IMPACT OF CHOLECALCIFEROL SUPPLEMENTATION ON SKELETAL AND NON-SKELETAL MANIFESTATIONS IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM SUBMITTED TO PARATHYROIDECTOMY OR FOLLOWED UP WITHOUT SURGERY: CARDIOVASCULAR OUTCOMES

Context: Cardiovascular (CV) complications are a still debated issue in patients with biochemically mild primary hyperparathyroidism (PHPT) and may be related to both the PHPT condition itself and the hypovitaminosis D. Objective: To evaluate the prevalence, nature and reversibility of CV disease and associated risk factors in a large cohort of postmenopausal mild PHPT patients surgically cured (PTx Group) or observed for two years without surgical intervention (no-PTx Group). To preliminarily assess, in both group, if the administration of two different doses (800 UI and 2000 UI) of cholecalciferol (VitD) versus no supplementation could affect the CV disease evolution. Design: Randomized longitudinal prospective open label study. Settings: The study was conducted in the Endocrinology Unit of two university hospitals. Participants: 91 post-menopausal women with PHPT (38 in the PTx Group and 53 in the no-PTx Group) participated in the study. Outcome Measures: Cardiac and vascular damage (blood pressure, transthoracic echocardiography and carotid ultrasonography), lipids and glucose metabolism, renin-angiotensin system (RAAS) activity. Results: Arterial hypertension (AH) was found in 50.5% of patients and was not associated with PHPT after adjusting data for major CV risk factor. Diastolic dysfunction, LV hypertrophy and valve calcifications were diagnosed in 54.9%, 13.2% and 12.1% of patients and were respectively predicted by body mass index (BMI) and advancing age, by the presence of AH and by advancing age and the presence of AH, respectively. Similarly, advancing age was the only significant predictor of the presence of carotid plaque and AH was the only significant predictor of carotid intima-media thickness. We did not find any association between calcium, PTH or 25OHD and all glycemic parameters. No activation of RAAS was found in normotensive mild PHPT patients. All CV complications and risk factors were neither reversed nor significantly improved by surgery and/or VitD administration up to 24 months’ follow-up. Conclusions: The high incidence of CV disease and metabolic derangements reported in mild PHPT may be primarily related to the coexistence of AH, advanced age or increased BMI. Moreover, the administration of VitD supplements would seem to have a neutral effect at least as regards CV complications and CV risk factors in mild PHPT patients.