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Zhang Y, Wu H, Yang A, Y H Ng N, Zhang X, Lau ESH, Chow EWK, Kong APS, Chow EYK, Chan JCN, Luk AOY, Ma RCW. Higher risk of incident diabetes among patients with primary hyperparathyroidism. Clin Endocrinol (Oxf) 2024. [PMID: 39038182 DOI: 10.1111/cen.15118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 06/13/2024] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES There is relatively scarce data regarding the association between primary hyperparathyroidism (PHPT) and incident diabetes in large population-based longitudinal studies. We aimed to evaluate the risk of incident diabetes in individuals with and without PHPT and investigate the association between serum calcium concentrations and the risk of incident diabetes in patients with PHPT. METHODS We included 2749 PHPT patients and 13,745 age, sex and index year matched non-PHPT individuals during 2000-2019. We used Cox regression models to compare the risk of incident diabetes in individuals with and without PHPT, and the risk of incident diabetes in PHPT patients with serum calcium concentration above and below the median value. The association between serum calcium concentrations and the risk of incident diabetes was examined by restricted cubic spline analyses in patients with PHPT. RESULTS During a median follow-up time of 5.17 years (IQR 2.17, 9.58), 433 patients (15.75%) with PHPT and 2110 individuals (15.35%) without PHPT developed diabetes, respectively. Patients with PHPT had a higher incidence rate of diabetes compared to non-PHPT individuals (27.60 [95% CI 25.00, 30.30] vs. 23.90 [95% CI 22.80, 24.90] per 1000 person-years, log-rank test p = .007]. Crude Cox regression model showed PHPT was associated with a 15% higher risk of incident diabetes (HR 1.15, 95%CI 1.04, 1.28). In patients with PHPT, a 44% higher risk of incident diabetes was found in patients with serum calcium concentrations above the median value (2.63 mmol/L), compared to those below the median value (HR 1.44, 95%CI 1.08, 1.90). Restricted cubic spline analyses confirmed a positive linear association between serum calcium concentrations and the risk of incident diabetes in those with PHPT (p-value for nonlinear = .751) CONCLUSIONS: Patients with PHPT had a higher risk of incident diabetes compared to non-PHPT individuals. A positive linear association was found between serum calcium concentrations and the risk of incident diabetes in patients with PHPT.
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Affiliation(s)
- Yingchai Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Noel Y H Ng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Xinge Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Edith W K Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
| | - Elaine Y K Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, P. R. China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
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Iglesias P, Arias J, López G, Romero I, Díez JJ. Primary Hyperparathyroidism and Cardiovascular Disease: An Association Study Using Clinical Natural Language Processing Systems and Big Data Analytics. J Clin Med 2023; 12:6718. [PMID: 37959184 PMCID: PMC10650925 DOI: 10.3390/jcm12216718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Primary hyperparathyroidism (PHPT) seems to be associated with different cardiovascular diseases (CVDs). We evaluated the association of PHPT with major CV risk factors (CVRFs) and CVDs by using artificial intelligence (AI) tools. An observational and retrospective study was conducted using data from the electronic health records (EHRs) of the Hospital Universitario Puerta de Hierro Majadahonda (Spain). Of a total of 699,157 patients over 18 years of age studied (54.7% females), 6515 patients (0.9%; 65.4% women; mean age 67.6 ± 15.9 years) had a diagnosis of PHPT. The overall frequencies of hypertension, dyslipidemia, diabetes mellitus, and smoking habit in the cohort of patients with PTHP were all significantly (p < 0.001) higher than those found in patients without a diagnosis of PTHP. The total frequency of stroke, ischemic heart disease, atrial fibrillation, deep vein thrombosis, and pulmonary embolism in the cohort of PHPT patients were significantly (p < 0.001) higher than that found in patients without the diagnosis of PHPT. A multivariate regression analysis showed that PHPT was significantly (p < 0.001) and independently associated with all the CVDs evaluated. Our data show that there is a significant association between the diagnosis of PHPT and the main CVRFs and CVDs in our hospital population.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de AranaMajadahonda, 28222 Madrid, Spain;
- Department of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Javier Arias
- MedSavana S.L., 28004 Madrid, Spain; (J.A.); (G.L.); (I.R.)
| | | | - Iago Romero
- MedSavana S.L., 28004 Madrid, Spain; (J.A.); (G.L.); (I.R.)
| | - Juan J. Díez
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de AranaMajadahonda, 28222 Madrid, Spain;
- Department of Medicine, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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Barnett MJ. Association Between Primary Hyperparathyroidism and Secondary Diabetes Mellitus: Findings From a Scoping Review. Cureus 2023; 15:e40743. [PMID: 37350980 PMCID: PMC10284313 DOI: 10.7759/cureus.40743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 06/24/2023] Open
Abstract
An ill-defined association exists between diabetes mellitus (insulin resistance) and primary hyperparathyroidism. This article explores this phenomenon while providing an explanation for such a relationship and reviewing the evidence regarding the response to insulin sensitivity following a parathyroidectomy. Primary hyperparathyroidism may increase the risk of developing insulin resistance; peculiarly, this is not present in all patients. It is likely that both intracellular hypercalcemia and hypophosphatemia alter the insulin receptor expression and response; the contribution of parathyroid hormone is less clear. Following parathyroidectomy, patients may demonstrate improvement in their insulin sensitivity, while others have no response or a detrimental effect. A varied phenotype exists among patients, and furthermore, it is unclear why certain patients demonstrate improvement in insulin sensitivity following a parathyroidectomy, whereas others fail to do so. While this review provides a broad overview of the general endocrine community, it is imperative to note that clinical applicability is limited until further studies address these remaining uncertainties. Due to the lack of understanding regarding this endocrinological enigma, the presence of insulin resistance, at this present time, should not be a criterion for a parathyroidectomy.
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Affiliation(s)
- Maxim J Barnett
- Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, USA
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Pretorius M, Lundstam K, Heck A, Fagerland MW, Godang K, Mollerup C, Fougner SL, Pernow Y, Aas T, Hessman O, Rosén T, Nordenström J, Jansson S, Hellström M, Bollerslev J. Mortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation. Ann Intern Med 2022; 175:812-819. [PMID: 35436153 DOI: 10.7326/m21-4416] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is a common endocrine disorder associated with increased risk for fractures, cardiovascular disease, kidney disease, and cancer and increased mortality. In mild PHPT with modest hypercalcemia and without known morbidities, parathyroidectomy (PTX) is debated because no long-term randomized trials have been performed. OBJECTIVE To examine the effect of PTX on mild PHPT with regard to mortality (primary end point) and key morbidities (secondary end point). DESIGN Prospective randomized controlled trial. (ClinicalTrials.gov: NCT00522028). SETTING Eight Scandinavian referral centers. PATIENTS From 1998 to 2005, 191 patients with mild PHPT were included. INTERVENTION Ninety-five patients were randomly assigned to PTX, and 96 were assigned to observation without intervention (OBS). MEASUREMENTS Date and causes of death were obtained from the Swedish and Norwegian Cause of Death Registries 10 years after randomization and after an extended observation period lasting until 2018. Morbidity events were prospectively registered annually. RESULTS After 10 years, 15 patients had died (8 in the PTX group and 7 in the OBS group). Within the extended observation period, 44 deaths occurred, which were evenly distributed between groups (24 in the PTX group and 20 in the OBS group). A total of 101 morbidity events (cardiovascular events, cerebrovascular events, cancer, peripheral fractures, and renal stones) were also similarly distributed between groups (52 in the PTX group and 49 in the OBS group). During the study, a total of 16 vertebral fractures occurred in 14 patients (7 in each group). LIMITATION During the study period, 23 patients in the PTX group and 27 in the OBS group withdrew. CONCLUSION Parathyroidectomy does not appear to reduce morbidity or mortality in mild PHPT. Thus, no evidence of adverse effects of observation was seen for at least a decade with respect to mortality, fractures, cancer, cardiovascular and cerebrovascular events, or renal morbidities. PRIMARY FUNDING SOURCE Swedish government, Norwegian Research Council, and South-Eastern Norway Regional Health Authority.
