Rising Glucagon-Like Peptide 1 Concentrations After Parathyroidectomy in Patients With Primary Hyperparathyroidism

Antonopoulou, Vasiliki; Karras, Spyridon Ν.; Koufakis, Theocharis; Yavropoulou, Maria P; Katsiki, Niki; Gerou, Spyridon; Papavramidis, Theodossis S; Kotsa, Kalliopi

doi:10.1016/j.jss.2019.07.019

Cited by 6 publications

(4 citation statements)

References 51 publications

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“…However, these results have not been confirmed by available intervention trials. We recently demonstrated a significant increase of glucose-stimulated glucagon-like peptide 1 secretion after successful PTx for asymptomatic primary hyperparathyroidism [25], indicating a favorable profile in incretion secretion physiology after surgical intervention.…”

Section: Discussionmentioning

confidence: 98%

Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes

et al. 2020

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We have previously described increased fasting plasma glucose levels in patients with normocalcemic primary hyperparathyroidism (NPHPT) and co-existing prediabetes, compared to prediabetes per se. This study evaluated the effect of parathyroidectomy (PTx) (Group A), versus conservative follow-up (Group B), in a small cohort of patients with co-existing NPHPT and prediabetes. Sixteen patients were categorized in each group. Glycemic parameters (levels of fasting glucose (fGlu), glycosylated hemoglobin (HbA1c), and fasting insulin (fIns)), the homeostasis model assessment for estimating insulin secretion (HOMA-B) and resistance (HOMA-IR), and a 75-g oral glucose tolerance test were evaluated at baseline and after 32 weeks for both groups. Measurements at baseline were not significantly different between Groups A and B, respectively: fGlu (119.4 ± 2.8 vs. 118.2 ± 1.8 mg/dL, p = 0.451), HbA1c (5.84 ± 0.3 %vs. 5.86 ± 0.4%, p = 0.411), HOMA-IR (3.1 ± 1.2 vs. 2.9 ± 0.2, p = 0.213), HOMA-B (112.9 ± 31.8 vs. 116.9 ± 21.0%, p = 0.312), fIns (11.0 ± 2.3 vs. 12.8 ± 1.4 μIU/mL, p = 0.731), and 2-h post-load glucose concentrations (163.2 ± 3.2 vs. 167.2 ± 3.2 mg/dL, p = 0.371). fGlu levels demonstrated a positive correlation with PTH concentrations for both groups (Group A, rho = 0.374, p = 0.005, and Group B, rho = 0.359, p = 0.008). At the end of follow-up, Group A demonstrated significant improvements after PTx compared to the baseline: fGlu ((119.4 ± 2.8 vs. 111.2 ± 1.9 mg/dL, p = 0.021) (−8.2 ± 0.6 mg/dL)), and 2-h post-load glucose concentrations ((163.2 ± 3.2 vs. 144.4 ± 3.2 mg/dL, p = 0.041), (−18.8 ± 0.3 mg/dL)). For Group B, results demonstrated non-significant differences: fGlu ((118.2 ± 1.8 vs. 117.6 ± 2.3 mg/dL, p = 0.031), (−0.6 ± 0.2 mg/dL)), and 2-h post-load glucose concentrations ((167.2 ± 2.7 vs. 176.2 ± 3.2 mg/dL, p = 0.781), (+9.0 ± 0.8 mg/dL)). We conclude that PTx for individuals with NPHPT and prediabetes may improve their glucose homeostasis when compared with conservative follow-up, after 8 months of follow-up.

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Section: Discussionmentioning

confidence: 98%

Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes

et al. 2020

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“…The absence of significant concomitant changes in HOMA-B, reflecting beta cell function, suggests that this improvement could be mainly mediated by an improved peripheral insulin sensitivity. Indeed, although an elevated serum PTH level could induce pancreatic beta cell dysfunction [ 32 ], both elevated serum PTH and calcium levels are also known to impair peripheral insulin sensitivity [ 30 , 32 , 33 ]. However, no correlation was found between the changes in phosphocalcic and glucose metabolism parameters following PTX, suggesting that indirect mechanisms are implicated.…”

Section: Discussionmentioning

confidence: 99%

Effect of Parathyroidectomy on Metabolic Homeostasis in Primary Hyperparathyroidism

Frey

Bourgade

May

et al. 2022

JCM

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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.

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“…Khaleeli et al [ 30 ] demonstrate that following a parathyroidectomy, fasting and two-hour post-prandial glucose levels are significantly reduced (p < 0.05, p < 0.01) in addition to a 50% reduction in diabetes mellitus frequency, and a 33% reduction in the frequency of impaired glucose tolerance/impaired fasting glucose (along with a 35% increased frequency of normal glucose tolerance). Antonopoulou et al [ 31 ] note that following a parathyroidectomy, a positive correlation remains between PTH and HOMA-2 in regard to beta cell function (pre-operatively r = 0.74, p = 0.02; post-operatively r = 0.55, p = 0.04). Antonopoulou et al [ 26 ] note that HOMA-B and PTH remain significant following such surgery (r = 0.76, p = 0.002).…”

Section: Reviewmentioning

confidence: 99%

Association Between Primary Hyperparathyroidism and Secondary Diabetes Mellitus: Findings From a Scoping Review

Barnett¹

2023

Cureus

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An ill-defined association exists between diabetes mellitus (insulin resistance) and primary hyperparathyroidism. This article explores this phenomenon while providing an explanation for such a relationship and reviewing the evidence regarding the response to insulin sensitivity following a parathyroidectomy. Primary hyperparathyroidism may increase the risk of developing insulin resistance; peculiarly, this is not present in all patients. It is likely that both intracellular hypercalcemia and hypophosphatemia alter the insulin receptor expression and response; the contribution of parathyroid hormone is less clear. Following parathyroidectomy, patients may demonstrate improvement in their insulin sensitivity, while others have no response or a detrimental effect. A varied phenotype exists among patients, and furthermore, it is unclear why certain patients demonstrate improvement in insulin sensitivity following a parathyroidectomy, whereas others fail to do so. While this review provides a broad overview of the general endocrine community, it is imperative to note that clinical applicability is limited until further studies address these remaining uncertainties. Due to the lack of understanding regarding this endocrinological enigma, the presence of insulin resistance, at this present time, should not be a criterion for a parathyroidectomy.

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Rising Glucagon-Like Peptide 1 Concentrations After Parathyroidectomy in Patients With Primary Hyperparathyroidism

Cited by 6 publications

References 51 publications

Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes

Improving Glucose Homeostasis after Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism with Co-Existing Prediabetes

Effect of Parathyroidectomy on Metabolic Homeostasis in Primary Hyperparathyroidism

Association Between Primary Hyperparathyroidism and Secondary Diabetes Mellitus: Findings From a Scoping Review

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