title: Effect of curative parathyroidectomy on insulin resistance.
abstract: 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.
  
  
  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 andP= 0.104) and Group 2 (P= 0.376 andP= 0.488). Before surgery, HOMA-IR was higher, and QUICKI was significantly lower, in both Group 1 (P= 0.058 andP= 0.009) and Group 2 (P= 0.023 andP= 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Endocrinology, HFHS, Detroit, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Putnam
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Deba Prasad
authors.initials: DP
authors.lastname: Dhibar
authors.affiliation: Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Shweta
authors.initials: S
authors.lastname: Varshney
authors.affiliation: Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Arunanshu
authors.initials: A
authors.lastname: Behera
authors.affiliation: Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: B R
authors.initials: BR
authors.lastname: Mittal
authors.affiliation: Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhansali
authors.affiliation: Department of Endocrinology, HFHS, Detroit, USA.
authors.forename: Sudhaker D
authors.initials: SD
authors.lastname: Rao
authors.affiliation: Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sanjay Kumar
authors.initials: SK
authors.lastname: Bhadada
keywords: Homeostasis model assessment-insulin resistance; insulin resistance; parathyroidectomy; primary hyperparathyroidism; quantitative insulin sensitivity check index