Investigation of insulin resistance in patients with normocalcemic primary hyperparathyroidism

Cakir, Ilkay; Ünlühızarcı, Kürşad; Tanrıverdi, Fatih; Elbüken, Gülşah; Karaca, Züleyha; Keleştimur, Fahrettin

doi:10.1007/s12020-012-9627-x

Cited by 43 publications

(28 citation statements)

References 19 publications

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“…Noteworthy our data show a positive correlation between serum total calcium levels and insulin resistance. Consistently, recent studies do not find an increased insulin resistance in patients with normocalcemic PHPT [34,35]. However, it has to be underlined that cytosol calcium content seems more important than serum calcium to influence insulin secretion and sensitivity [36].…”

Section: Discussionmentioning

confidence: 80%

Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

et al. 2013

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Cardiometabolic disorders have been associated with primary hyperparathyroidism (PHPT), while the relationship of cardiovascular risk score (CRS) and metabolic syndrome (MS) with different clinical presentation of PHPT remains undefined. Our aim was to evaluate CRS, MS and its components in PHPT looking for their correlation to different clinical forms. In 68 consecutive PHPT patients and 68 matched controls, CRS, MS and its components were assessed to perform an observational case-control study at an ambulatory referral center for Bone Metabolism Diseases. Patients were stratified in symptomatic and asymptomatic PHPT; these latter were divided in high-risk and low-risk subgroups for end-organ damage. An increased proportion of PHPT patients had intermediate-high CRS and MS (mean, 95 % Confidence Interval (CI) 51.5 %, 39.6-63.3 and 20.6 %, 11.0-30.2, respectively, p < 0.02 vs. controls). Intermediate-high CRS was prevalent both in symptomatic and low-risk asymptomatic PHPT while MS resulted prevalent in low-risk asymptomatic but not in symptomatic PHPT. Type 2 DM, IFG, mixed dyslipidemia, hypertriglyceridemia, HDL-hypocholesterolemia, and LDL-hypercholesterolemia predominated in low-risk asymptomatic, while only LDL-hypercholesterolemia prevailed also in symptomatic PHPT. In patients and controls without cardiometabolic risk factors, HOMA-IR index was significantly increased in PHPT vs. controls (p < 0.03) and associated to total calcium (R = 0.73; p < 0.001). By multivariate analysis low-risk asymptomatic PHPT predicted MS after adjusting for age, sex, and BMI. Our data show an increased frequency of intermediate-high CRS both in symptomatic and low-risk asymptomatic PHPT while MS prevails in low-risk asymptomatic PHPT, supporting the potential for cardiovascular morbidity and mortality also in this form.

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Section: Discussionmentioning

confidence: 80%

Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

et al. 2013

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“…But limited data are available in NC-PHPT for insulin sensitivity. A case-control study reported by Cakir et al investigated insulin resistance in NC-PHPT patients [16]. In this study, 18 patients with NC-PHPT and 18 matched controls had comparisons of glucose metabolism as assessed by OGTT.…”

Section: Discussionmentioning

confidence: 99%

“…It is unclear whether NC-PHPT carries the same risk for increased CV morbidity as the hypercalcemic form [13]. There are few and contradictory data available regarding metabolic abnormalities of normocalcemic PHPT patients in the literature [12,[14][15][16].…”

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confidence: 99%

Patients with normocalcemic primary hyperparathyroidism may have similar metabolic profile as hypercalcemic patients

et al. 2016

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“…Tordjman and cols., evaluated a cohort comprising 32 patients with normocalcemic hyperparathyroidism and found a high prevalence of osteoporosis (36%), with 9% presenting nephrolithiasis (7). Cakir and cols., in their investigation of 18 patients with normocalcemic hyperparathyroidism and a mean age of 50 years (47% female) found that 47% had osteoporosis and 11% nephrolithiasis (8).…”

Section: Case Reportmentioning

confidence: 98%

Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas

Pimentel

Portela

Loureiro

et al. 2014

Arq Bras Endocrinol Metab

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SUMMARYNormocalcemic primary hyperparathyroidism (NPHPT) is a condition characterized by elevation of the parathyroid hormone (PTH) in the presence of normal serum calcium and the absence of secondary causes. The case described illustrates the long-term follow-up of a postmenopausal woman with NPHPT patient who progressed with multiple adenomas. This case reports a 77-year-old female who has chronic generalized pain and osteoporosis. Her initial serum PTH was 105 pg/mL, with total serum calcium of 9.6 mg/dL, albumin 4.79 g/dL, phosphorus 2.8 mg/dL, and 25OHD after supplementation was 34.6 ng/mL. The bone densitometry (BMD) results were as follows: lumbar spine: T-score -3.0, femoral neck: T-score -2.6 and distal radius: -4.2. Other causes of secondary hyperparathyroidism were ruled out and cervical ultrasound and Tc-99-Sestamibi scan were negative. She used oral alendronate and three infusions of zoledronic acid for treatment of osteoporosis. In the 10 th year of follow-up, after successive negative cervical imaging, ultrasound showed a nodule suggestive of an enlarged right inferior parathyroid gland. PTH levels in fluid which was obtained during fine-needle aspiration (FNA) were over 5,000 pg/mL and a Sestamibi scan was negative. The patient underwent parathyroidectomy, and a histological examination confirmed parathyroid adenoma. Post-operatively serum PTH remained elevated in the presence of normal serum calcium levels. A follow-up cervical ultrasound showed a new solid nodule suggestive of an enlarged right superior parathyroid gland. PTH levels in the aspiration fluid were remarkably high. A second parathyroidectomy was performed, with the excision of a histologically confirmed parathyroid adenoma. In conclusion, this is an unusual presentation of NPHPT and highlights the long-term complications. Arq Bras Endocrinol Metab. 2014;58(5):583-6 SUMáRioHiperparatiroidismo primário normocalcêmico (NPHPT) caracteriza-se pela elevação do hormô-nio da paratiroide (PTH), na ausência da elevação dos níveis séricos de cálcio e exclusão de causas secundárias. O caso descrito ilustra o seguimento de uma mulher na pós-menopausa com NPHPT que evoluiu com múltiplos adenomas. Este caso relata uma paciente de 77 anos de idade que tem dor generalizada crônica e osteoporose. O PTH inicial foi elevado com níveis séricos de cálcio, albumina, fósforo e 25OH vitamina D normais. A densitometria óssea (DMO) evidenciou um T-SCORE da coluna lombar: -3.0, colo do fêmur: -2.6 e rádio distal: -4.2. Outras causas de hiperparatireoidismo secundário foram descartadas e a ultrassonografia cervical e varredura com Sestamibi foram negativos. Fez uso de alendronato e três infusões de ácido zoledrônico para o tratamento da osteoporose. No décimo ano de seguimento, depois de sucessivas imagens negativas, a ultrassonografia evidenciou um nódulo sugestivo de adenoma de paratireoide inferior direita. A paciente foi submetida à paratireoidectomia, e um exame histológico confirmou a hipótese. A elevação dos níveis séricos de PTH no pós-operatório se ma...

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Investigation of insulin resistance in patients with normocalcemic primary hyperparathyroidism

Cited by 43 publications

References 19 publications

Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

Cardiovascular risk and metabolic syndrome in primary hyperparathyroidism and their correlation to different clinical forms

Patients with normocalcemic primary hyperparathyroidism may have similar metabolic profile as hypercalcemic patients

Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas

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