Effect of Parathyroidectomy on Metabolic Homeostasis in Primary Hyperparathyroidism

Abstract

Background: The benefits of parathyroidectomy on cardiovascular risk in primary hyperparathyroidism (PHPT) are controversial. This monocentric, observational, prospective study aimed to assess the effects of parathyroidectomy on glucose and lipid metabolism in classic or mild PHPT. Methods: Patients who underwent parathyroidectomy for classic (calcemia >2.85 mmol/L) or mild PHPT (calcemia ≤2.85 mmol/L) between 2016 and 2019 were included. A metabolic assessment was performed before and 1 year after parathyroidectomy. Patients with a history of diabetes were excluded. Results: Nineteen patients had classic and 120 had mild PHPT. Ninety-five percent were normocalcemic 6 months after surgery. Fasting plasma glucose and insulin levels decreased after parathyroidectomy in patients with mild PHPT (p < 0.001). HOMA-IR decreased after surgery in the overall population (p < 0.001), while plasma adiponectin concentrations increased in patients with both classic (p = 0.005) and mild PHPT (p < 0.001). Plasma triglyceride levels decreased significantly only in patients with classic PHPT (p = 0.021). Plasma PCSK9 levels decreased in patients with mild PHPT (p < 0.001). Conclusions: Parathyroidectomy for PHPT improves insulin resistance and decreases plasma triglyceride levels in classic PHPT and plasma PCSK9 levels in mild PHPT. Further studies are needed to better characterize the consequences of such metabolic risk factors’ improvements on cardiovascular events.

Changes in bone turnover markers and bone mineral density after radiofrequency ablation for mild primary hyperparathyroidism: a prospective cohort study

“…In this open-label prospective study, patients diagnosed with sporadic PHPT in Gansu Provincial Hospital from November 2018 to September 2021 were included, including 36 treated with RFA and 45 who were observed without intervention (OBS). The inclusion criteria were as follows: (I) confirmed diagnosis of asymptomatic PHPT, defined as an elevated serum PTH level with or without elevated blood calcium levels ( 11 , 12 ); (II) at least one enlarged parathyroid gland clearly displayed on ultrasound (US), and (III) positive technetium 99m Tc-sestamibi (MIBI) results or negative MIBI results but with the gland confirmed to be parathyroid tissue by fine-needle aspiration (FNA) and tissue fluid PTH analysis. The patients undergoing RFA were required to meet criteria II and III listed above.…”

Parathyroidectomy for primary hyperparathyroidism: effect on quality of life after 3 years – a prospective cohort study

“…The Cohorte Prospective Hyperparathyroïdie Primaire (‘prospective cohort with primary hyperparathyroidism patients,’ or CoHPT NCT05469087) is a monocentric prospective cohort designed to study the consequences of PTX for PHPT in which all consecutive patients diagnosed with sporadic PHPT in a French tertiary referral center were included. PHPT was defined as an elevated or inappropriate serum PTH level compared with an elevated (>2.60 mmol/l) SCa; or an elevated serum PTH level compared with a normal SCa 26 , 27 . Noninclusion criteria were age under 18, pregnancy, secondary or tertiary hyperparathyroidism, hypocalciuric hypercalcaemia, and/or multiple endocrine neoplasia.…”

Turning Points in Cross-Disciplinary Perspective of Primary Hyperparathyroidism and Pancreas Involvements: Hypercalcemia-Induced Pancreatitis, MEN1 Gene-Related Tumors, and Insulin Resistance

“…When it comes to metabolic syndrome, as the signature of insulin resistance, in subjects confirmed with primary hyperparathyroidism, we identified ten studies [ 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 ] within the timeframe of research in addition to one study that was prior mentioned with respect to insulinoma analysis [ 111 ] and a cohort of primary hyperparathyroidism [ 28 ]. The overall results are still heterogeneous, and no clear conclusion can be drawn yet ( n = 10, N = 1010 subjects with primary hyperparathyroidism, among them, 193 individuals had normocalcemic/mild type [ 152 , 156 , 158 , 159 ]). Among them, there were six longitudinal studies upon parathyroidectomy (assessments were conducted after one, three, eight, twelve, and thirteen months) [ 151 , 153 , 156 , 157 , 158 , 160 ], for a total of 651 patients ( Table 7 ).…”

“…The overall results are still heterogeneous, and no clear conclusion can be drawn yet ( n = 10, N = 1010 subjects with primary hyperparathyroidism, among them, 193 individuals had normocalcemic/mild type [ 152 , 156 , 158 , 159 ]). Among them, there were six longitudinal studies upon parathyroidectomy (assessments were conducted after one, three, eight, twelve, and thirteen months) [ 151 , 153 , 156 , 157 , 158 , 160 ], for a total of 651 patients ( Table 7 ).…”

“…Six studies addressed the issue of metabolic changes upon parathyroidectomy, but the assessments and study design were not homogenous [ 151 , 153 , 156 , 157 , 158 , 160 ]. A single-centric study was performed on 65 subjects (an average age of 45.44 years) who underwent parathyroidectomy (they were assessed before surgery and one month and three months after the procedure).…”