Cardiovascular and metabolic status in patients with primary hyperparathyroidism: a single-center experience

IntroductionCardiovascular diseases (CVD) and metabolic disorders (MD) have retained leading positions in the structure of morbidity and mortality for many years. Primary hyperparathyroidism (PHPT) is also associated with a greater incidence of CVD and MD. The aim of the present study was to describe the prevalence and structure of CVD and MD in hospitalized patients with PHPT and to search for possible associations between these pathologies.Methods838 patients with a verified PHPT were included in the study. The studied cohort was divided into 2 groups according to their age at the time of admission: patients aged 18 to 49 years (group A, n = 150); patients aged 50 years and older (group B, n = 688).ResultsThere were no significant differences between two groups in parameters of calcium-phosphorus metabolism. Obesity was diagnosed in 24.2% of patients in group A and in 35.9% in group B. Type 2 diabetes mellitus was more common in older patients (14.4% in group B vs. 2.6% in group A). Arterial hypertension, ischemic heart disease, chronic heart failure and brachiocephalic arteries atherosclerosis were more frequent in older patients, occurring in 79.1%, 10.8%, 8.4%, and 84% of cases respectively. The cutoff points that increased the risk of CVD detection turned out to be age above 56 years, eGFR below 92 ml/min/1.73m2, BMI above 28.3 kg/m2.DiscussionThe present study demonstrated a high incidence of some CVD, as well as disorders of lipid, carbohydrate and purine metabolism in patients with PHPT

Ethnic differences in risk factors and prevalence of type 2 diabetes in the adult population of the Russian Federation (a sub-analysis of the NATION study)

A retrospective analysis of the database of the NATION nation-wide epidemiological cross-sectional study was carried out. Depending on the self-declared ethnicity and anthropological characteristics, the following ethnic groups were identified: “Mongoloid population”, “Peoples of the Volga region”, “Peoples of the North Caucasus”, “Peoples of Transcaucasia”, “Russians”. The analysis consisted of several stages and included: analysis of the selected groups’ anthropometrics, analysis of the prevalence of carbohydrate metabolism disorders in the selected ethnic groups, analysis of ethnic-specific T2D risk factors, and analysis of region-specific factors affecting the prevalence of carbohydrate metabolism disorders in various ethnic groups. We defined carbohydrate metabolism disorders as diabetes and/or a prediabetes condition. In accordance with the WHO criteria, HbA1c≥6.5% was interpreted as diabetes, whereas values ​​in the range of 5.7%≤HbA1c<6.5% as prediabetes.RESULTS: The highest prevalence of carbohydrate metabolism disorders was observed among the “Peoples of the Volga region” group (31.2%), the lowest – among the “Peoples of the North Caucasus” group (15.6%). The “Peoples of the Volga region” group had a significantly lower BMI vs. the “Peoples of the North Caucasus” group. Carbohydrate metabolism disorders occurred more often in patients with abdominal obesity / 1st-stage obesity or aged over 45 among the “Mongoloid population” and the “Peoples of the Volga region” groups vs. the “Peoples of the Northern Caucasus” and the “Peoples of Transcaucasia” groups. Prevalence of carbohydrate metabolism disorders among the “Peoples of the Volga region” group residing in their native lands was higher than among Russians residing in the same regions: 32.5% vs. 24.3% (p<0.001 χ2 test) and also higher than among Russians residing in the Central Federal District: 32.5% vs. 27.4%, respectively (p=0.001, χ2 test). Prevalence of carbohydrate metabolism disorders among the “Peoples of the North Caucasus” group was lower than among the “Russians” group: 13.9% vs. 27.36%, respectively (p<0.001, χ2 test). Prevalence of carbohydrate metabolism disorders among the “Peoples of the North Caucasus” group living in their native lands (n=598) was lower than among the same group residing elsewhere in Russia (n=164) (13.9% vs. 21.95%, p=0.012, χ2 test

Mathematical model for preoperative differential diagnosis for the parathyroid neoplasms

Background and objective: Preoperative diagnosis of parathyroid carcinoma (PC) is critical for the determination of the scope of surgical intervention. Nowadays, specific diagnostic markers for differentiation of PC and benign tumors are unknown, and less than half of patients with PC undergo necessary en bloc surgery. The aim of this study was to develop the instrument for preoperative diagnosis of PC. Methods: A multi-center retrospective study included 242 patients with primary hyperparathyroidism: 50 patients with PC, 30 with аtypical adenoma (AA), and 162 with adenoma of the parathyroid glands. Results: Patients with PC and AA had higher levels of PTH, ionized and albumin-corrected calcium, ALP, volume and the largest diameter of neoplasm, and the higher frequency of GFR decrease less than 60 ml/min/1.73 m2 compared to patients with adenoma. The frequency of low-energy fractures was higher in the carcinoma group versus the adenoma group (32% vs 8%). Heterogeneous structure and indefinite contour of glands detected by US were more typical for PC than for AA and adenomas. The mathematical model was developed using CatBoost gradient boosting algorithm for the noninvasive preoperative differential diagnosis of PC, AA, and adenoma. Conclusions: Model can predict adenoma with PPV 100% and PC with PPV 81–92%. Using model clinicians could plan extended en bloc resection for PC and selective parathyroidectomy for adenoma. If AA is predicted, he has to make a decision on the choice of the necessary volume of PTE based on his experience, because AA are the zone of uncertainty