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Insulin resistance is more severe in patients with primary hyperparathyroidism

  • Ashwaq Al-Jehani
    Affiliations
    University of Lorraine, CHRU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine, Thyroid, and Metabolic Surgery, Nancy, France

    Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Medicine, Department of Surgery, Riyadh, Saudi Arabia
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  • Feras Al-Ahmed
    Affiliations
    University of Lorraine, CHRU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine, Thyroid, and Metabolic Surgery, Nancy, France

    Security Forces Hospital, Surgery Department, Division of General Surgery, Riyadh, Saudi Arabia
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  • Phi-Linh Nguyen-Thi
    Affiliations
    University of Lorraine, CHRU Nancy, Department of Medical Informatics and Evaluation, Nancy, France
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  • Florence Bihain
    Affiliations
    University of Lorraine, CHRU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine, Thyroid, and Metabolic Surgery, Nancy, France
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  • Claire Nomine-Criqui
    Affiliations
    University of Lorraine, CHRU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine, Thyroid, and Metabolic Surgery, Nancy, France
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  • Lea Demarquet
    Affiliations
    University of Lorraine, CHRU Nancy, Department of Endocrinology, Diabetology, and Nutrition (EDN), Nancy, France
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  • Bruno Guerci
    Affiliations
    University of Lorraine, CHRU Nancy, Department of Endocrinology, Diabetology, and Nutrition (EDN), Nancy, France
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  • Olivier Ziegler
    Affiliations
    University of Lorraine, CHRU Nancy, Department of Endocrinology, Diabetology, and Nutrition (EDN), Nancy, France
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  • Laurent Brunaud
    Correspondence
    Reprint requests: Laurent Brunaud, Department of Surgery (CVMC), Unit of Endocrine, Thyroid and Metabolic Surgery, CHRU Nancy (Brabois 7ème étage), Université de Lorraine, 11 allée du morvan, 54511 Vandoeuvre-les-Nancy, France.
    Affiliations
    University of Lorraine, CHRU Nancy - Hospital Brabois Adultes, Department of Surgery (CVMC), Unit of Endocrine, Thyroid, and Metabolic Surgery, Nancy, France

    University of Lorraine, INSERM U1256, “Nutrition, Genetics, Environmental Risks,” Faculty of Medicine, Nancy, France
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Published:April 01, 2022DOI:https://doi.org/10.1016/j.surg.2022.02.012

      Abstract

      Background

      Primary hyperparathyroidism is associated with an increased cardiovascular mortality, and its underlying mechanisms remain unclear. Insulin resistance has been suggested with low level of evidence. The goal of this study was to evaluate glucose metabolism and insulin resistance in primary hyperparathyroidism patients, to compare with control subjects, and to identify risk factors for insulin resistance in patients with primary hyperparathyroidism.

      Methods

      Cross-sectional study of consecutive primary hyperparathyroidism patients without history of diabetes or severe chronic kidney disease (glomerular filtration rate ≤30 mL/min/1.73 m2). Fasting glucose and insulin were evaluated before parathyroidectomy. Glucose metabolism was compared with population-based control subjects (n = 171).

      Results

      One hundred and seventy-four patients with primary hyperparathyroidism (140 females) were included. Mean fasting glucose was 0.983 ± 0.129 g/L, and 63 patients (36%) had prediabetes (>1.0 g/L). Mean Homeostatic model assessment of insulin resistance (HOMA-IR) was 3.386 ± 3.111 mUI/L, and 78 patients (45%) had insulin resistance (HOMA-IR >2.6). Blood calcium levels (0.171; P = .023) and body mass index (0.450; P < .001) were correlated positively with HOMA-IR. Insulin secretion (HOMA-B%) was correlated positively with preoperative systolic blood pressure in mm Hg (0.187; P = .013). In multivariate analysis, classic hypercalcemic primary hyperparathyroidism (18.47, 6.84–49.87; <.001), mild hypercalcemic primary hyperparathyroidism (5.35, 2.40–11.95; <.001), and body mass index (1.27, 1.17–1.38; <.001) remained independent predictors for insulin resistance (HOMA-IR >2.6). When compared with control subjects, mean HOMA-IR was significantly higher in primary hyperparathyroidism patients (3.386 ± 3.111 vs 1.919 ± 1.158; P < .001).

      Conclusion

      Insulin resistance was significantly higher in primary hyperparathyroidism patients than in control subjects. The impact of parathyroidectomy on insulin resistance should be evaluated in patients with higher calcium levels.
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