Carotid Intima-Media Thickness, Adrenomedullin, and Pentraxin-3 as Indicators of Subclinical Cardiovascular Risk in Primary Hyperparathyroidism: Early Response to Parathyroidectomy

Objective: Primary hyperparathyroidism (PHPT) has been linked to adverse cardiovascular (CV) remodeling and atherosclerosis. We assessed subclinical CV disease in PHPT using carotid intima-media thickness (CIMT), and serum adrenomedullin (ADM) and pentraxin‑3 (PTX3) concentrations, and explored early changes after parathyroidectomy.Methods: In this case–control study, adults with PHPT (n=40) and healthy controls (n=23) underwent clinical assessment, laboratory testing, and high‑resolution carotid ultrasound. A subset of PHPT patients who had surgery (n=22) were reassessed 3 months post‑parathyroidectomy. Serum ADM and PTX3 were measured by ELISA. Group differences and pre/post comparisons used parametric or non‑parametric tests as appropriate; correlations used Spearman’s rho. Significance was set at p<0.05.Results: Compared with controls, the PHPT group had higher CIMT and PTX3 and lower ADM (p=0.009, p=0.029 and p<0.001, respectively). Post‑parathyroidectomy, ADM increased significantly versus preoperative values (p=0.004), whereas CIMT and PTX3 showed no significant short‑term change (p=0.632 and p=0.547, respectively). Changes in ADM didn’t correlate with CIMT or biochemical variables.Conclusions: PHPT was associated with alterations in CIMT, ADM, and PTX3, suggesting a potential increase in subclinical CV risk. ADM increased 3 months after surgery, while CIMT and PTX3 were unchanged at this early time point. These markers may have potential utility in the assessment of subclinical CV alterations in PHPT; however, their predictive value requires confirmation in larger, adequately powered studies.