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Exp Clin Endocrinol Diabetes 2015; 123(06): 336-341
DOI: 10.1055/s-0035-1549906
Article
© Georg Thieme Verlag KG Stuttgart · New York

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

G. Cvijovic
1   Center for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Diseases of Metabolism, Belgrade, Serbia
,
D. Micic
2   Medical Faculty, University of Belgrade, Belgrade, Serbia
,
A. Kendereski
2   Medical Faculty, University of Belgrade, Belgrade, Serbia
,
N. Milic
2   Medical Faculty, University of Belgrade, Belgrade, Serbia
,
S. Zoric
1   Center for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Diseases of Metabolism, Belgrade, Serbia
,
M. Sumarac-Dumanovic
2   Medical Faculty, University of Belgrade, Belgrade, Serbia
,
D. Stamenkovic-Pejkovic
1   Center for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Diseases of Metabolism, Belgrade, Serbia
,
S. Polovina
1   Center for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Diseases of Metabolism, Belgrade, Serbia
,
D. Jeremic
1   Center for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Diseases of Metabolism, Belgrade, Serbia
,
A. Gligic
1   Center for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Diseases of Metabolism, Belgrade, Serbia
› Author Affiliations
Further Information

Publication History

received 27 August 2014
first decision 29 March 2015

accepted 13 April 2015

Publication Date:
09 June 2015 (online)

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Abstract

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.

Key words

PTH - calcium - clamp - homa - ISI - surgery
 

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