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Affiliation(s)
- Mikkel Pretorius
- Section of Specialized Endocrinology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway (M.P., A.H., J.B.)
| | - Karolina Lundstam
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, and Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden (K.L., M.H.)
| | - Ansgar Heck
- Section of Specialized Endocrinology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway (M.P., A.H., J.B.)
| | - Morten W Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway (M.W.F.)
| | - Kristin Godang
- Section of Specialized Endocrinology, Oslo University Hospital, Oslo, Norway (K.G.)
| | - Charlotte Mollerup
- Clinic of Breast and Endocrine Surgery, Center HOC, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (C.M.)
| | - Stine L Fougner
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway (S.L.F.)
| | - Ylva Pernow
- Department of Molecular Medicine and Surgery, Department of Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden (Y.P.)
| | - Turid Aas
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway (T.A.)
| | - Ola Hessman
- Department of Surgery and Centre for Clinical Research of Uppsala University, Västmanland Hospital, Västerås, Sweden (O.H.)
| | - Thord Rosén
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden (T.R.)
| | - Jörgen Nordenström
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (J.N.)
| | - Svante Jansson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden (S.J.)
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, and Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden (K.L., M.H.)
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway (M.P., A.H., J.B.)
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Nikooei Noghani S, Milani N, Afkhamizadeh M, Kabiri M, Bonakdaran S, Vazifeh-Mostaan L, Asadi M, Morovatdar N, Mohebbi M. Assessment of insulin resistance in patients with primary hyperparathyroidism before and after Parathyroidectomy. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00294. [PMID: 34505755 PMCID: PMC8502214 DOI: 10.1002/edm2.294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/20/2021] [Accepted: 07/03/2021] [Indexed: 12/31/2022]
Abstract
Background Primary hyperparathyroidism (PHPT) can lead to renal and skeletal disorders, as well as insulin resistance and impaired glucose metabolism. The current study aimed to assess the effects of parathyroidectomy on insulin resistance in patients with PHPT. Materials and Methods The present study was conducted on 65 patients with PHPT and indications for parathyroidectomy who were referred to the endocrinology clinics of Mashhad University of Medical Sciences. Thereafter, the demographic characteristics of the patients were recorded. Blood tests, including haemoglobin A1c (HbA1c), fasting blood glucose (FBG) and insulin levels, were assessed one week before and three months after the surgery. The insulin resistance score (HOMA‐IR) was calculated and compared using the relevant formula. Results A total of 65 participants with a mean age of 45.44 ± 9.59 years were included in the current study. In one‐month postoperative tests, mean scores of FBG (p < .05), insulin level (p < .05) and HbA1c (p < .05) were significantly reduced. Moreover, the HOMA‐IR index decreased in 51 patients after the surgery. Conclusion According to our findings, parathyroidectomy can be effective in the reduction of insulin resistance and corresponding complications in patients with PHPT in the present short‐term study. However, it has yet to be confirmed as a treatment method for insulin resistance in these patients. Future long‐term studies are required to be done to investigate the effect of parathyroidectomy on insulin resistance. The present study aimed to assess the effects of parathyroidectomy on insulin resistance in patients with primary hyperparathyroidism (PHPT). The present study was conducted on 65 patients with PHPT and indications for parathyroidectomy. Demographic characteristics of the patients were recorded. Blood tests, including fasting blood sugar (FBS), haemoglobin A1c (HbA1c) and insulin levels, were assessed one week before and three months after the surgery. The Homeostatic Model Assessment for Insulin Resistance (HOMA‐IR index) was calculated. In one‐month postoperative tests, mean scores of FBS (p < .05), insulin level (p < .05) and HbA1c (p < 0.05) were significantly reduced compared to these variables prior to the surgery. Moreover, the HOMA‐IR index decreased in 51 patients after the surgery. As evidenced by the results of the present study, parathyroidectomy can be effective in reducing insulin resistance and its complications in patients with primary hyperparathyroidism (PHPT).
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Affiliation(s)
- Soudabeh Nikooei Noghani
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasrin Milani
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mozhgan Afkhamizadeh
- Faculty of Medicine, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Kabiri
- Faculty of Medicine, Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shokoufeh Bonakdaran
- Faculty of Medicine, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Vazifeh-Mostaan
- Department of ORL-Head & Neck Surgery, Faculty of Medicine, Otolaryngologist - Head & Neck Surgeon, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Asadi
- Faculty of Medicine, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Faculty of Medicine, Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Mohebbi
- Faculty of Medicine, Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Anastasilakis AD, Tsourdi E, Tabacco G, Naciu AM, Napoli N, Vescini F, Palermo A. The Impact of Antiosteoporotic Drugs on Glucose Metabolism and Fracture Risk in Diabetes: Good or Bad News? J Clin Med 2021; 10:jcm10050996. [PMID: 33801212 PMCID: PMC7957889 DOI: 10.3390/jcm10050996] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Abstract
Osteoporosis and diabetes mellitus represent global health problems due to their high, and increasing with aging, prevalence in the general population. Osteoporosis can be successfully treated with both antiresorptive and anabolic drugs. While these drugs are clearly effective in reducing the risk of fracture in patients with postmenopausal and male osteoporosis, it is still unclear whether they may have the same efficacy in patients with diabetic osteopathy. Furthermore, as bone-derived cytokines (osteokines) are able to influence glucose metabolism, it is conceivable that antiosteoporotic drugs may have an effect on glycemic control through their modulation of bone turnover that affects the osteokines’ release. These aspects are addressed in this narrative review by means of an unrestricted computerized literature search in the PubMed database. Our findings indicate a balance between good and bad news. Active bone therapies and their modulation of bone turnover do not appear to play a clinically significant role in glucose metabolism in humans. Moreover, there are insufficient data to clarify whether there are any differences in the efficacy of antiosteoporotic drugs on fracture incidence between diabetic and nondiabetic patients with osteoporosis. Although more studies are required for stronger recommendations to be issued, bisphosphonates appear to be the first-line drug for treatment of osteoporosis in diabetic patients, while denosumab seems preferable for older patients, particularly for those with impaired renal function, and osteoanabolic agents should be reserved for patients with more severe forms of osteoporosis.
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Affiliation(s)
| | - Elena Tsourdi
- Department of Medicine (III) &Center for Healthy Aging, Technische Universität Dresden Medical Center, 01307 Dresden, Germany
- Correspondence: ; Tel.: +49-351-458-12933; Fax: +49-351-458-5801
| | - Gaia Tabacco
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy; (G.T.); (A.M.N.); (N.N.); (A.P.)
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy; (G.T.); (A.M.N.); (N.N.); (A.P.)
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy; (G.T.); (A.M.N.); (N.N.); (A.P.)
| | - Fabio Vescini
- Department of Endocrinology and Diabetes, Santa Maria della Misericordia Hospital, 33100 Udine, Italy;
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy; (G.T.); (A.M.N.); (N.N.); (A.P.)
