Prevalence of Type 2 Diabetes Mellitus In Patients With Primary Hyperparathyroidism

Cardenas, Monica G.; Vigil, Karen J.; Talpos, Gary B.; Lee, Min Won; Peterson, Edward L.; Rao, D. Sudhaker

doi:10.4158/ep.14.1.69

Cited by 28 publications

(16 citation statements)

References 30 publications

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“…The high prevalence of type 2 diabetes mellitus in patients with PHPT was not confirmed in a large cohort of patients, even though the prevalence was still high in a subgroup of older patients and in men (47); differences are probably due to the retrospective nature of the investigation and the lack of appropriate controls (47). More subtle alterations of glucose metabolism, such as glucose intolerance and insulin resistance, have also been described in PHPT patient compared to controls by some (48,49,50), but not by all authors (35).…”

Section: Glucose Metabolismmentioning

confidence: 99%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

129

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Data on cardiovascular disease in primary hyperparathyroidism (PHPT) are controversial; indeed, at present, cardiovascular involvement is not included among the criteria needed for parathyroidectomy. Aim of this narrative review is to analyze the available literature in an effort to better characterize cardiovascular involvement in PHPT. Due to physiological effects of both parathyroid hormone (PTH) and calcium on cardiomyocyte, cardiac conduction system, smooth vascular, endothelial and pancreatic beta cells, a number of data have been published regarding associations between symptomatic and mild PHPT with hypertension, arrhythmias, endothelial dysfunction (an early marker of atherosclerosis), glucose metabolism impairment and metabolic syndrome. However, the results, mainly derived from observational studies, are inconsistent. Furthermore, parathyroidectomy resulted in conflicting outcomes, which may be linked to several potential biases. In particular, differences in the methods utilized for excluding confounding co-existing cardiovascular risk factors together with differences in patient characteristics, with varying degrees of hypercalcemia, may have contributed to these discrepancies. The only meta-analysis carried out in PHPT patients, revealed a positive effect of parathyroidectomy on left ventricular mass index (a predictor of cardiovascular mortality) and more importantly, that the highest pre-operative PTH levels were associated with the greatest improvements. In normocalcemic PHPT, it has been demonstrated that cardiovascular risk factors are almost similar compared to hypercalcemic PHPT, thus strengthening the role of PTH in the cardiovascular involvement. Long-term longitudinal randomized trials are needed to determine the impact of parathyroidectomy on cardiovascular diseases and mortality in PHPT.

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Section: Glucose Metabolismmentioning

confidence: 99%

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Pepe

Cipriani

Sonato

et al. 2017

European Journal of Endocrinology

129

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“…Obesity is therefore considered to be a risk factor for hypovitaminosis D. The cause of low 25(OH)D concentration in obese individuals is still under debate, where enhanced uptake by adipose tissue (4), sunlight underexposure (6), or low dairy consumption of calcium and vitamin D (7) are the most plausible explanations. Interestingly, although high parathyroid hormone (PTH) is usually viewed as a compensatory mechanism for low 25(OH) vitamin D, PTH has also been reported as an independent risk factor for diabetes (8,9). On the contrary, there is evidence to suggest that the association between 25(OH)D and impairments in glucose metabolism may be independent of PTH concentration, supporting a direct role for 25(OH)D in pancreatic β‐cell function and insulin‐sensitivity (10).…”

Section: Introductionmentioning

confidence: 99%

25‐Hydroxyvitamin D Concentration Correlates With Insulin‐Sensitivity and BMI in Obesity

