The Relationship between Primary Hyperparathyroidism and Thrombotic Events: Report of Three Cases and a Review of Potential Mechanisms
We have described three uncommon cases of patients who presented with clinical thrombotic events (stroke, pulmonary embolism and deep venous thrombosis) during the course of a hypercalcemia-induced hypercoagulable state. After thorough investigation, the diagnosis of primary hyperparathyroidism - due to a parathyroid adenoma - was established in all cases. The association between hypercalcemia and venous or arterial thrombosis has been previously described; however, relevant data are still insufficient. The existing evidence in the field was reviewed and the interesting underlying pathophysiologic mechanisms were also discussed. Further studies are required to shed more light on the unusual, still intriguing relationship between calcium and thrombosis.
Ariyan CE, Sosa JA. Assessment and management of patients with abnormal calcium. Crit Care Med. 2004; 32 (4 Suppl):S146-54.
Dent DM, Miller JL, Klaff L, et al. The incidence and causes of hypercalcaemia. Postgrad Med J. 1987; 63(743):745-750.
Bilezikian JP, Silverberg SJ. Clinical practice. Asymptomatic primary hyperparathyroidism. N Engl J Med. 2004; 350(17):1746-51.
DeLellis RA, Mazzaglia P, Mangray S. Primary hyperparathyroidism: a current perspective. Arch Pathol Lab Med. 2008; 132(8):1251-62.
Ahmad R, Hammond JM. Primary, secondary, and tertiary hyperparathyroidism. Otolaryngol Clin North Am. 2004; 37(4): 701-13.
Yu N, Donnan PT, Flynn RW, et al. Increased mortality and morbidity in mild primary hyperparathyroid patients. The Parathyroid Epidemiology and Audit Research Study (PEARS). Clin Endocrinol (Oxf). 2010; 73(1):30-4
Walker MD, Rubin M, Silverberg SJ. Nontraditional manifestations of primary hyperparathyroidism. J Clin Densitom. 2013; 16(1):40-7.
Luigi P, Chiara FM, Laura Z, et al. Arterial Hypertension, Metabolic Syndrome and Subclinical Cardiovascular Organ Damage in Patients with Asymptomatic Primary Hyperparathyroidism before and after Parathyroidectomy: Preliminary Results. Int J Endocrinol. 2012;2012:408295.
Hilgard P. Experimental hypercalcaemia and whole blood clotting. J Clin Pathol. 1973; 26(8):616-9.
Boström H, Alveryd A. Stroke in hyperparathyroidism. Acta Med Scand. 1972;192(4):299-308.
Gorelick P, Caplan L. Calcium, hypercalcemia, and stroke. Stroke. 1985;20:13-7.
Walker GL, Williamson PM, Ravich RB, et al. Hypercalcaemia associated with cerebral vasospasm causing infarction. J Neurol Neurosurg Psychiatry. 1980; 43(5):464-467.
Yarnell PR, Caplan LR. Basilar artery narrowing and hyperparathyroidism: illustrative case. Stroke. 1986; 17(5):1022-4.
Riyaz S, Tymms J. Hypercalcemia: A rare cause of cerebral infarction. Cent Eur J Med. 2008; 3(4):514–516.
Siesjo B. The role of calcium in cell death. In: Price DL, Thoenen H, Aguayo AJ, editors. Neurodegenerative disorders; mechanisms and prospects for therapy. Chichester: John Wiley & Sons Ltd; 1991, pp 35–59.
Erem C, Kocak M, Hacihasanoglu A, et al. Blood coagulation, fibrinolysis and lipid profile in patients with primary hyperparathyroidism: increased plasma factor VII and X activities and D-Dimer levels. Exp Clin Endocrinol Diabetes. 2008;116(10):619-24.
Erem C, Kocak M, Nuhoglu, I, et al. Increased plasminogen activator inhibitor-1, decreased tissue factor pathway inhibitor, and unchanged thrombin-activatable fibrinolysis inhibitor levels in patients with primary hyperparathyroidism. Eur J Endocrinol. 2009; 160(5):863-8.
Chertok-Shacham E, Ishay A, Lavi I, et al. Biomarkers of hypercoagulability and inflammation in primary hyperparathyroidism. Med Sci Monit. 2008; 14(12):CR628-32.
Lishmanov A, Dorairajan S, Pak Y, et al. Elevated serum parathyroid hormone is a cardiovascular risk factor in moderate chronic kidney disease. Int Urol Nephrol. 2012; 44(2):541-7.
Goettsch C, Iwata H, Aikawa E. Parathyroid hormone: critical bridge between bone metabolism and cardiovascular disease. Arterioscler Thromb Vasc Biol. 2014; 34(7):1333-5.
|Issue||Vol 12, No 3 (2018)|
|Calcium Primary hyperparathyroidism Thrombosis Stroke Pulmonary embolism Deep venous thrombosis|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|