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Vondra K, Hampl R. Vitamin D and new insights into pathophysiology of type 2 diabetes. Horm Mol Biol Clin Investig 2021; 42:203-208. [PMID: 33655734 DOI: 10.1515/hmbci-2020-0055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 02/11/2021] [Indexed: 01/09/2023]
Abstract
Deficiency in vitamin D plays a role in the onset and development of insulin resistance (IR) and type 2 diabetes (T2DM). A normal level of vitamin D is able to reduce low grade inflammation, which is a major process in inducing insulin resistance. It is also engaged in maintaining low resting levels of reactive species and radicals, normal Ca2+ signaling, a low expression of pro-inflammatory cytokines but increased formation of anti-inflammatory cytokines. Vitamin D is also able to prevent hypermethylation (of DNA) and consequent functional inactivation of many genes, as well as other epigenetic alterations in β cells and in other insulin-sensitive peripheral tissues, mainly liver, adipose tissue and muscle. Vitamin D deficiency thus belongs to key factors accelerating the development of IR and consequently T2DM as well. However, vitamin D supplementation aimed at the control of glucose homeostasis in humans showed controversial effects. As a result, further studies are running to gain more detailed data needed for the full clinical utilization of vitamin D supplementation in the prevention and treatment of T2DM. Until new results are published, supplementation with high doses of vitamin D deficiency is not recommended. However, prevention of vitamin D deficiency and its correction are highly desired.
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Affiliation(s)
- Karel Vondra
- Institute of Endocrinology, Prague, Czech Republic
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8
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Castellano E, Attanasio R, Boriano A, Borretta V, Tassone F, Borretta G. Diabetes and Bone Involvement in Primary Hyperparathyroidism: Literature Review and Our Personal Experience. Front Endocrinol (Lausanne) 2021; 12:665984. [PMID: 33953702 PMCID: PMC8092358 DOI: 10.3389/fendo.2021.665984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) and type 2 diabetes mellitus (T2DM) are common endocrine disorders impacting on skeletal health, whose concomitant occurrence is becoming more frequent. PATIENTS AND METHODS We searched the PubMed database from the National Library of Medicine about the relationship between T2DM and its treatment and bone manifestations of PHPT. Thereafter, we retrospectively evaluated a consecutive series of 472 PHPT patients. Among them 55 were also affected by T2DM. At the diagnosis of PHPT we compared bone turnover markers and bone densitometry between 55 patients with and 417 without T2DM and in the former group according to antidiabetic treatment. RESULTS Few data are available about T2DM and PHPT bone involvement, studies about T2DM treatments and PHPT bone manifestations are lacking. Among patients with PHPT of our series, those with T2DM were older, had a lower prevalence of osteitis fibrosa cystica, higher lumbar and femoral T-scores than the remaining patients. No difference was disclosed among the diabetic patients according to ongoing antidiabetic treatment, even though modern treatments were under-represented. CONCLUSIONS No clinical study specifically evaluated the impact of T2DM on bone involvement in PHPT. In our experience, diabetic patients resulted more frequently "mild asymptomatic" than non-diabetic patients and showed a lower prevalence of radiological PHPT bone manifestations. The treatment of T2DM does not seem to affect the biochemical or clinical features of PHPT in our series. Further studies are needed to fully disclose the influence of T2DM and antidiabetic treatment on bone health in patients with PHPT.
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Affiliation(s)
- Elena Castellano
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
- *Correspondence: Elena Castellano,
| | - Roberto Attanasio
- IRCCS Orthopedic Institute Galeazzi, Endocrinology Service, Milan, Italy
| | - Alberto Boriano
- Medical Physics Department, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Valentina Borretta
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Francesco Tassone
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Giorgio Borretta
- Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
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Zhu B, Lin Z, Chen X, Gusdon AM, Shen W, Chen J, Zheng L, Sun H, Li Y, Zhu C, Li J, Qu S. Circulating osteocalcin: A potential predictor of ketosis in type 2 diabetes. Diabetes Metab Res Rev 2020; 36:e3265. [PMID: 31850672 DOI: 10.1002/dmrr.3265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 07/05/2019] [Accepted: 12/11/2019] [Indexed: 12/28/2022]
Abstract
AIMS Osteocalcin contributes to the regulation of endocrine system. However, the association between osteocalcin and ketosis has not been evaluated. We thus aimed to explore the relationship between total osteocalcin and risk of ketosis in type 2 diabetes (T2DM). MATERIALS AND METHODS We identified 6157 diabetes patients from Shanghai Tenth People's Hospital between 1 January 2011 and 1 March 2017. Six hundred eight subjects were enrolled in the retrospective cross-sectional study: 304 T2DM patients with ketosis whose age, gender, and body mass index were matched with 304 T2DM patients without ketosis. A further retrospective nested case-control study was conducted in 252 T2DM patients without ketosis for a mean duration of 21.58 ± 12.43 months to investigate the occurrence of ketosis. RESULTS Osteocalcin levels were negatively correlated with blood ketones (adjusted r = -0.263) and urine ketones (adjusted r = -0.183). The inverse dose-dependent relationship of osteocalcin and risk of ketosis was present across osteocalcin level quintiles (top quintile as the reference, adjusted odds ratio [95% CI] = 2.56 [0.80-8.17], 3.71 [0.90-15.29], 10.77 [2.63-44.15], 23.81 [4.32-131.17] per osteocalcin quintile, respectively). Ketosis occurred in 17 of the 252 T2DM patients during follow-up. The Cox regression analysis indicated that osteocalcin was an independent protective factor against development of ketosis (adjusted hazard ratio [95% CI]: 0.668 [0.460-0.971]). CONCLUSIONS Total osteocalcin can be used as a predictor of ketosis in T2DM.
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Affiliation(s)
- Bing Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- National Metabolic Management Center, Shanghai, China
| | - Ziwei Lin
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- National Metabolic Management Center, Shanghai, China
| | - Xianying Chen
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology, School of Medicine, Nanjing Medical University, Nanjing, China
| | - Aaron M Gusdon
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Wenjun Shen
- Division of Endocrinology,Gerontology and Metabolism, Stanford University, Stanford, CA, USA
- Veterans Affairs Palo AltoHealth Care System, Palo Alto, CA, USA
| | - Jia Chen
- Department of Endocrinology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Liang Zheng
- Heart, Lung and Blood Vessel Center, Tongji University, Shanghai, China
| | - Hang Sun
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- National Metabolic Management Center, Shanghai, China
| | - Yan Li
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- National Metabolic Management Center, Shanghai, China
| | - Cuiling Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- National Metabolic Management Center, Shanghai, China
| | - Jue Li
- Heart, Lung and Blood Vessel Center, Tongji University, Shanghai, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- National Metabolic Management Center, Shanghai, China
- Department of Endocrinology, School of Medicine, Nanjing Medical University, Nanjing, China
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Abstract
Although untreated primary hyperparathyroidism is associated with increased cardiovascular mortality, controversy exists regarding the therapeutic effects of parathyroidectomy on cardiovascular health. This review will examine the evidence linking primary hyperparathyroidism (PHPT) and cardiovascular disease, specifically hypertension, and evaluate the available literature regarding the natural history of hypertension after successful parathyroidectomy.
