Secondary hyperparathyroidism and glucose intolerance in children with uremia.
Glucose metabolism was studied using the glucose clamp technique in 8 children with CRF (4 pubertal and 4 prepubertal) before and after correction of secondary hyperparathyroidism (HPD) by a regime of phosphate binders and dietary phosphate restriction. Glucose metabolic rate (M) increased by 34%, insulin response (I) increased by 32%, and insulin sensitivity (M/I) did not change. Compared to corresponding normal values, these patients were glucose-intolerant (low M) before treatment and became glucose-tolerant after treatment (normal M). They were insulin-resistant (low M/I) before treatment and remained so after treatment. The 5 uremic children without secondary HPD were treated with the same regime to prevent the secondary HPD. Their M, I, and M/I did not change after treatment. The change in I correlated closely with the change in M in all 13 patients. One pubertal patient with uremia was studied on three occasions. Initially, without secondary HPD, he had a normal M and a low M/I. When he developed secondary HPD, M decreased by 39%, I decreased by 37%, and M/I did not change. Treatment of his secondary HPD restored M and I values back to initial levels, and M/I again did not change. Treatment of secondary HPD by correction of phosphate retention led to an improvement of glucose intolerance with an increase in insulin secretion.
D000293:Adolescent; D002136:Calcium, Dietary / Q000008:administration & dosage; D002648:Child; D003131:Combined Modality Therapy; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D005947:Glucose / Q000378:metabolism*; D005951:Glucose Tolerance Test; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000378:metabolism / Q000628:therapy*; D007333:Insulin Resistance; D008657:Metabolic Clearance Rate; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000008:administration & dosage*; D014511:Uremia / Q000150:complications* / Q000378:metabolism
D002136:Calcium, Dietary; D004040:Dietary Carbohydrates; D010281:Parathyroid Hormone; D010710:Phosphates; D005947:Glucose