Abstract
Patients with primary hyperparathyroidism (PHPT) have impaired vasodilation both dependent
and independent of endothelium. The aims of our study were to measure three different
biochemical markers of endothelial activation, i. e., plasma thrombomodulin, soluble(s)
E-selectin, and von Willebrand factor, in PHPT patients before and one year after
successful parathyroidectomy, and to distinguish the potential effect of hypercalcemia
and/or high parathyroid hormone from that of major cardiovascular risk factors (diabetes
mellitus, hyperlipidemia, hypertension, obesity, smoking habit) on endothelial function.
Twenty consecutive patients with PHPT subdivided into two groups according to the
absence (n = 8) or presence (n = 12) of one or more risk factors, and fifteen healthy
normocalcemic subjects were studied. Baseline thrombomodulin levels were similar in
the groups with and without risk factors, and in controls. In contrast, sE-selectin
and von Willebrand factor were higher in PHPT patients with risk factors than in those
without risk factors (p < 0.05 and p < 0.01, respectively) and controls (p < 0.01).
Neither thrombomodulin nor sE-selectin changed after parathyroidectomy in either PHPT
group. Plasma von Willebrand factor decreased (p < 0.01) in patients without risk
factors, while persisting at high levels in patients with risk factors. In conclusion,
in spite of a limitation due to the small number of patients, our study suggests that
classic cardiovascular risk factors seem to be the main determinants for the high
plasma levels of sE-selectin and vWF in PHPT. Together with unaltered thrombomodulin
and sE-selectin levels, a plasma vWF decrease after parathyroidectomy might reflect
a specific mechanism of its endothelial calcium- and/or PTH-stimulated secretion in
some PHPT patients without risk factors. Whether a vWF reduction after parathyroidectomy
may be used as a biochemical index for improved endothelial function in PHPT patients
without risk factors has yet to be demonstrated in larger studies.
Key words
Primary hyperparathyroidism · endothelium · von Willebrand factor
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F. FalloM. D.
Department of Medical and Surgical Sciences · Clinica Medica 3 · University of Padova
Via Ospedale 105 · 35128 Padova · Italy
Fax: +39(049)8213332
eMail: francesco.fallo@unipd.it
