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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Article info
Publication history
Published online: April 01, 2022
Accepted:
February 19,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
