title: Factors influencing insulin sensitivity in patients with mild primary hyperparathyroidism before and after parathyroidectomy.
abstract: OBJECTIVE
  Primary hyperparathyroidism (PHPT) is associated with cardiovascular disease. The aims of this study were to investigate lipid and glucose metabolism in mild PHPT, and to identify whether insulin sensitivity correlates with circulating levels of adiponectin, SHBG, and osteocalcin before and after parathyroidectomy (PTX).
  
  
  METHODS
  Forty-five patients with PHPT were examined before and 1 year after PTX. Circulating levels of triglycerides, total cholesterol, HDL-cholesterol, insulin, glucose, adiponectin, SHBG, osteocalcin, and erythropoietin were measured.
  
  
  RESULTS
  At baseline, the mean serum levels of total cholesterol, LDL-cholesterol and triglycerides were above the upper reference limit or in the upper normal range, and insulin sensitivity was reduced as assessed using the HOMA index. One year after parathyroidectomy, serum lipids as well as HOMA index and erythropoietin were unchanged while adiponectin had increased (p < 0.05), and SHBG and osteocalcin had decreased (p < 0.05 and p < 0.0001, respectively). HOMA index correlated negatively with circulating levels of adiponectin, SHBG and osteocalcin. In multiple regression analysis SHBG was the most important predictor of insulin sensitivity, both pre- and postoperatively.
  
  
  CONCLUSIONS
  Untreated mild PHPT is associated with a moderate derangement of lipid and glucose metabolism. As previously shown in population-based cohorts, insulin sensitivity is positively associated with circulating concentrations of adiponectin, SHBG and osteocalcin. One year after PTX, the mean level of adiponectin was increased, but the levels of SHBG and osteocalcin had decreased and the levels of serum lipids and the insulin sensitivity remained unchanged as compared with baseline.
authors: Department of Medicine, Central Hospital, Skövde, Sweden. erik.almqvist@vgregion.se
authors: Erik G
authors: EG
authors: Almqvist
authors: Anne-Greth
authors: AG
authors: Bondeson
authors: Lennart
authors: L
authors: Bondeson
authors: Dan
authors: D
authors: Mellström
authors: Johan
authors: J
authors: Svensson
mesh_terms: D052242:Adiponectin / Q000097:blood; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D004921:Erythropoietin / Q000097:blood; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000503:physiopathology* / Q000601:surgery; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D016105:Parathyroidectomy
chemical_list: D052242:Adiponectin; D001786:Blood Glucose; D007328:Insulin; D008055:Lipids; D015675:Osteocalcin; D004921:Erythropoietin