METABOLIC ABNORMALITIES IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM BEFORE AND AFTER CURATIVE PARATHYROIDECTOMY.

Abstract

Background: Primary hyperparathyroidism (PHPT) is a very common endocrine disorder that has been linked to a wide number of metabolic abnormalities including glucose intolerance, hypertension, obesity, hyperuricemia, and cardiovascular abnormalities. Surgery offers a cure for this disease but whether or not the metabolic parameters improve, remains debatable.

Objective: To assess various metabolic parameters including insulin resistance in patients with PHPT and to study the effects of surgery on these parameters.

Study Design: Prospective hospital-based study.

Materials & Methods: Among 50  patients, that were assessed using a defined protocol 6 were male and 44 female, with a mean(±SD) age of 44.2 ±13.9 years. Anthropometry and various parameters including calcium, phosphorus, uric acid, PTH, creatinine, vitamin D, 75 gms OGTT, lipid profile and insulin resistance using homeostatic model for insulin resistance (HOMA-IR) were measured and values compared 3 months after curative parathyroidectomy. Localization of adenoma was done using ultrasound and confirmed using 4D CT or MIBI scan.

 Results:  Nephrolithiasis was the most common presentation seen in 70% of patients while the left inferior parathyroid adenoma was the most dominant adenoma occurring in 56% of study patients. The surgical cure rate was 100%. Among the various metabolic parameters calcium, phosphorus, PTH levels, vitamin D, uric acid and 24-hour urinary calcium normalized after surgery. Insulin resistance that was measured using the HOMA-IR method showed significant improvement 3 months after surgery ( p<0.001). However, there was no effect of curative parathyroidectomy on lipid profile and glucose tolerance of study patients.

Conclusion:  Parathyroidectomy not only cures PHPT patients but also improves the various metabolic derangements including insulin resistance in them.