Skip to main content

Advertisement

Log in

Parathyroidectomy Decreases Insulin Resistance Index in Patients with Primary Hyperparathyroidism

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

Primary hyperparathyroidism (PHPT) has been considered a cause of insulin resistance (IR) and impaired glucose metabolism. However, there are conflicting results related with the recovery of insulin resistance in patients with PHPT following curative parathyroidectomy. Our aim is to evaluate the effects of curative parathyroidectomy on IR in patients with PHPT. This is a prospective interventional study. Twenty-one consecutive patients with symptomatic PHPT were included into the study. All patients underwent parathyroidectomy. Fasting serum glucose, calcium, phosphorous, parathormone, plasma insulin, and vitamin D levels were measured both at baseline and 2 months after parathyroidectomy. Insulin resistance was calculated by homeostasis of model assessment-insulin resistance (HOMA-IR). Two months after curative parathyroidectomy, serum levels of calcium (p = 0.001), PTH (p < 0.001), insulin (p = 0.003), and HOMA-IR (p = 0.003) decreased, while phosphorous levels increased (p = 0.001). During this period, no changes were observed at vitamin D and glucose levels. We concluded that curative parathyroidectomy decreases HOMA-IR index in patients with PHPT. Studies with larger population and longer follow-up period are required to confirm our results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Walsh JP, Divitini ML, Knuiman MW (2013) Plasma calcium as a predictor of cardiovascular disease in a community-based cohort. Clin Endocrinol 78:852–857

    Article  CAS  Google Scholar 

  2. Bollerslev J (2013) The important players in primary hyperparathyroidism. Clin Endocrinol. doi:10.1111/cen.12291

    Google Scholar 

  3. Goswami S, Ghosh S (2012) Hyperparathyroidism: cancer and mortality. Indian J Endocrinol Metab 16(suppl 2):s217–s220

    PubMed  PubMed Central  Google Scholar 

  4. Osto E, Fallo F, Pelizzo MR, Maddalozzo A, Sorgato N, Corbetti F et al (2012) Coronary microvascular dysfunction induced by primary hyperparathyroidism is restored after parathyroidectomy. Circulation 126:1031–1039

    Article  PubMed  Google Scholar 

  5. Bannon MP, van Heerden JA, Palumbo PJ, Ilstrup DM (1998) The relationship between primary hyperparathyroidism and diabetes mellitus. Ann Surg 207:430–433

    Article  Google Scholar 

  6. Kumar S, Olukoga AO, Gordon C, Mawer EB, France M, Hosker JP (1994) Impaired glucose tolerance and insulin insensitivity in primary hyperparathyroidism. Clin Endocrinol 40:47–53

    Article  CAS  Google Scholar 

  7. Cardenas MG, Vigil KJ, Talpos GB, Lee MW, Peterson E, Rao DS (2008) Prevalence of type diabetes mellitus in patients with hyperparathyroidism. Endocr Pract 14:69–75

    Article  PubMed  Google Scholar 

  8. Luboshitzky R, Chertoc-Schaham Y, Lavi I, Ishay A (2009) Cardiovascular risk factors in primary hyperparathyroidism. J Endocrinol Investig 32:317–321

    Article  CAS  Google Scholar 

  9. Ybarra J, Donate T, Jurado J, Pou JM (2007) Primary hyperparathyroidism, insulin resistance, and cardiovascular disease: a review. Nurs Clin N Am 42:79–85

    Article  Google Scholar 

  10. Tassone F, Procopio M, Gianotti L, Visconti G, Pia A, Terzolo M et al (2009) Insulin resistance is not coupled with defective insulin secretion in primary hyperparathyroidism. Diabet Med 26:968–973

    Article  CAS  PubMed  Google Scholar 

  11. Taylor WH, Khaleeli AA (2001) Coincident diabetes mellitus and primary hyperparathyroidism. Diabetes Metab Res Rev 17:175–180

    Article  CAS  PubMed  Google Scholar 

  12. Procopio M, Magro G, Cesario F, Piovesan A, Pia A, Molineri M et al (2002) The oral glucose tolerance test reveals a high frequency of both impaired glucose tolerance and undiagnosed type 2 diabetes mellitus in primary hyperparathyroidism. Diabet Med 19:958–961

    Article  CAS  PubMed  Google Scholar 

  13. Haap M, Heller E, Thamer C, Tschritter O, Stefan N, Fritsche A (2006) Association of serum phosphate levels with glucose tolerance, insulin sensitivity and insulin secretion in non-diabetic subjects. Eur J Clin Nutr 60:734–739

    Article  CAS  PubMed  Google Scholar 

  14. Yamaguchi T, Kanazawa I, Takaoka S, Sugimoto T (2011) Serum calcium is positively correlated with fasting plasma glucose and insulin resistance, independent of parathyroid hormone, in male patients with type 2 diabetes mellitus. Metabolism 60:1334–1339

