Effect of Parathyroidectomy on Metabolic Homeostasis in Primary Hyperparathyroidism.

Samuel Frey,Cédric Le May,Edith Bigot-Corbel,Raphaël Bourgade,Claire Blanchard,Bertrand Cariou,Eric Mirallié,Cécile Caillard,Mikaël Croyal,Matthieu Wargny,Nelly Renaud-Moreau

doi:10.3390/jcm11051373

Abstract

Background: The benefits of parathyroidectomy on cardiovascular risk in primary hyperparathyroidism (PHPT) are controversial. This monocentric, observational, prospective study aimed to assess the effects of parathyroidectomy on glucose and lipid metabolism in classic or mild PHPT. Methods: Patients who underwent parathyroidectomy for classic (calcemia >2.85 mmol/L) or mild PHPT (calcemia ≤2.85 mmol/L) between 2016 and 2019 were included. A metabolic assessment was performed before and 1 year after parathyroidectomy. Patients with a history of diabetes were excluded. Results: Nineteen patients had classic and 120 had mild PHPT. Ninety-five percent were normocalcemic 6 months after surgery. Fasting plasma glucose and insulin levels decreased after parathyroidectomy in patients with mild PHPT (p < 0.001). HOMA-IR decreased after surgery in the overall population (p < 0.001), while plasma adiponectin concentrations increased in patients with both classic (p = 0.005) and mild PHPT (p < 0.001). Plasma triglyceride levels decreased significantly only in patients with classic PHPT (p = 0.021). Plasma PCSK9 levels decreased in patients with mild PHPT (p < 0.001). Conclusions: Parathyroidectomy for PHPT improves insulin resistance and decreases plasma triglyceride levels in classic PHPT and plasma PCSK9 levels in mild PHPT. Further studies are needed to better characterize the consequences of such metabolic risk factors’ improvements on cardiovascular events.

Highlights

Introduction conditions of the Creative CommonsPrimary hyperparathyroidism (PHPT) is the third most common endocrine disorder worldwide [1]
The p-value < 0.05 is considered as statistically significant (Spearman’s correlation). This monocentric, prospective, and observational cohort showed that PTX was associated with an improvement of glucose metabolism parameters 1 year after surgery and with variations in lipid parameters that differed depending on the severity of primary hyperparathyroidism (PHPT)
While serum TC and low-density lipoprotein cholesterol (LDL-C) levels increased in all patients, serum TG levels decreased only in patients with classic PHPT

Summary

Introduction

Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder worldwide [1]. It results from an abnormal parathyroid hormone (PTH) secretion from the parathyroid glands, leading to elevated serum calcium (SCa) and low serum phosphorus. PTH level alone) is the most common form of PHPT, accounting for about 80% of cases [3]. The benefits of parathyroidectomy on cardiovascular risk in primary hyperparathyroidism (PHPT) are controversial. This monocentric, observational, prospective study aimed to assess the effects of parathyroidectomy on glucose and lipid metabolism in classic or mild PHPT

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Conclusion