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Affiliation(s)
- Sarah B Fisher
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Yao XA, Wei BJ, Jiang T, Chang H. The characteristics of clinical changes in primary hyperparathyroidism in Chinese patients. J Bone Miner Metab 2019; 37:336-341. [PMID: 29721808 DOI: 10.1007/s00774-018-0922-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
In Western countries, the presentation of primary hyperparathyroidism (PHPT) changed from a symptomatic to an asymptomatic disease after the 1970s, whereas in China, only one study has evaluated the changing clinical characteristics and biochemical profiles of PHPT patients. The aim of this study was to explore changes in the clinical characteristics of PHPT in Chinese patients. Overall, 140 consecutive patients with PHPT were studied between January 1, 2010 and June 30, 2016. The patients were divided into two groups: 32 consecutive patients from January 1, 2010 to March 31, 2013 were included in group 1, and 108 consecutive patients from April 1, 2013 to June 30, 2016 were included in group 2. The most frequent complaints were ostealgia (46.02%), urolithiasis (41.59%), constipation (25.66%), fatigue (18.58%), polydipsia and polyuria (15.93%) and fracture history (15.04%). The number of cases in group 2 was 3.38-fold greater than that of group 1. The parathyroid hormone (PTH) and fasting blood glucose (FPG) levels were higher in group 1 than those in group 2 (p = 0.039, p < 0.001). In 62.14% of patients with PHPT, the proportion of the first diagnosis due to hypercalcemia found using a multichannel autoanalyzer in group 1 was lower than that found in group 2 (p = 0.039), and the proportion of the first diagnosis due to parathyroid lesions captured using routine neck ultrasonography in group 1 was higher than in group 2 (p = 0.003). The proportion of parathyroid carcinoma cases was higher in group 1 than group 2 (p = 0.036). Cases of PHPT increased with time, but the proportion of parathyroid carcinoma cases was lower in group 1 than that in group 2. Over time, the first diagnosis switched from parathyroid lesions captured by routine neck ultrasound to hypercalcemia found by a multichannel autoanalyser. At our centre, PHPT in Chinese patients still demonstrates classic characteristics.
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Affiliation(s)
- Xiao-Ai Yao
- Department of Endocrinology, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
| | - Bo-Jun Wei
- Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China.
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.
| | - Tao Jiang
- Department of Endocrinology, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China.
| | - Hong Chang
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Haidian District, Beijing, 100038, China
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12
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Brey CW, Akbari-Alavijeh S, Ling J, Sheagley J, Shaikh B, Al-Mohanna F, Wang Y, Gaugler R, Hashmi S. Salts and energy balance: A special role for dietary salts in metabolic syndrome. Clin Nutr 2018; 38:1971-1985. [PMID: 30446179 DOI: 10.1016/j.clnu.2018.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/20/2018] [Accepted: 10/28/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dietary salts sodium (Na+), potassium (K+), magnesium (Mg2+), and calcium (Ca2+) are important in metabolic diseases. Yet, we do not have sufficient understanding on the salts global molecular network in these diseases. In this systematic review we have pooled information to identify the general effect of salts on obesity, insulin resistance and hypertension. AIMS To assess the roles of salts in metabolic disorders by focusing on their individual effect and the network effect among these salts. METHODS We searched articles in PubMed, EMBASE and Google Scholar. We selected original laboratory research, systematic reviews, clinical trials, observational studies and epidemiological data that focused on dietary salts and followed the preferred reporting items for systematic review in designing the present systematic review. RESULTS From the initial search of 2898 studies we selected a total of 199 articles that met our inclusion criteria and data extraction. Alterations in metabolic pathways associated with the sensitivity of sodium, potassium, magnesium and calcium may lead to obesity, hypertension, and insulin resistance. We found that the results of most laboratory research, animal studies and clinical trials are coherent but some research outcome are either inconsistent or inconclusive. CONCLUSION Important of salts in metabolic disorder is evident. In order to assess the effects of dietary salts in metablic diseases, environmental factors, dietary habits, physical activity, and the microbiome, should be considered in any study. Although interest in this area of research continues to grow, the challenge is to integrate the action of these salts in metabolic syndrom.
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Affiliation(s)
| | - Safoura Akbari-Alavijeh
- Laboratory of Developmental Biology, Center for Vector Biology, Rutgers University, 180 Jones Avenue, New Brunswick, NJ, 08901, USA
| | - Jun Ling
- Department of Basic Sciences, Geisinger Commonwealth School of Medicine, 525 Pine Street, Scranton, PA, 18509, USA
| | - Jordan Sheagley
- Department of Basic Sciences, Geisinger Commonwealth School of Medicine, 525 Pine Street, Scranton, PA, 18509, USA
| | - Bilal Shaikh
- Laboratory of Developmental Biology, Center for Vector Biology, Rutgers University, 180 Jones Avenue, New Brunswick, NJ, 08901, USA
| | | | - Yi Wang
- Laboratory of Developmental Biology, Center for Vector Biology, Rutgers University, 180 Jones Avenue, New Brunswick, NJ, 08901, USA
| | - Randy Gaugler
- Laboratory of Developmental Biology, Center for Vector Biology, Rutgers University, 180 Jones Avenue, New Brunswick, NJ, 08901, USA
| | - Sarwar Hashmi
- Laboratory of Developmental Biology, Center for Vector Biology, Rutgers University, 180 Jones Avenue, New Brunswick, NJ, 08901, USA; Rutgers Center for Lipid Research, New Jersey Institute for Food, Nutrition, & Health, Rutgers University, USA.
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13
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Godang K, Lundstam K, Mollerup C, Fougner SL, Pernow Y, Nordenström J, Rosén T, Jansson S, Hellström M, Bollerslev J, Heck A. The effect of surgery on fat mass, lipid and glucose metabolism in mild primary hyperparathyroidism. Endocr Connect 2018; 7:941-948. [PMID: 30300532 PMCID: PMC6144936 DOI: 10.1530/ec-18-0259] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CONTEXT Mild primary hyperparathyroidism has been associated with increased body fat mass and unfavorable cardiovascular risk factors. OBJECTIVE To assess the effect of parathyroidectomy on fat mass, glucose and lipid metabolism. DESIGN, PATIENTS, INTERVENTIONS, MAIN OUTCOME MEASURES 119 patients previously randomized to observation (OBS; n = 58) or parathyroidectomy (PTX; n = 61) within the Scandinavian Investigation of Primary Hyperparathyroidism (SIPH) trial, an open randomized multicenter study, were included. Main outcome measures for this study were the differences in fat mass, markers for lipid and glucose metabolism between OBS and PTX 5 years after randomization. RESULTS In the OBS group, total cholesterol (Total-C) decreased from mean 5.9 (±1.1) to 5.6 (±1.0) mmol/L (P = 0.037) and LDL cholesterol (LDL-C) decreased from 3.7 (±1.0) to 3.3 (±0.9) mmol/L (P = 0.010). In the PTX group, the Total-C and LDL-C remained unchanged resulting in a significant between-group difference over time (P = 0.013 and P = 0.026, respectively). This difference was driven by patients who started with lipid-lowering medication during the study period (OBS: 5; PTX: 1). There was an increase in trunk fat mass in the OBS group, but no between-group differences over time. Mean 25(OH) vitamin D increased in the PTX group (P < 0.001), but did not change in the OBS group. No difference in parameters of glucose metabolism was detected. CONCLUSION In mild PHPT, the measured metabolic and cardiovascular risk factors were not modified by PTX. Observation seems safe and cardiovascular risk reduction should not be regarded as a separate indication for parathyroidectomy based on the results from this study.
