamente não-funcionantes) encontrando-se uma frequência de 1,3% de pacientes NEM1 dentre os portadores de adenomas hipofisários. Os pacientes com NEM1 eram, em sua maioria, do sexo feminino e a média de idade ao diagnóstico da lesão hipofisária foi de 42,7 anos, variando entre 24 e 57 anos de idade. Os tumores hipofisários desses pacientes eram mais frequentemente macroadenomas e o subtipo predominante foi somatotropinoma. Ao diagnóstico inicial, dos pacientes eram, aparentemente, portadores de lesões pituitárias esporádicas, no entanto, ou foram confirmados precocemente com NEM1, pois já possuíam sinais e/ou sintomas relacionados ao hiperparatireoidismo, ou foram diagnosticados muito tardiamente devidos sintomas leves da doença paratireoidiana. Portanto, o rastreio com dosagens de cálcio e PTH séricos em pacientes portadores de adenomas hipofisários é recomendado, principalmente, por serem exames necessários para identificar a doença mais frequente na NEM1, o hiperparatireoidismo primário. O estudo contribuiu para identificação de novos pacientes com NEM 1, naqueles portadores de adenomas hipofisários com o benefício do diagnóstico precoce, abordagem terapêutica adequada e aconselhamento genético nas formas familiares.

Introducción: analizamos la relación entre fracturas y densidad mineral ósea (DMO) y los SNP (polimorfismos de un solo nucleótido) rs3102735 (163 A/G), rs3134070 (245 T/G) y rs2073618 (1181 G/C) de OPG, el SNP rs2277438 SNP de RANKL, el SNP rs7121 (393 T/C) de GNAS1 y del SNP rs219780 del gen CLDN14 en pacientes con HPP (hiperparatiroidismo primario) esporádico. Métodos: reclutamos 298 pacientes con HPP y 328 voluntarios sanos en un estudio transversal. Analizamos historia de fracturas o litiasis renal, parámetros bioquímicos, DMO en columna lumbar, cadera total, cuello femoral y radio distal y genotipado de los SNP mencionados. Resultados: no encontramos diferencias entre los genotipos de ninguno de los SNP estudiados en relación con la frecuencia de fracturas en HPP o en sujetos control. La DMO fue menor en el radio en los HPP homocigotos para el alelo menor en comparación con el resto de grupos en los SNP de OPG (163 A/G) y (245 T/G) pero no en sujetos control. En el resto de los SNP estudiados no encontramos diferencias entre genotipos y DMO en los sujetos con HPP o control excepto en el SNP de OPG (1181 G/C) en sujetos control con mayor DMO lumbar en el grupo CC respecto del GG. Conclusiones: los sujetos con HPP y homocigotos para el alelo menor (GG) en los SNP rs3102735 (163 A/G) y rs3134070 (245 T/G) de OPG tienen menor DMO en el radio distal. El resto de SNP estudiados no parecen influir en la diferente expresión de las manifestaciones óseas del HPP. / Background: we analyze the relationship between fractures and BMD (bone mineral density) and the rs3102735 (163 A/G), rs3134070 (245 T/G) and rs2073618 (1181 G/C) SNPs of the OPG, the rs2277438 SNP of the RANKL, the rs7121 SNP (393 T/C) of GNAS1 and the rs219780 of CLDN14 in patients with sporadic PHPT (primary hyperparathyroidism). Methods: We enrolled 298 Caucasian patients with PHPT and 328 healthy volunteers in a cross-sectional study. We analyzed history of fractures or renal lithiasis, biochemical determinants, BMD measurements in the lumbar spine, total hip, femoral neck and distal radius, and genotyping for the SNPs to be studied. Results: Regarding the frequency of fractures we found no differences between genotypes in any of the SNPs studied in the PHPT or in the control subjects groups. Significant lower BMD in the distal radius was found in the minor allele homozygotes (GG) compared to heterozygotes and major allele homozygotes in both OPG rs3102735 (163 A/G) and OPG rs3134070 (245 T/G) SNPs in those with PHPT but not in control subjects. We found no difference between genotypes of the rest of the SNPs studied in PHPT or control subjects with the exception of SNP OPG rs2073618 (1181 G/C) in control CC subjects which showed higher lumbar BMD than GG ones. Conclusions: Subjects with PHPT and minor homocygote genotype (GG) for the OPG rs3102735 (163 A/G) and OPG rs3134070 (245 T/G) SNPs have lower BMD in the distal radius. All the other SNPs studied do not appear to influence the different expression of HPP in bone.

