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Evaluation and Treatment of Primary Hyperparathyroidism
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To the Editor: In his appraisal of the uncertainties surrounding the optimal management of patients with mild primary hyperparathyroidism, Dr Strewler1 discusses the possibility that the disorder may be associated with an increased risk of mortality from cardiovascular disease and highlights the inconsistent results of epidemiological studies in this area. Despite these uncertainties, some authorities invoke increased cardiovascular risk in recommending surgical intervention for all patients with mild primary hyperparathyroidism.2
Body weight is an important potential confounder of the purported link between primary hyperparathyroidism and cardiovascular disease that does not appear to have been adjusted for in the published observational reports.3-4 Patients with primary hyperparathyroidism are heavier than eucalcemic controls5 and may have been so throughout adult life.6 Since a number of the "nonclassical associations" of primary hyperparathyroidism (hypertension, glucose intolerance, cardiovascular disease, gallbladder disease, some forms of malignancy)7-10 are also associated with body weight, we suggest that reevaluation of . . . [Full Text of this Article]
Andrew Grey, MD
a.grey@auckland.ac.nz
Mark Bolland, MBChB;
Ian R. Reid, MD
Department of Medicine
University of Auckland
Auckland, New Zealand
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