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Affiliation(s)
- Kristin Godang
- Section of Specialized EndocrinologyOslo University Hospital, Oslo, Norway
| | - Karolina Lundstam
- Department of RadiologyInstitute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotte Mollerup
- Clinic of Breast and Endocrine SurgeryCenter HOC, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Ylva Pernow
- Departments of Molecular MedicineSurgery and Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jörgen Nordenström
- Department of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - Thord Rosén
- Department of MedicineSahlgrenska University Hospital, Gothenburg, Sweden
| | - Svante Jansson
- Department of Endocrine SurgerySahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Hellström
- Department of RadiologyInstitute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jens Bollerslev
- Section of Specialized EndocrinologyOslo University Hospital, Oslo, Norway
- Faculty of MedicineUniversity of Oslo, Oslo, Norway
| | - Ansgar Heck
- Section of Specialized EndocrinologyOslo University Hospital, Oslo, Norway
- Faculty of MedicineUniversity of Oslo, Oslo, Norway
- Correspondence should be addressed to A Heck:
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Thorsteinsson AL, Hansen L, Vestergaard P, Eiken P. Long-term benefits and risks of parathyroid hormone treatment in compliant osteoporotic patients. A Danish national register based cohort study. Arch Osteoporos 2018; 13:50. [PMID: 29717390 DOI: 10.1007/s11657-018-0444-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/06/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Medical treatment of osteoporosis should preferably be both effective and have minimal side effects. The aim of the present study was to examine long-term benefits and risks of parathyroid hormone (PTH) treatment in compliant patients. METHODS This is a nationwide retrospective cohort study based on national registers in which we identified 1739 patients treated with PTH (2003-2010) (index cases) for at least 18 months and with a medication possession rate of > 0.8. For comparison, patients treated with bisphosphonate (BP) (n = 13,131) and anti-osteoporotic treatment-naïve controls (n = 12,721) were selected. Incidence of fractures, drug consumption, and comorbidity were compared between the three cohorts. Mean follow-up of the PTH-treated patients was 4.3 years (range 1.8-8.7 years). RESULTS Before initiation of treatment, PTH patients had a significantly higher Charlson comorbidity index score and more osteoporotic fractures than both BP patients and controls. No difference was detected in the incidence of fractures during PTH treatment or years after between PTH patients and BP patients. No significant difference in the use of drugs was seen between PTH and BP patients, except for PPI intake which was higher in PTH patients. No significant increases were found in the incidence of cancers or other ICD-10 diagnoses among PTH-treated patients in comparison with both BP and controls. CONCLUSION Overall, PTH treatment is effective and safe. Following PTH treatment in compliant patients, neither fracture incidence nor drug consumption differed between PTH-treated and BP-treated patients, despite the fact that PTH-treated patients had more severe osteoporosis. No increased incidence of malignant diseases or other diseases was detected.
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Affiliation(s)
- Anne-Luise Thorsteinsson
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Louise Hansen
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark
| | - Peter Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Pia Eiken
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Hillson R. Urinary symptoms in diabetes. PRACTICAL DIABETES 2018. [DOI: 10.1002/pdi.2167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Ye J, Deng G, Gao F. Theoretical overview of clinical and pharmacological aspects of the use of etelcalcetide in diabetic patients undergoing hemodialysis. Drug Des Devel Ther 2018; 12:901-909. [PMID: 29719376 PMCID: PMC5914547 DOI: 10.2147/dddt.s160223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Etelcalcetide is the first intravenous calcimimetic agent authorized for the treatment of secondary hyperparathyroidism (sHPT) in patients undergoing hemodialysis in Europe, the US, and Japan. The relationship between sHPT and diabetes resides on complex, bidirectional effects and largely unknown homeostatic mechanisms. Although 30% or more patients with end-stage renal disease are diabetics and about the same percentage of those patients suffer from sHPT associated with hemodialysis, no data on the specificities of the use of etelcalcetide in such patients are available yet. Regarding pharmacokinetic interactions, etelcalcetide may compete with oral hypoglycemics recommended for use in patients undergoing hemodialysis and insulins detemir and degludec, causing unexpected hypocalcemia or hypoglycemia. More importantly, hypocalcemia, a common side effect of etelcalcetide, may cause decompensation of preexisting cardiac insufficiency in diabetic patients or worsen dialysis-related hypotension and lead to hypotension-related cardiac events, such as myocardial ischemia. In diabetic patients, hypocalcemia may lead to dangerous ventricular arrhythmias, as both insulin-related hypoglycemia and hemodialysis prolong QT interval. Patients with diabetes, therefore, should be strictly monitored for hypocalcemia and associated effects. Due to an altered parathormone activity in this patient group, plasma calcium should be the preferred indicator of etelcalcetide effects. Until more clinical experience with etelcalcetide is available, the clinicians should be cautious when using this calcimimetic in patients with diabetes.
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Affiliation(s)
- Jianzhen Ye
- Department of Endocrinology, Huangzhou District People’s Hospital, Huanggang, People’s Republic of China
| | - Guangrui Deng
- Department of Endocrinology, Huangzhou District People’s Hospital, Huanggang, People’s Republic of China
| | - Feng Gao
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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Ahn C, Kang JH, Jeung EB. Calcium homeostasis in diabetes mellitus. J Vet Sci 2018; 18:261-266. [PMID: 28927245 PMCID: PMC5639077 DOI: 10.4142/jvs.2017.18.3.261] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/16/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus (DM) is becoming a lifestyle-related pandemic disease. Diabetic patients frequently develop electrolyte disorders, especially diabetic ketoacidosis or nonketotic hyperglycemic hyperosmolar syndrome. Such patients show characteristic potassium, magnesium, phosphate, and calcium depletion. In this review, we discuss a homeostatic mechanism that links calcium and DM. We also provide a synthesis of the evidence in favor or against this linking mechanism by presenting recent clinical indications, mainly from veterinary research. There are consistent results supporting the use of calcium and vitamin D supplementation to reduce the risk of DM. Clinical trials support a marginal reduction in circulating lipids, and some meta-analyses support an increase in insulin sensitivity, following vitamin D supplementation. This review provides an overview of the calcium and vitamin D disturbances occurring in DM and describes the underlying mechanisms. Such elucidation will help indicate potential pathophysiology-based precautionary and therapeutic approaches and contribute to lowering the incidence of DM.
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Affiliation(s)
- Changhwan Ahn
- Laboratory of Veterinary Biochemistry and Molecular Biology, College of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Ji-Houn Kang
- Laboratory of Veterinary Internal Medicine, Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Korea
| | - Eui-Bae Jeung
- Laboratory of Veterinary Biochemistry and Molecular Biology, College of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Korea
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Xu C, Ma HH, Wang Y. Maternal Early Pregnancy Plasma Concentration of 25-Hydroxyvitamin D and Risk of Gestational Diabetes Mellitus. Calcif Tissue Int 2018; 102:280-286. [PMID: 29058058 DOI: 10.1007/s00223-017-0346-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/13/2017] [Indexed: 12/16/2022]
Abstract
We examined whether 25-Hydroxyvitamin D [25(OH) D] concentrations, measured at the first prenatal visit, would be associated with risk of gestational diabetes mellitus (GDM). From July 2015 to June 2016, consecutive women who admitted to the two-obstetrics center in china were included. Relevant data were collected between 24 and 28 weeks of gestation, including fasting plasma glucose (FPG) and 25(OH) D concentrations at the first prenatal visit and the one-step GDM screened with 75-g oral glucose tolerance test (OGTT). Blood from women at first prenatal visit was available for 827 women and 101 of them developed GDM (12.2%). The GDM distribution across the 25(OH) D quartiles ranged between 3.9% (fourth quartile, Q4) and 26.1% (first quartile, Q1). The median plasma concentration of 25(OH) D at first prenatal visit was significantly lower in women who developed GDM compared with those not developed (p < 0.001). In multivariate models comparing the 25(OH) D of Q1, second (Q2) and third quartiles (Q3) against the Q4, it observed that concentrations of 25(OH) D in Q1 and Q2 were associated with later developed GDM, and risk of GDM was increased by 240 and 48%, respectively. The women group with combined vitamin D deficiency and obesity had an OR of 4.66 [95% CI (2.91-8.15); p < 0.001] for GDM compared to those without vitamin D deficiency and obesity. Low 25(OH) D concentrations at the first prenatal visit were associated with increased risk of GDM and might be useful in identifying women at risk of GDM for performing early prevention strategies.