Muscogiuri

Sorice

Prioletta

et al. 2010

Obesity

137

105

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The prevalence of hypovitaminosis D is high among obese subjects. Further, low 25‐hydroxyvitamin D (25(OH)D) concentration has been postulated to be a risk factor for type 2 diabetes, although its relation with insulin‐sensitivity is not well investigated. Thus, we aimed to investigate the relationship between 25(OH)D concentration and insulin‐sensitivity, using the glucose clamp technique. In total, 39 subjects with no known history of diabetes mellitus were recruited. The association of 25(OH)D concentration with insulin‐sensitivity was evaluated by hyperinsulinemic euglycemic clamp. Subjects with low 25(OH)D (<50 nmol/l) had higher BMI (P = 0.048), parathyroid hormone (PTH) (P = 0.040), total cholesterol (P = 0.012), low‐density lipoprotein (LDL) cholesterol (P = 0.044), triglycerides (P = 0.048), and lower insulin‐sensitivity as evaluated by clamp study (P = 0.047). There was significant correlation between 25(OH)D and BMI (r = −0.58; P = 0.01), PTH (r = −0.44; P < 0.01), insulin‐sensitivity (r = 0.43; P < 0.01), total (r = −0.34; P = 0.030) and LDL (r = −0.40; P = 0.023) (but not high‐density lipoprotein (HDL)) cholesterol, and triglycerides (r = 0.45; P = 0.01). Multivariate analysis using 25(OH)D concentration, BMI, insulin‐sensitivity, HDL cholesterol, LDL cholesterol, total cholesterol, and triglycerides, as the cofactors was performed. BMI was found to be the most powerful predictor of 25(OH)D concentration (r = −0.52; P < 0.01), whereas insulin‐sensitivity was not significant. Our study suggested that there is no cause–effect relationship between vitamin D and insulin‐sensitivity. In obesity, both low 25(OH)D concentration and insulin‐resistance appear to be dependent on the increased body size.

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“…[10] demonstrated that the prevalence of metabolic syndrome in patients with PHPT is not increased in comparison with general population. Also, prevalence of T2DM in patients with PHPT was increased only in age group of 64-75 years in comparison with Michigan's general population [11].…”

mentioning

confidence: 97%

The Effect of Parathyroidectomy on Insulin Sensitivity in Patients with Primary Hyperparathyroidism – an never Ending Story?

Cvijović

Mićić

Kendereški

et al. 2015

Exp Clin Endocrinol Diabetes

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Previous studies demonstrated insulin resistance and increased prevalence of impaired glucose tolerance and type 2 diabetes mellitus in patients with primary hyperparathyroidism (PHPT). The effect of curative parathyroidectomy on insulin sensitivity was associated with conflicting results depending on which method for measuring the insulin sensitivity has been used. There was no improvement using HOMA and QUICKI while minimal model demonstrated significant improvement in insulin sensitivity. The aim of our study was to evaluate the insulin sensitivity before and after parathyroidectomy in patients with PHPT using a euglycemic clamp. 44 patients with PHPT and 11 age and body mass index matched healthy controls participated in study protocol. Before surgery M values and HOMA IR suggest insulin resistance in patients with PHPT. There was no difference in M index (3.74±1.89 vs. 4.62±2.27, p>0.05), HOMA IR (2.94±1.39 vs. 3.29±0.81, p>0.05), AUC glucose (863.0±261.3 vs. 842.3±165.5, p>0.05), AUC insulin (7068.7±4159.0 vs. 7229.6±2581.7, p>0.05), ISI (4.73±2.77 vs. 4.25±2.94, p>0.05) and AIR (47.89±32.05 vs. 38.96±21.20, p>0.05) between patients with PHPT and HC. There was significant improvement in insulin sensitivity after parathyroidectomy but both preoperative and postoperative M values were not significantly different in comparison to HC. There were no significant changes in HOMA IR, AUC glucose, AUC insulin, ISI and AIR before and after therapy. In conclusion, we observed significant improvement in insulin sensitivity after parathyroidectomy in patients with PHPT. There was no difference in parameters of insulin secretion before and after parathyroidectomy in patients with PHPT.

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Prevalence of Type 2 Diabetes Mellitus In Patients With Primary Hyperparathyroidism

Cited by 28 publications

References 30 publications

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

25‐Hydroxyvitamin D Concentration Correlates With Insulin‐Sensitivity and BMI in Obesity

The Effect of Parathyroidectomy on Insulin Sensitivity in Patients with Primary Hyperparathyroidism – an never Ending Story?

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