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

Abstract

ContextMild primary hyperparathyroidism has been associated with increased body fat mass and unfavorable cardiovascular risk factors.ObjectiveTo assess the effect of parathyroidectomy on fat mass, glucose and lipid metabolism.Design, patients, interventions, main outcome measures119 patients previously randomized to observation (OBS; n = 58) or parathyroidectomy (PTX; n = 61) within the Scandinavian Investigation of Primary Hyperparathyroidism (SIPH) trial, an open randomized multicenter study, were included. Main outcome measures for this study were the differences in fat mass, markers for lipid and glucose metabolism between OBS and PTX 5 years after randomization.ResultsIn the OBS group, total cholesterol (Total-C) decreased from mean 5.9 (±1.1) to 5.6 (±1.0) mmol/L (P = 0.037) and LDL cholesterol (LDL-C) decreased from 3.7 (±1.0) to 3.3 (±0.9) mmol/L (P = 0.010). In the PTX group, the Total-C and LDL-C remained unchanged resulting in a significant between-group difference over time (P = 0.013 and P = 0.026, respectively). This difference was driven by patients who started with lipid-lowering medication during the study period (OBS: 5; PTX: 1). There was an increase in trunk fat mass in the OBS group, but no between-group differences over time. Mean 25(OH) vitamin D increased in the PTX group (P < 0.001), but did not change in the OBS group. No difference in parameters of glucose metabolism was detected.ConclusionIn mild PHPT, the measured metabolic and cardiovascular risk factors were not modified by PTX. Observation seems safe and cardiovascular risk reduction should not be regarded as a separate indication for parathyroidectomy based on the results from this study.

Unmet therapeutic, educational and scientific needs in parathyroid disorders: Consensus Statement from the first European Society of Endocrinology Workshop (PARAT)

“…A recent meta-analysis on the effect on echocardiography measures of surgical treatment in PHPT could not demonstrate signs of reversibility neither in observational nor randomized studies (124). The findings are in accordance with biochemical markers of insulin resistance and CV-risk based on 2 and 5-year data from the randomized Scandinavian study of PHPT (121, 125). Even though a positive treatment effect of surgery on vitamin D levels (25(OH)D) was demonstrated, no effect was seen on body composition and various measures of insulin resistance 5 years following randomization (116, 125).…”

Endocrine diseases as causes of secondary hyperlipidemia

“…of follow-up (1.17 ± 0.11 mmol/L) [67]. On the other hand, other researchers have shown that parathyroidectomy did not lead to any significant change in lipid profile [68]. The differences in favour of non-surgically treated patients have been attributed to lipid-lowering therapy.…”

Cardiovascular consequences of parathyroid disorders in adults

“…Long-term treatment effect of surgery on CV-risk markers in the debated mild form of PHPT was recently published based on five-year data from the Scandinavian study (SIPH), (59). Out of the original 191 patients with mild PHPT randomized to either immediate surgery or observation without intervention, 119 concluded the five-year follow-up.…”