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Affiliation(s)
- Changen Xu
- Department of Obstetrics, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | - He-Hong Ma
- Department of Obstetrics, Cangzhou Central Hospital, Cangzhou, China
| | - Yao Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, No.639, Zhizaoju Road, 200011, Shanghai, China.
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El Hajj C, Chardigny JM, Boirie Y, Yammine K, Helou M, Walrand S. Effect of Vitamin D Treatment on Glucose Homeostasis and Metabolism in Lebanese Older Adults: A Randomized Controlled Trial. J Nutr Health Aging 2018; 22:1128-1132. [PMID: 30379314 DOI: 10.1007/s12603-018-1083-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A low serum 25-hydroxyvitamin D [(25(OH) D)] concentration was shown to correlate with higher fasting blood glucose (FBG) and insulin levels. Since age affect insulin sensitivity and the metabolism, we aimed in this randomized controlled trial to investigate the effect of vitamin D supplementation on glucose homeostasis and index of insulin resistance in elderly subjects living in Beirut, Lebanon. METHODS Participants (n= 115) deficient in vitamin D were randomly divided into two groups, a group receiving 30,000 IU cholecalciferol/week for a period of 6 months, and a placebo group. The index of insulin resistance HOMA (homeostasis model assessment) was the primary outcome. Glucose homeostasis and metabolic markers were also measured at start of treatment and at 6 months. RESULTS Vitamin D supplementation led to significant improvements in blood levels of [25(OH) D] (P< 0.0001), and a significant decreased of HOMA, PTH and FBG concentrations (P< 0.0001) in the intervention group compared to placebo. No significant changes were observed in HbA1c levels for both groups. Total cholesterol and LDL cholesterol concentrations have also decreased significantly in the intervention group (P< 0.0001). CONCLUSION Short-term supplementation with cholecalciferol improved vitamin D status, and markers of insulin resistance in healthy elder population. This trial was registered at ClinicalTrials.gov; Identifier number#:NCT03478475.
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Affiliation(s)
- C El Hajj
- Cynthia El Hajj, Département de Diététique et de Nutrition, Hôpital Saint-Charles, Beirut, Lebanon, , Tel: +9613409590
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Rajput R, Mittal A, Singh J, Dalal S, Vohra S. Recurrent diabetic ketoacidosis: a rare presenting manifestation of primary hyperparathyroidism. CLINICAL CASES IN MINERAL AND BONE METABOLISM 2017; 13:262-264. [PMID: 28228796 DOI: 10.11138/ccmbm/2016.13.3.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a rare case of primary hyperparathyroidism in a young female who presented with recurrent diabetic ketoacidosis. The patient had suffered an episode of acute pancreatitis in the past. On evaluation patient was found to have primary hyperparathyroidism and after removal of left inferior parathyroid adenoma her insulin requirement decreased by twelve units.
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Affiliation(s)
- Rajesh Rajput
- Department of Endocrinology & Medicine Unit VI, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Ashima Mittal
- Department of Endocrinology & Medicine Unit VI, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Jasminder Singh
- Department of Endocrinology & Medicine Unit VI, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Satish Dalal
- Department of Surgery, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shaweta Vohra
- Department of Endocrinology & Medicine Unit VI, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Renal dysfunction in primary hyperparathyroidism; effect of Parathyroidectomy: A retrospective Cohort Study. Int J Surg 2016; 36:383-387. [DOI: 10.1016/j.ijsu.2016.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/02/2016] [Indexed: 01/16/2023]
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Celer O, Akalın A, Oztunali C. Effect of teriparatide treatment on endothelial function, glucose metabolism and inflammation markers in patients with postmenopausal osteoporosis. Clin Endocrinol (Oxf) 2016; 85:556-60. [PMID: 27321876 DOI: 10.1111/cen.13139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Teriparatide, an anabolic agent used in the treatment of postmenopausal osteoporosis, can induce effects similar to primary hyperparathyroidism. Our objective was to evaluate the effects of teriparatide on endothelial functions, glucose metabolism and inflammation markers in patients diagnosed with postmenopausal osteoporosis. DESIGN, PATIENTS AND MEASUREMENTS This was a single-centre, single-arm, 6-month prospective study. Twenty-three postmenopausal women over 65 years old with a lumbar spine or femoral neck T-score of -4·0 or lower and having at least two compression fractures in thoracic or lumbar spine were studied. Low-dose intermittent teriparatide (20 μg/day) was supplemented with calcium carbonate (1000 mg elemental calcium) and 880 IU cholecalciferol for 6 months. The biochemical parameters for glucose metabolism, inflammation and atherosclerosis were determined. For the assessment of vascular endothelial function, carotid intima-media thickness (CIMT), brachial artery intima-media thickness (BIMT), per cent change in flow-mediated dilation (FMD%) and nitroglycerine-induced dilations (NID%) were measured on ultrasonography. RESULTS The fasting plasma glucose, homoeostatic model assessment of insulin resistance, fibrinogen, homocysteine and high-density lipoprotein cholesterol increased significantly with teriparatide treatment (P < 0·05 for all). Baseline CIMT and BIMT did not change significantly with 6 months of teriparatide treatment (P > 0·05); however, FMD% and NID% showed significant decrease after treatment (P < 0·01 for both). CONCLUSIONS Intermittent teriparatide treatment may adversely affect some parameters of glucose metabolism, inflammation and endothelial function. On the basis of our findings, further large-scale and controlled studies are needed to clarify the exact effect of teriparatide treatment on glucose metabolism, inflammation and endothelial function.
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Affiliation(s)
- Ozgen Celer
- Department of Endocrinology and Metabolism, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Aysen Akalın
- Department of Endocrinology and Metabolism, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Cigdem Oztunali
- Department of Radiology, Eskisehir Osmangazi University, Eskisehir, Turkey
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Duran C, Sevinc B, Kutlu O, Karahan O. Parathyroidectomy Decreases Insulin Resistance Index in Patients with Primary Hyperparathyroidism. Indian J Surg 2016; 79:101-105. [PMID: 28442834 DOI: 10.1007/s12262-015-1431-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 12/23/2015] [Indexed: 12/19/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) has been considered a cause of insulin resistance (IR) and impaired glucose metabolism. However, there are conflicting results related with the recovery of insulin resistance in patients with PHPT following curative parathyroidectomy. Our aim is to evaluate the effects of curative parathyroidectomy on IR in patients with PHPT. This is a prospective interventional study. Twenty-one consecutive patients with symptomatic PHPT were included into the study. All patients underwent parathyroidectomy. Fasting serum glucose, calcium, phosphorous, parathormone, plasma insulin, and vitamin D levels were measured both at baseline and 2 months after parathyroidectomy. Insulin resistance was calculated by homeostasis of model assessment-insulin resistance (HOMA-IR). Two months after curative parathyroidectomy, serum levels of calcium (p = 0.001), PTH (p < 0.001), insulin (p = 0.003), and HOMA-IR (p = 0.003) decreased, while phosphorous levels increased (p = 0.001). During this period, no changes were observed at vitamin D and glucose levels. We concluded that curative parathyroidectomy decreases HOMA-IR index in patients with PHPT. Studies with larger population and longer follow-up period are required to confirm our results.
