Rising Glucagon-Like Peptide 1 Concentrations After Parathyroidectomy in Patients With Primary Hyperparathyroidism

Vasiliki Antonopoulou; Spyridon N Karras; Theocharis Koufakis; Maria Yavropoulou; Niki Katsiki; Spyridon Gerou; Theodosios Papavramidis; Kalliopi Kotsa

doi:10.1016/j.jss.2019.07.019

Rising Glucagon-Like Peptide 1 Concentrations After Parathyroidectomy in Patients With Primary Hyperparathyroidism

J Surg Res. 2020 Jan:245:22-30. doi: 10.1016/j.jss.2019.07.019. Epub 2019 Aug 7.

Authors

Vasiliki Antonopoulou¹, Spyridon N Karras¹, Theocharis Koufakis¹, Maria Yavropoulou¹, Niki Katsiki¹, Spyridon Gerou², Theodosios Papavramidis³, Kalliopi Kotsa⁴

Affiliations

¹ Division of Endocrinology and Metabolism, First Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
² Laboratories "Analysi Iatriki S.A.", Thessaloniki, Greece.
³ 1st Department of Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁴ Division of Endocrinology and Metabolism, First Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: kkalli@auth.gr.

PMID: 31400574
DOI: 10.1016/j.jss.2019.07.019

Abstract

Background: Although primary hyperparathyroidism has been associated with insulin resistance, potential optimal effects of parathyroidectomy (PTX) on glucose homeostasis remain controversial. Accordingly, the impact of PTX on glucose-stimulated incretin (glucagon-like peptide 1 [GLP-1] and gastric inhibitory peptide) secretion has not been evaluated. The aim of this pilot study was to compare glucose-stimulated incretin secretion (GSIS) in patients with asymptomatic primary hyperparathyroidism with normal glucose homeostasis, before and after PTX.

Methods: Fourteen patients were included in the study. Fasting calcium, parathyroid hormone, glucose, insulin, GLP-1, and gastric inhibitory peptide were measured pre- and post-operatively. Homeostasis Model Assessment 2, QUICKI, and Matsuda indexes were used as markers of insulin sensitivity and resistance before and after PTX. Preoperatively, a 75 g oral glucose tolerance test (OGTT) was performed to evaluate the response of glucose, insulin, and GSIS. OGTT measurements were repeated 6 ± 2 wk post-PTX.

Results: Patients had a mean age of 52.93 ± 9.96 y, and female-to-male ratio was 12:2. Pre- and post-operatively, a positive correlation between parathyroid hormone and Homeostasis Model Assessment 2 for β-cell function was evident (r = 0.74, P = 0.002 and r = 0.55, P = 0.04, respectively). After PTX, a significant increase in GSIS for GLP-1 during OGTT was observed (in 60 min: 63.06 ± 44.78 versus 102.64 ± 40.19 pg/mL, P = 0.02; and in 120 min: 71.20 ± 35.90 versus 102.49 ± 40.02 pg/mL, P = 0.03).

Conclusions: The increase of GLP-1 response following oral glucose load after PTX may reflect an initial recovery phase of glucose homeostasis. Long-term studies are required to elucidate the physiological interplay between the normalization of calciotropic axis and the rising GLP-1 concentrations post-PTX.

Keywords: Glucagon-like peptide 1; Glucose metabolism; Insulin resistance; Parathyroid hormone; Parathyroidectomy; Primary hyperparathyroidism.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Blood Glucose / analysis
Blood Glucose / metabolism*
Fasting
Female
Glucagon-Like Peptide 1 / blood*
Glucagon-Like Peptide 1 / metabolism
Glucose Tolerance Test
Humans
Hyperparathyroidism, Primary / blood
Hyperparathyroidism, Primary / metabolism
Hyperparathyroidism, Primary / surgery*
Male
Middle Aged
Parathyroid Hormone / blood
Parathyroid Hormone / metabolism
Parathyroidectomy / adverse effects*
Pilot Projects
Postoperative Period

Substances

Blood Glucose
Parathyroid Hormone
Glucagon-Like Peptide 1