Insulin secretion, insulin sensitivity and hepatic insulin extraction in primary hyperparathyroidism before and after surgery

Kautzky‐Willer, Alexandra; Pacini, Giovanni; Niederle, Bruno; Schernthaner, Guntram; Prager, R.

doi:10.1111/j.1365-2265.1992.tb02299.x

Cited by 88 publications

(62 citation statements)

References 34 publications

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“…Present findings, in agreement with results of other Authors [6,11,32,33], have also shown that insulin resistance is significantly increased in PHPT patients without altered glucose tolerance and cardiovascular risk factors; this increased insulin resistance probably leads over many years to metabolic disorders, hypertension, and to increased cardiovascular morbidity and mortality. Noteworthy our data show a positive correlation between serum total calcium levels and insulin resistance.…”

Section: Discussionsupporting

confidence: 93%

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: Discussionsupporting

confidence: 93%

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

et al. 2013

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“…Hyperparathyroidism, found in vitamin D depletion, may be such a link. There is evidence that insulin resistance occurs in primary hyperparathyroidism, which improves after parathyroidectomy [10]. Impaired insulin release, insulin resistance and impaired glucose tolerance developing in subjects with renal failure improves with the administration of 1,25(OH) 2 D 3 .…”

Section: Discussionmentioning

confidence: 99%

Vitamin D, glucose tolerance and insulinaemia in elderly men

et al. 1997

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We have been interested in environmental factors which may contribute to the development of non-insulin-dependent diabetes mellitus (NIDDM). Previous analysis of dietary factors in a cohort of elderly Dutch people has shown that regular fish eating reduced the 4-year risk of glucose intolerance in normoglycaemic individuals [1]. Experimentally vitamin D is required for normal insulin secretion and glucose tolerance [2]. Since fish can be an important dietary source of vitamin D this sub-study was designed to determine whether variation in vitamin D status relates to glucose intolerance. Subjects, materials and methods Study population:In 1960 a population-based random sample of 878 men (born 1900-1920) were enrolled in the Zutphen Study, the Dutch contribution to the Seven Countries Study. Clinical examinations and dietary surveys were conducted initially and at regular intervals thereafter. In 1990 all living participants (314) were invited for the 30-year follow-up and 238 (77 %) agreed. Men known by then to have diabetes were excluded (n = 29). Complete data on diet and BMI from both the 10-and 30-year surveys and on glucose tolerance at the 30-year survey were available on 158 subjects. Serum for 25-hydroxyvitamin D (25(OH)D) analysis was available on 142 of those who formed the study group.Protocol: All men were examined as in previously reported surveys [3]. At the 30-year follow-up an OGTT conforming to World Health Organization (WHO) guidelines [4] was performed with samples at 0, 1 and 2 h after the glucose load. Plasma glucose was measured in fluoridated samples using hexokinase methodology. WHO criteria were used to classify the men into those with newly diagnosed NIDDM, impaired glucose tolerance or as normoglycaemic [4]. Serum total insulin was assayed by radioimmunoassay (Pharmacia Diagnostics, Uppsala, Sweden; cross-reaction with proinsulin 100 %).Clinical examinations and anthropomorphic measurements were made by physicians specifically trained for the study as

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“…However, there is also evidence, that phosphate supplementation in glucose intolerant hypophosphatemic patients improves glucose tolerance significantly (Wittmann and Nagy, 1997). In addition, surgical treatment of pHPT at least partly reverses IGT and insulin resistance in these subjects (Prager et al, 1990;Kautzky-Willer et al, 1992).…”

Section: Introductionmentioning

confidence: 99%

Association of serum phosphate levels with glucose tolerance, insulin sensitivity and insulin secretion in non-diabetic subjects

et al. 2006

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Background: Hypophosphatemia is associated with impaired glucose tolerance and insulin resistance in primary hyperparathyroidism. However, little is known about the association between serum phosphate and glucose metabolism in healthy subjects. Methods: We measured fasting serum phosphate levels (SP, normal range 2.6-4.5 mg/dl) and serum calcium (S-Ca, normal range 2.1-2.6 mmol/l) in 881 non-diabetic subjects (341 male/540 female, age: 3871 years, body mass index 25.970.2 kg/m 2 (mean7standard error of the mean). An oral glucose tolerance test (OGTT) with determination of glucose and insulin every 30 min was performed in all subjects. Insulin secretion and insulin sensitivity (IS) were estimated from the OGTT using validated indices. Furthermore, we tested whether serum phosphate predicts glucose tolerance in 115 subjects during a lifestyle intervention program (LIP). Results: Serum phosphate was negatively correlated with 2-h blood glucose levels independent of age, gender and percent body fat (r ¼ À0.13, Po0.0001). This association remained significant after additional adjustment for S-Ca, creatinine and parathyroid hormone. Serum phosphate was positively correlated with IS (r ¼ 0.10, P ¼ 0.0006), but not with insulin secretion. This was independent of age, gender, percent body fat, S-Ca and serum creatinine. In the subjects taking part in the LIP low serum phosphate levels at baseline were associated with higher postprandial glucose levels. Conclusions: In non-diabetic subjects, low serum phosphate levels are associated with high 2-h blood glucose levels and reduced IS. Whether low serum phosphate levels are a cause or a consequence of low IS and impairment of glucose tolerance needs to be tested in further studies.

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Insulin secretion, insulin sensitivity and hepatic insulin extraction in primary hyperparathyroidism before and after surgery

Cited by 88 publications

References 34 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

Vitamin D, glucose tolerance and insulinaemia in elderly men

Association of serum phosphate levels with glucose tolerance, insulin sensitivity and insulin secretion in non-diabetic subjects

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