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Affiliation(s)
- Cevdet Duran
- Department of Internal Medicine, Endocrinology and Metabolism, Konya Training and Research Hospital, 42100 Konya, Turkey
| | - Barıs Sevinc
- Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Orkide Kutlu
- Department of Internal Medicine, Endocrinology and Metabolism, Konya Training and Research Hospital, 42100 Konya, Turkey
| | - Omer Karahan
- Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey
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Tosunbayraktar G, Bas M, Kut A, Buyukkaragoz AH. Low serum 25(OH)D levels are assocıated to hıgher BMI and metabolic syndrome parameters in adult subjects in Turkey. Afr Health Sci 2015; 15:1161-9. [PMID: 26958017 DOI: 10.4314/ahs.v15i4.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the association of 25(OH)D levels with biochemical, anthropometric, and metabolic data obtained from normal and obese people. METHODS This study was carried out on 90 individuals between the ages of 18 to 63 that had various body mass indexes. Blood samples and anthropometric measurements were taken. RESULTS Waist circumferences, fat mass, LDL cholesterol levels, HDL cholesterol levels, 25(OH)D levels, and triglyceride levels were significantly different according to the body mass index groups of the participants (p<0.05). When compared to the normal body mass index group, both other groups (overweight and obese) had higher waist circumferences, triglyceride levels, LDL cholesterol levels, fasting insulin levels, HOMA-IR ratios, parathyroid hormone levels, and fat mass, and had lower 25(OH)D levels (p<0.05). The overweight group participants had higher 25(OH)D levels than the obese group, and had lower waist circumferences, fat mass, fasting insulin level, HOMA-IR ratios, and HbA1C and PTH levels than those in the obese group (p<0.05). CONCLUSION In conclusion, the mean level of 25(OH)D is very low in overweight and obese individuals and low serum 25(OH)D levels appear to be associated with obesity, visceral obesity, hypertriglyceridemia, insulin resistance, and metabolic syndrome in obese patients.
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Temizkan S, Demir S, Aydin K, Ozderya A, Ozturk HT, Sargin M. Relationship Between Parathormone and Obesity-Linked Disorders. Metab Syndr Relat Disord 2015; 13:470-6. [PMID: 26451492 DOI: 10.1089/met.2015.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In this study, we aimed to investigate whether high parathormone (PTH) levels in obese patients contribute to the metabolic complications of obesity. METHODS A total of 400 obese subjects aged 18-65 years were included. Anthropometric bioelectrical bioimpedance measures, blood tests, and 75 gram oral glucose tolerance test results were evaluated. RESULTS Of the 400 obese subjects, 335 were female. The mean age was 39 ± 10 years. The median body mass index was 36 (interquartile range 34-41). Subjects were divided into quartiles according to blood PTH levels. Groups included quartile 1 [n = 100, median PTH; 42 (range 36-45)], quartile 2 [n = 100, median PTH; 55 (51-59)], quartile 3 [n = 100, median PTH; 73 (68-78)], and quartile 4 [n = 100, median PTH; 99 (89-125)]. Quartiles were evaluated with a generalized linear model adjusted for age, sex, and season of recruitment. Systolic and diastolic blood pressure, fasting glucose, homeostatic model assessment-estimated insulin resistance, insulin sensitivity index, triglyceride level, and high-density lipoprotein cholesterol (HDL-C) were not different among quartiles. PTH and 25 hydroxyvitamin D (25(OH)D) were not associated with higher odds of prevalent metabolic syndrome in obese subjects (odds ratio, OR, 0.99 [95% confidence interval, CI, 0.981.00], P = 0.38 and 0.99 95% CI 0.96-1.01], P = 0.46, respectively). Decreased 25(OH)D levels were significantly correlated with higher odds of low HDL-C (OR 0.96 [95% CI 0.93-0.99], P = 0.04). CONCLUSIONS PTH does not contribute to the occurrence of metabolic components of obesity, but there is a positive correlation between 25(OH)D and HDL-C.
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Affiliation(s)
- Sule Temizkan
- 1 Department of Endocrinology and Metabolic Diseases, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul, Turkey
| | - Sevin Demir
- 2 Department of Family Medicine, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul, Turkey
| | - Kadriye Aydin
- 1 Department of Endocrinology and Metabolic Diseases, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul, Turkey
| | - Aysenur Ozderya
- 1 Department of Endocrinology and Metabolic Diseases, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul, Turkey
| | - Hilal Toplu Ozturk
- 2 Department of Family Medicine, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul, Turkey
| | - Mehmet Sargin
- 2 Department of Family Medicine, Kartal Dr. Lutfi Kirdar Training and Research Hospital , Istanbul, Turkey
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Vélayoudom-Céphise FL, Wémeau JL. Primary hyperparathyroidism and vitamin D deficiency. ANNALES D'ENDOCRINOLOGIE 2015; 76:153-62. [PMID: 25916759 DOI: 10.1016/j.ando.2015.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/11/2015] [Indexed: 12/01/2022]
Abstract
Primary hyperparathyroidism (PHPT) and vitamin D (VD) deficiency are frequent conditions due to the widespread application of assays for calcium and VD. PHPT presentation is dominated by diversity in its expression and the current predominance of asymptomatic forms. VD, which plays a major role in calcium and phosphate homeostasis, is also involved in many physiological processes in this disease, such as lipid and glucose metabolism, and in the signalling pathways and functioning of many cell types. The bone and cardiometabolic complications described in PHPT are exacerbated by vitamin D deficiency, the prevalence of which varies according to many parameters (environment, skin pigmentation, associated chronic diseases, liver and kidney function, assay kit used, etc.). In response to this observation, experts in field from medical societies validated the indication for systematic assay of VD occurring with PHPT and the need for replacement in case of deficiency. Several epidemiological studies have confirmed that replacement with natural vitamin D is well tolerated and safe in subjects with PHPT and VD deficiency. This supplementation reduces hyperparathormonemia, does not have symptomatic effects on calciuria, and especially improves the bone and functional condition of patients.
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Affiliation(s)
- Fritz-Line Vélayoudom-Céphise
- Service d'endocrinologie-diabétologie, CHU de Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe; Équipe de recherche ECM-LAMIA EA4540, université des Antilles, Antilles, Guadeloupe.
| | - Jean-Louis Wémeau
- Clinique endocrinologique Marc-Linquette, CHRU de Lille, 59037 Lille, France
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Mendoza-Zubieta V, Gonzalez-Villaseñor GA, Vargas-Ortega G, Gonzalez B, Ramirez-Renteria C, Mercado M, Molina-Ayala MA, Ferreira-Hermosillo A. High prevalence of metabolic syndrome in a mestizo group of adult patients with primary hyperparathyroidism (PHPT). BMC Endocr Disord 2015; 15:16. [PMID: 25886602 PMCID: PMC4415358 DOI: 10.1186/s12902-015-0014-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 03/27/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) and metabolic syndrome (MS) have been independently related to cardiovascular morbidities, however this association is still controversial. Mexican population has a high prevalence of metabolic syndrome, however its frequency seems to be even higher than expected in patients with PHPT. METHODS We retrospectively reviewed the charts of patients that underwent parathyroidectomy for PHPT in a referral center and used the criteria from the National Cholesterol Educational Program (NCEP)/Adult Treatment Panel III (ATP III) to define MS before surgery. We compared the characteristics between the patients with and without MS. RESULTS 60 patients were analyzed, 77% were female and 72% had a single parathyroid adenoma. MS was present in 59% of the patients, this group was significantly older (57 vs. 48 years, p = 0.01) and they had lower iPTH (115 vs. 161 ng/ml, p = 0.017). Other parameters did not show differences. CONCLUSIONS MS is frequent in our population diagnosed with primary hyperparathyroidism, adverse cardiovascular parameters are common and significant differences in calcium metabolism compared to the non-MS group are present.
