Serum Levels of Uric Acid and Diabetes Mellitus Influence Survival after Surgery for Primary Hyperparathyroidism: A Prospective Cohort Study

• Published in: World journal of surgery Vol. 31; no. 7; pp. 1393 - 1400
• Main Authors: Bergenfelz, Anders, Bladström, Anna, Their, Mark, Nordenström, Erik, Valdemarsson, Stig, Westerdahl, Johan
• Format: Journal Article
• Language: English
• Published: New York Springer‐Verlag 01.07.2007; Springer; Springer Nature B.V
• Subjects: Adenoma - complications; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Calcium - blood; Clinical Medicine; Creatinine - blood; Diabetes Mellitus - epidemiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Glomerular Filtration Rate; Humans; Hyperparathyroidism, Primary - blood; Hyperparathyroidism, Primary - epidemiology; Hyperparathyroidism, Primary - etiology; Hyperparathyroidism, Primary - mortality; Hyperparathyroidism, Primary - surgery; Kirurgi; Klinisk medicin; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Parathyroid Neoplasms - complications; Primary Hyperparathyroidism; Proportional Hazards Models; Prospective Studies; Serum Uric Acid; Surgery; Survival Analysis; Triglycerides - blood; Uric Acid; Uric Acid - blood; Uric Acid Level; Endocrinopathy; Diabetes mellitus; Uric acid; Survival; Medicine; Prospective; Treatment; Parathyroid diseases; Surgery; Cohort study; Primary; Serum; Hyperparathyroidism; Public health
• ISSN: 0364-2313; 1432-2323; 1432-2323
• DOI: 10.1007/s00268-007-9091-6

Background Primary hyperparathyroidism (pHPT) is associated with an increased mortality attributable to cardiovascular disease (CVD), suggested to be alleviated by surgery. The exact mechanism of the beneficial influence of parathyroidectomy on survival is unknown. Furthermore, studies suggest that there is no increased mortality compared to the mortality rate in the general population during recent years. This study therefore investigated relative survival (RS), as well overall mortality associated with the clinical and biochemical variables in patients undergoing operation for sporadic pHPT. Furthermore, the influence of surgery on biochemical variables associated with pHPT was analyzed. Methods A group of 323 patients with sporadic pHPT operated between September 1989 and July 2003 were followed from surgery over a 10‐year period. The median and mean follow‐up time was 69 and 70 months, respectively (range: 1–120 months). Relative survival (RS) was calculated, and the impact of clinical and biochemical variables on overall death were evaluated. Results Postoperatively, serum levels of triglycerides and uric acid decreased. Glucose levels and glomerular filtration rate remained unchanged. A decreased RS was evident during the latter part of the 10 year follow‐up period. In the multivariate Cox‐analysis, diabetes mellitus (hazard ratio [HR] = 2.8, 95%; confidence interval [CI] 1.2–6.7), and the combination of an increased level of serum uric acid and cardiovascular disease (CVD) (HR = 8.6, 95%; CI 1.5–49.7) was associated with a higher mortality. The increased risk of death was evident for patients with persistently increased levels of uric acid postoperatively (HR = 4.8, 95%; CI = 1.4–16.01) Conclusions Patients undergoing operation for pHPT had a decreased RS during a 10‐year follow‐up compared to the general population. This decrease in RS is associated with diabetes mellitus and increased levels of uric acid pre‐and postoperatively.