Lipids Profile in Primary Hyperparathyroidism
Lipids Profile in Primary Hyperparathyroidism
Severe Primary hyperparathyroidism (PHP) has been associated with increased cardiovascular
 morbidity and mortality. Hypertension, dyslipidemia and impaired glucose tolerance were
 demonstrated in severe PHP, with improvement after surgery in these variables. Recent
 evidence suggests that the 'quality' rather than only the 'quantity' of low-density
 lipoprotein (LDL)-cholesterol exerts a direct influence on the cardiovascular risk. Thus, the
 proposed study protocol is intended to evaluate lipoprotein phenotype and LDL size and
 subclasses in patients with primary hyperparathyroidism.
Severe traditional PHP has been associated with increased cardiovascular morbidity and
 mortality with an increase in acute MI prior to surgery.PHP is associated with increased
 prevalence of left ventricular hypertrophy, independent of blood pressure. Also prevalent in
 PHP, are valvular and myocardial calcifications as well as diastolic filling impairment, with
 a significant correlation with serum calcium and PTH levels.

 Hypertension, dyslipidemia and impaired glucose metabolism were demonstrated in severe PHP,
 with improvement after surgery in these variables.Glucose tolerance test performed in
 patients with PHP revealed that 51% had impaired glucose tolerance, 34% had diabetes mellitus
 and 17% had impaired fasting glucose values. After successful parathyroidectomy fasting and
 2-h plasma glucose falls significantly. Others have demonstrated hyperinsulinemia and
 impaired glucose tolerance without normalization after parathyroidectomy.

 Most of the literature showing an increased cardiovascular risk is in those patients with
 more severe PHP .Patients with mild PHP had higher serum cholesterol, triglycerides, glucose,
 urate and hemoglobin values compared with controls.Also, moderate to severe vitamin D
 deficiency is a risk factor for developing cardiovascular disease especially in patients with
 hypertension.

 Atherosclerosis is a diffuse disease formerly considered a lipid storage disease, which
 actually involves an ongoing inflammatory response. Elevated circulating levels of acute
 phase proteins, cytokines, and cell adhesion molecules indicate that inflammatory processes
 are occurring systemically . C-reactive protein [CRP] and the presence of metabolic syndrome
 were interrelated and were highly predictive for cardiovascular disease. Hyperinsulinemia was
 proposed as the common factor of all the traditional risk factors for cardiovascular disease,
 and insulin resistance is recognized as a chronic low-level inflammatory state.Although
 various inflammatory markers were individually significantly related to future cardiovascular
 disease risk, they added very little additional prognostic information to the traditional
 markers.

 Recently, we have shown that greater probability of metabolic syndrome and insulin resistance
 were observed in patients with severe PHP. Serum calcium is a predictor of these
 cardiovascular risk factors.

 Recent evidence suggests that the 'quality' rather than only the 'quantity' of LDL exerts a
 direct influence on the cardiovascular risk. LDL comprises multiple distinct subclasses that
 differ in size, density, physicochemical composition, metabolic behaviour and atherogenicity.
 There are at least four major subspecies of LDL (e.g. large LDL-I, medium LDL-II, small
 LDL-III, very small LDL-IV) and the predominance of small dense LDL has been accepted as an
 emerging cardiovascular risk factor .

 Thus, the proposed study protocol is intended to evaluate lipoprotein phenotype and LDL size
 and subclasses in patients with primary hyperparathyroidism.
Inclusion Criteria:

 -  Patients with primary hyperparathyroidism

 Exclusion Criteria:

 -  pregnant women

 -  patient taking hypolipidemic drugs

 -  patients with known cardiovascular, peripheral or cerebral atherosclerotic disease.