    Article  CAS  PubMed  Google Scholar 

  15. Chiu KC, Chuang LM, Lee NP, Ryu JM, McGullam JL, Tsai GP et al (2000) Insulin sensitivity is inversely correlated with plasma intact parathyroid hormone level. Metabolism 49:1501–1505

    Article  CAS  PubMed  Google Scholar 

  16. Kautzky-Willer A, Pacini G, Niederle B, Schernthaner G, Prager R (1992) Insulin secretion, insulin sensitivity and hepatic insulin extraction in primary hyperparathyroidism before and after surgery. Clin Endocrinol 37:147–155

    Article  CAS  Google Scholar 

  17. Bhadada SK, Bhansali A, Shah VN, Rao DS (2011) Changes in serum leptin and adiponectin concentrations and insulin resistance after curative parathyroidectomy in moderate to severe primary hyperparathyroidism. Singap Med J 52:890–893

    CAS  Google Scholar 

  18. Ljunghall S, Palmer M, Akerstrom G, Wide L (1983) Diabetes mellitus, glucose tolerance and insulin response to glucose in patients with primary hyperparathyroidism before and after parathyroidectomy. Eur J Clin Investig 13:373–377

    Article  CAS  Google Scholar 

  19. Almqvist EG, Bondeson AG, Bondeson L, Mellstrom D, Svensson J (2012) Factors influencing insulin sensitivity in patients with mild primary hyperparathyroidism before and after parathyroidectomy. Scand J Clin Lab Invest 72:92–99

    Article  CAS  PubMed  Google Scholar 

  20. Ishay A, Herer P, Luboshitzky R (2011) Effects of successful parathyroidectomy on metabolic cardiovascular risk factors in patients with severe primary hyperparathyroidism. Endocr Pract 17:584–590

    Article  PubMed  Google Scholar 

  21. Rudman A, Pearson ER, Smith D, Srivastava R, Murphy MJ, Leese GP (2010) Insulin resistance before and after parathyroidectomy in patients with primary hyperparathyroidism—a pilot study. Endocr Res 35:85–93

    Article  CAS  PubMed  Google Scholar 

  22. Bollerslev J, Rosen T, Mollerup CL, Nordenström J, Baranowski M, Franco C, the SIPH Study Group et al (2009) Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism. J Clin Endocrinol Metab 94:2255–2261

    Article  CAS  PubMed  Google Scholar 

  23. Bannon MP, van Heerden JA, Palumbo PJ, Ilstrup DM (1998) The relationship between primary hyperparathyroidism and diabetes mellitus. Ann Surg 4:430–433

    Google Scholar 

  24. Khaleeli AA, Johnson JN, Taylor WH (2007) Prevalence of glucose intolerance in primary hyperparathyroidism and the benefit of parathyroidectomy. Diabetes Metab Res Rev 23:43–48

    Article  CAS  PubMed  Google Scholar 

  25. Bilezikian JP, Khan AA, Potts JT Jr (2009) Third International Workshop on the management of asymptomatic primary hyperparathyroidism. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab 94:335

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Akgün S, Ertel NH (1978) Hyperparathyroidism and coexisting diabetes mellitus: ALTERED carbohydrate metabolism. Arch Intern Med 138:1500–1502

    Article  PubMed  Google Scholar 

  27. Prager R, Kovarik J, Schernthaner G, Woloszczuk W, Willwonseder R (1983) Peripheral insulin resistance in primary hyperparathyroidism. Metabolism 32:800–805

    Article  CAS  PubMed  Google Scholar 

  28. Ayturk S, Gursoy A, Bascil Tutuncu N, Ertugrul DT, Guvener Demirag N (2006) Changes in insulin sensitivity and glucose and bone metabolism over time in patients with asymptomatic primary hyperaldosteronism. J Clin Endocrinol Metab 91:4260–4263

    Article  CAS  PubMed  Google Scholar 

  29. Saxe AW, Gibson G, Levy J (1999) Effect of vitamin D infusion upon in vivo glucose disposal. Calcif Tissue Int 64:248–251

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cevdet Duran.

Ethics declarations

Informed consents were taken from all participants, and the study protocol was approved by the Ethics Committee for Human Studies of Meram Medical School, Selçuk University.

Conflict of Interest

Authors have no relevant conflict of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duran, C., Sevinc, B., Kutlu, O. et al. Parathyroidectomy Decreases Insulin Resistance Index in Patients with Primary Hyperparathyroidism. Indian J Surg 79, 101–105 (2017). https://doi.org/10.1007/s12262-015-1431-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-015-1431-4

Keywords

Navigation