Primary hyperparathyroidism induces erythropoietin resistance through fibroblast growth factor 23.

IF 5.3 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

European Journal of Endocrinology Pub Date : 2025-03-03 DOI:10.1093/ejendo/lvaf039

Aurélie Huber, Marco Demarchi, Thomas Verissimo, Marylise Fernandez, Anne Dufey, Lena Berchtold, Delal Dalga, Frédéric Triponez, Samira M Sadowski, Belen Ponte, Sophie de Seigneux

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引用次数: 0

Abstract

Introduction: Primary hyperparathyroidism (PHPT) often causes hypercalcemia and complications requiring parathyroidectomy (PTX). Anemia affects 15%-50% of PHPT patients, but its mechanisms remain unclear. While parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) contribute to anemia in secondary hyperparathyroidism through erythropoietin (EPO) resistance and bone marrow fibrosis, their roles in PHPT are less defined. This study explores the effect of PHPT on erythropoiesis by assessing hemoglobin (Hb), EPO, and FGF23 levels before and after PTX.

Methods: In a monocentric longitudinal study (2018-2020), PHPT patients scheduled for PTX were followed for 6 months. Blood and urine samples were collected at baseline (surgery day), at 10 days and 6 months postsurgery. Pearson correlation assessed relationships between Hb, EPO, PTH, FGF23, calcium, and phosphate at baseline and 6 months. Mixed-effects models evaluated the impact of PTH and FGF23 on Hb, adjusting for confounders.

Results: In a cohort of 111 PHPT patients (81% women, median age 64, normal body mass index), anemia prevalence decreased from 9.9% at baseline to 2.7% 6 months post-PTX, despite stable EPO levels. Postsurgery, PTH, FGF23, and calcium significantly decreased. PTH did not significantly correlate with Hb or EPO at any time point. Before surgery, FGF23 negatively correlated with Hb (R = -0.20, P = .020) and positively correlated with log-EPO (R = 0.38, P < .001). Mixed-effects models showed no predictive effect of PTH on Hb. However, multivariable models indicated a significant association between FGF23 and declining Hb (β = -.01, 95% confidence interval [-0.02; -0.01]).

Conclusion: Anemia in PHPT is linked to elevated FGF23 levels, potentially causing EPO resistance.

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来源期刊

European Journal of Endocrinology 医学-内分泌学与代谢

CiteScore

9.80

自引率

3.40%

发文量

354

审稿时长

1 months

期刊介绍： European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica. The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology. Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials. Equal consideration is given to all manuscripts in English from any country.