Introdução: O hiperparatireoidismo primário (HP) é a terceira maior causa de doenças endocrinológicas na população, sendo a principal causa de hipercalcemia. Caracteriza-se por hipersecreção do paratormônio (PTH) pelas células principais da paratireoide, levando a um distúrbio da homeostase do cálcio (Ca). O adenoma de paratireoide é a principal causa do HP, com 80-85% dos casos, sendo o objeto deste estudo. Mutações genéticas podem corresponder a mais de 11% da origem deste tumor benígno hipersecretor. Apesar dos avanços dos métodos de diagnóstico, o tratamento é essencialmente cirúrgico, havendo carência de tratamentos alternativos eficientes, que podem ser aprimorados com maior conhecimento fisiopatológico. Como as células do adenoma são hipersecretoras de proteínas, possuem abundante quantidade de retículo endoplasmático (RE), onde as proteínas sofrem dobramento, adquirindo sua conformação nativa. Em células hipersecretoras é comum o aumento da atividade da maquinaria de tratamento protéico, gerando sinais de sobrecarga no RE e citoplasma, sendo denominado de estresse do retículo endoplasmático (ERE). O ERE e as suas vias efetoras, a UPR (resposta a proteínas não-dobradas) e o ERAD (degradação associada ao retículo endoplasmático), estão presentes na fisiopatologia de diversas doenças ou de células hipersecretoras, servindo como importante alvo terapêutico. Objetivos: Analisar a atividade do ERE nas células do adenoma de paratireoide. Casuística e Métodos: Análise da expressão dos principais genes do ERE por RealTime-PCR, em 14 pacientes portadores de adenoma de paratireoide operados no Serviço de Cirurgia de Cabeça e Pesoco do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, comparando-se a expressão do adenoma em relação ao controle (tecido normal). Resultados: Houve aumento da expressão de vários genes relacionados ao ERE, ERAD e à UPR, com significância estatística, principalmente da via de PERK (Pancreatic endoplasmic reticulum kina), do ERAD e da autofagia, evidenciando um quadro de cronicidade e eficência da maquinaria do ERE, com finalidade antiapoptótica. O resultado foi compatível com a manifestação clínica do adenoma de paratireoide, que cursa com raros casos de remissão espontânea e necrose central. Conclusão: Verificou-se que há uma atividade do ERE na fisiopatologia do adenoma de paratireoide, com efetividade na síntese e seleção protéica do PTH, trazendo longevidade às células do adenoma por meio da prevalência dos mecanismos de citoproteção, em detrimento da via da apoptose. O estudo traz importantes informações que podem ser úteis na elaboração de novos tratamentos medicamentosos, fazendo com que o ERE seja um futuro alvo terapêutico também no adenoma de paratireoide, assim como já é a realidade em outras patologias. / Background: Primary Hyperparathyroidism (PHP) is the third most common cause of endocrinologic disorders in the world, and the main cause of hypercalcemia. It is manifested by PTH (parathormone) hypersecretion by the parathyroid chief cells and consecutive calcium (Ca) homeostasis disturbance. Parathyroid adenoma (PA) is present in 80-85% of patients and, for this reason, is the aim of this study. Gene mutations is associated with at least 11% of this hypersecretory benign tumor. Even though the clinical presentation is much better than the past few decades, therapeutic options beside surgery do not advance along increasing efficiency in diagnostic tools. This is partly because there are many lacks in the pathophysiology of Pas, that would give new possibilities of medical treatment. PA is composed of hypersecretory cells and rich endoplasmic reticulum cytoplasm, where the main protein treatment and selection factors are situated. Considering that PA cells have protein hypersecretory activities, it is expected an abundant ER mass, that provides the machinery to treat and fold the great amount of nascent protein, to turn it to native form. As protein traduction increases, more energy is needed to keep ER function and this may result in the endoplasmic reticulum stress (ERE) in the cells. ERE and the downstream