Primary Hyperparathyroidism in Young and Middle-age Patients is Associated With Metabolic Disorders: a Prospective Comparative Study

Abstract

Abstract Background: Components of metabolic syndrome can be observed in patients with primary hyperparathyroidism (PHPT). The pathogenesis of these disorders remain unclear because of the lack of relevant experimental models and the heterogeneity of examined patient groups. The effect of surgery on metabolic abnormalities is also controversial. We conducted a comprehensive assessment of metabolic parameters in young and middle-age patients with PHPT. Methods: One-center prospective comparative study was carried out. The participants underwent a complex biochemical and hormonal examination, a hyperinsulinemic euglycemic and hyperglycemic clamps, a bioimpedance analysis of the body composition before and 13 months after parathyroidectomy compared to sex-, age- and body mass index matched healthy volunteers. Results: 45.8% of patients (n=24) had excessive visceral fat. Insulin resistance was detected in 54.2% cases. PHPT patients had higher serum triglycerides, lower M-value and higher C-peptide and insulin levels in both phases of insulin secretion compared to the control group (p<0.05 for all). There are tendencies to decreased fasting glucose (р=0.031), uric acid (р=0.044) levels and insulin level of second secretion phase (р=0.039) after surgery, but no statistically significant changes of lipid profile and M-value as well as body composition were revealed. Negative correlations between serum calcium and total cholesterol levels as well as percent body fat and osteocalcin, b-CrossLaps and magnesium levels were revealed in patients before surgery. Conclusions. PHPT is associated with insulin resistance which is the main risk factor of serious metabolic disorders. Radical surgery may potentially improve carbohydrate and purine metabolism.