Effect of curative parathyroidectomy on insulin resistance

Abstract

Background:Primary hyperparathyroidism (PHPT) is characterized by inappropriately elevated serum parathyroid hormone (PTH) level despite elevated serum calcium. Insulin resistant is the basic pathophysiology, behind the higher prevalence of diabetes mellitus in patients with PHPT. However, the improvement in insulin resistance (IR) after curative parathyroidectomy (CPTX) has not been established yet, as the study results are conflicting.Materials and Methods:In this prospective interventional study, ten patients with mild PHPT (Group 1) and another ten patients with moderate to severe PHPT (Group 2) were undergone CPTX. The IR was assessed by homeostasis model assessment-IR (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), fasting plasma glucose (FPG), and fasting serum insulin (FSI), before and 3 months after CPTX.Results:There was no significant change of FPG and FSI, before and after CPTX in Group 1 (P = 0.179 and P = 0.104) and Group 2 (P = 0.376 and P = 0.488). Before surgery, HOMA-IR was higher, and QUICKI was significantly lower, in both Group 1 (P = 0.058 and P = 0.009) and Group 2 (P = 0.023 and P = 0.005) as compared to published normal reference mean, with no significant difference between the groups. Three months after surgery HOMA-IR increased further and QUICKI remained unchanged as compared to baseline, in both Group 1 (P = 0.072 and 0.082) and Group 2 (P = 0.54 and 0.56), but statistically insignificant.Conclusion:IR remained unchanged after CPTX in mild as well as moderate to severe PHPT. Asymptomatic PHPT with abnormal IR should not be used as criteria for parathyroidectomy.

Five-year retrospective study on primary hyperparathyroidism in South India: Emerging roles of minimally invasive parathyroidectomy and preoperative localization with methionine positron emission tomography-computed tomography scan

“…[ 14 15 ] Our study is not in agreement with the results of other Indian studies where majority of patients were <40 years of age. [ 16 17 18 ] In one study from Kashmir, the mean age of patients at presentation was 44.72 ± 12.46 years which matches with our data probably because 62% of patients in that study were enrolled after 2012. [ 19 ] The reason why PHPT presents at a younger age in our country is possibly because of the associated Vitamin D deficiency.…”

The effect of surgery on fat mass, lipid and glucose metabolism in mild primary hyperparathyroidism

“…Nevertheless, evidence for the beneficial effect of PTX in mild PHPT is scarce ( 13 ). In single arm studies following patients after PTX, a trend toward an increase of insulin resistance (HOMA-IR and QUICKI) was found in a single recent study ( 32 ), while another study found some improvement in glucose metabolism in non-diabetic patients ( 25 ). The present randomized, controlled study did not indicate a longitudinal change or between-group difference in the markers of the metabolic syndrome.…”

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

“…PTx improved glucose metabolism in PHPT patients after 6 months (28, 33, 53, 54) or 12 months (55), while other studies did not report such an improvement (56,57). Considering mild PHPT patients, an increased insulin resistance (HOMA IR) and lower quantitative insulin sensitivity check index (QUICKI) compared to controls, has been reported by some investigators (54); however, these findings were not confirmed by Gianotti et al (56).…”

“…Considering mild PHPT patients, an increased insulin resistance (HOMA IR) and lower quantitative insulin sensitivity check index (QUICKI) compared to controls, has been reported by some investigators (54); however, these findings were not confirmed by Gianotti et al (56). PTx in patients with mild PHPT showed no improvement in insulin sensitivity after one year (57,58,59) or 2 years (41). In patients with asymptomatic PHPT, a conservative follow-up of 18 months showed no progression of calcium and glucose metabolism abnormalities (60).…”