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2016 ; 20
(6
): 784-789
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Effect of curative parathyroidectomy on insulin resistance
#MMPMID27867880
Putnam R
; Dhibar DP
; Varshney S
; Behera A
; Mittal BR
; Bhansali A
; Rao SD
; Bhadada SK
Indian J Endocrinol Metab
2016[Nov]; 20
(6
): 784-789
PMID27867880
show ga
BACKGROUND: Primary hyperparathyroidism (PHPT) is characterized by
inappropriately elevated serum parathyroid hormone (PTH) level despite elevated
serum calcium. Insulin resistant is the basic pathophysiology, behind the higher
prevalence of diabetes mellitus in patients with PHPT. However, the improvement
in insulin resistance (IR) after curative parathyroidectomy (CPTX) has not been
established yet, as the study results are conflicting. MATERIALS AND METHODS: In
this prospective interventional study, ten patients with mild PHPT (Group 1) and
another ten patients with moderate to severe PHPT (Group 2) were undergone CPTX.
The IR was assessed by homeostasis model assessment-IR (HOMA-IR), quantitative
insulin sensitivity check index (QUICKI), fasting plasma glucose (FPG), and
fasting serum insulin (FSI), before and 3 months after CPTX. RESULTS: There was
no significant change of FPG and FSI, before and after CPTX in Group 1 (P = 0.179
and P = 0.104) and Group 2 (P = 0.376 and P = 0.488). Before surgery, HOMA-IR was
higher, and QUICKI was significantly lower, in both Group 1 (P = 0.058 and P =
0.009) and Group 2 (P = 0.023 and P = 0.005) as compared to published normal
reference mean, with no significant difference between the groups. Three months
after surgery HOMA-IR increased further and QUICKI remained unchanged as compared
to baseline, in both Group 1 (P = 0.072 and 0.082) and Group 2 (P = 0.54 and
0.56), but statistically insignificant. CONCLUSION: IR remained unchanged after
CPTX in mild as well as moderate to severe PHPT. Asymptomatic PHPT with abnormal
IR should not be used as criteria for parathyroidectomy.