effectors, UPR (unfolded response protein) and ERAD (endoplasmic reticulum associated degradation), are acting in the physiology of several diseases and others hypersecretory cell types, providing important treatment targets. Objectives: To analyze ERE activity in PA cells. Casuistic and Methods: Evaluation of the main ERE genes expressed with Real Time-PCR analysis, in 14 patients with PA PHP and that were treated with conventional surgery, with further comparison between PA and control groups. Results: There were significant expression elevation of ERE, UPR and ERAD related genes, with statistical significance, specially of PERK downstream, ERAD and autophagy induction, suggesting efficient, though chronic, ERE activity level, with stimulated anti-apoptosis pathway. The final results confirmed our hypothesis that there is lower pro-apoptosis activity than expected by some authors, but this is compatible with low incidence of spontaneous remission or PA necrosis. Conclusion: There is contundent ERE activity in the PA pathophysiology, with great protein metabolism effectiveness expressed by PTH bioactivity, increasing cell longevity by stimulating cytoprotection pathways, instead of pro-apoptosis one. We believe this outcome will influence others research on this challenging and gratifying field of investigation, that will certainly provide new treatment options to PA, as ERE has been playing a significant role as therapeutic target with others hypersecretory diseases.

Arterial stiffness represented by carotid-femoral pulse wave velocity (PWV) is considered to be an independent cardiovascular risk factor. This study was focused on large artery properties investigation in specific forms of hypertension using applanation tonometer Sphygmocor (Atcor Medical). PWV was significantly higher in resistant hypertension patients when compared to moderate essential hypertension (EH) patients. This difference appears to be independent of clinical blood pressure (BP). Night-time BP appears to be a more accurate predictor of PWV in EH. In another study we demonstrated that primary hyperparathyroidism (PH) (both hypertensive or non-hypertensive forms) might be associated with higher PWV when compared to EH patients or to normotensive controls and that this difference is independent of age and clinical BP. Neither calcium serum level, nor parathyroid hormone has been associated with PWV. Specific treatment by parathyroidectomy (PTX) seems to be beneficial for PWV decrease, which might be mainly determined by improved BP control after surgery. Since PTX indications for asymptomatic forms of PH have been discussed, our data suggest the potential benefit to the extent of subclinical organ damage after surgical treatment in these patients. Similarly, we prooved higher PWV in...

Arterial stiffness represented by carotid-femoral pulse wave velocity (PWV) is considered to be an independent cardiovascular risk factor. This study was focused on large artery properties investigation in specific forms of hypertension using applanation tonometer Sphygmocor (Atcor Medical). PWV was significantly higher in resistant hypertension patients when compared to moderate essential hypertension (EH) patients. This difference appears to be independent of clinical blood pressure (BP). Night-time BP appears to be a more accurate predictor of PWV in EH. In another study we demonstrated that primary hyperparathyroidism (PH) (both hypertensive or non-hypertensive forms) might be associated with higher PWV when compared to EH patients or to normotensive controls and that this difference is independent of age and clinical BP. Neither calcium serum level, nor parathyroid hormone has been associated with PWV. Specific treatment by parathyroidectomy (PTX) seems to be beneficial for PWV decrease, which might be mainly determined by improved BP control after surgery. Since PTX indications for asymptomatic forms of PH have been discussed, our data suggest the potential benefit to the extent of subclinical organ damage after surgical treatment in these patients. Similarly, we prooved higher PWV in...