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Affiliation(s)
- Victoria Mendoza-Zubieta
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Gloria A Gonzalez-Villaseñor
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Guadalupe Vargas-Ortega
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Baldomero Gonzalez
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Claudia Ramirez-Renteria
- Endocrinology Experimental Investigation Unit Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Moises Mercado
- Endocrinology Experimental Investigation Unit Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Mario A Molina-Ayala
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
| | - Aldo Ferreira-Hermosillo
- Endocrinology Departament Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Cuauhtemoc N° 330, Colonia Doctores, México City, DF, Mexico.
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Ivarsson KM, Clyne N, Almquist M, Akaberi S. Hyperparathyroidism and new onset diabetes after renal transplantation. Transplant Proc 2015; 46:145-50. [PMID: 24507041 DOI: 10.1016/j.transproceed.2013.07.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/30/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism persists after renal transplantation in a substantial number of patients. Primary hyperparathyroidism and secondary hyperparathyroidism are both associated with abnormalities in glucose metabolism, such as insufficient insulin release and glucose intolerance. The association of hyperparathyroidism and diabetes after renal transplantation has, as far as we know, not been studied. Our aim was to investigate whether hyperparathyroidism is associated with new-onset diabetes mellitus after transplantation (NODAT) during the first year posttransplantation. STUDY DESIGN In a retrospective study, we analyzed data on patient characteristics, treatment details, and parathyroid hormone (PTH) in 245 adult nondiabetic patients who underwent renal transplantation between January 2000 and June 2011. RESULTS The first year cumulative incidence of NODAT was 15%. The first serum PTH value after transplantation was above normal range in 74% of the patients. In multiple logistic regression analysis, PTH levels above twice normal range (>13.80 pmol/L) were significantly associated with NODAT (odds ratio [OR], 4.25; 95% confidence interval [CI], 1.13-15.92; P = .03) compared with PTH within normal range (≤6.9 pmol/L). Age between 45 and 65 years (OR, 2.80; 95% CI, 1.07-7.36; P = .04) compared with age <45 years was also associated with NODAT. CONCLUSION We found a strong association between hyperparathyroidism and NODAT in the first year after renal transplantation. Both conditions are common and have a negative impact on graft and patient survivals. Our results should be confirmed in prospective studies.
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Affiliation(s)
- K M Ivarsson
- Department of Nephrology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - N Clyne
- Department of Nephrology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - M Almquist
- Department of Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - S Akaberi
- Department of Nephrology, Clinical Sciences Lund, Lund University, Lund, Sweden.
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Becerra-Tomás N, Estruch R, Bulló M, Casas R, Díaz-López A, Basora J, Fitó M, Serra-Majem L, Salas-Salvadó J. Increased serum calcium levels and risk of type 2 diabetes in individuals at high cardiovascular risk. Diabetes Care 2014; 37:3084-91. [PMID: 25139884 DOI: 10.2337/dc14-0898] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin resistance and secretion depend on calcium homeostasis. Cross-sectional studies have associated elevated serum calcium levels with markers of impaired glucose metabolism. However, only one prospective cohort study has demonstrated an increased risk of diabetes in individuals with increased serum calcium concentrations. The aim of the current study was to prospectively investigate the association between albumin-adjusted serum calcium concentrations and type 2 diabetes in subjects at high cardiovascular risk. RESEARCH DESIGN AND METHODS Prospective assessment of participants from two Spanish PREDIMED study centers where serum calcium levels were measured at baseline and yearly during follow-up. Multivariate-adjusted Cox regression models were fitted to assess associations between baseline and changes during follow-up in serum calcium levels and relative risk of diabetes incidence. RESULTS After a median follow-up of 4.78 years, 77 new cases of type 2 diabetes occurred. An increase in serum calcium levels during follow-up was related to an increased risk of diabetes. In comparison with individuals in the lowest tertile (-0.78 ± 0.29 mg/dL), the hazard ratio (HR) and 95% CI for diabetes incidence in individuals in the higher tertile of change (0.52 ± 0.13 mg/dL) during follow-up was 3.48 (95% CI 1.48-8.17; P for trend = 0.01). When albumin-adjusted serum calcium was analyzed as a continuous variable, per 1 mg/dL increase, the HR of diabetes incidence was 2.87 (95% CI 1.18-6.96; P value = 0.02). These associations remained significant after individuals taking calcium supplements or having calcium levels out of normal range had been excluded. CONCLUSIONS An increase in serum calcium concentrations is associated with an increased risk of type 2 diabetes in individuals at high cardiovascular risk.
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Affiliation(s)
- Nerea Becerra-Tomás
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
| | - Ramón Estruch
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain Department of Internal Medicine, August Pi i Sunyer Institute of Biomedical Research, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Mònica Bulló
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
| | - Rosa Casas
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain Department of Internal Medicine, August Pi i Sunyer Institute of Biomedical Research, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Andrés Díaz-López
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
| | - Josep Basora
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
| | - Montserrat Fitó
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Medical Research Institute, Barcelona Biomedical Research Park, Barcelona, Spain
| | - Lluis Serra-Majem
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Jordi Salas-Salvadó
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
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Moreno Martínez MM, Sánchez Malo C, Gutiérrez Alcántara C, Montes Castillo C, Santiago Fernández P. Diabetes, ovarian tumor, hyperparathyroidism, and papillary cancer: association by chance? ACTA ACUST UNITED AC 2014; 61:548-50. [PMID: 25263333 DOI: 10.1016/j.endonu.2014.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
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Lorenzo C, Hanley AJ, Rewers MJ, Haffner SM. Calcium and phosphate concentrations and future development of type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetologia 2014; 57:1366-74. [PMID: 24763850 PMCID: PMC4119943 DOI: 10.1007/s00125-014-3241-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/14/2014] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS Low phosphate and high calcium concentrations have been linked to altered glucose tolerance and reduced insulin sensitivity in non-diabetic individuals. The aim of this study was to examine the relationships of calcium and phosphate levels and the calcium-phosphate product with the development of type 2 diabetes. METHODS Participants were 863 African-Americans, Hispanics and non-Hispanic whites in the Insulin Resistance Atherosclerosis Study who were free of diabetes at baseline. The mean follow-up period was 5.2 years. The insulin sensitivity index (SI) and acute insulin response (AIR) were directly measured using the frequently sampled IVGTT. RESULTS Calcium concentration (OR per 1 SD unit increase, 1.26 [95% CI 1.04, 1.53]) and calcium-phosphate product (OR 1.29 [95% CI 1.04, 1.59]) were associated with incident diabetes after adjustment for demographic variables, family history of diabetes, and 2 h glucose. The relationship between phosphate concentration and progression to diabetes was close to statistical significance (OR 1.21 [95% CI 0.98, 1.49]). Calcium concentration (OR 1.37 [95% CI 1.09, 1.72]) and calcium-phosphate product (OR 1.39 [95% CI 1.09, 1.77]) remained associated with incident diabetes after additional adjustment for BMI, plasma glucose, SI, AIR, C-reactive protein, estimated GFR, diuretic drugs and total calcium intake. CONCLUSIONS/INTERPRETATION Elevated serum calcium and calcium-phosphate product are associated with increased risk of developing type 2 diabetes independently of measured glucose, insulin secretion and insulin resistance. Future studies need to analyse the role of calcium-phosphate homeostasis in the pathophysiology of diabetes.
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Affiliation(s)
- Carlos Lorenzo
- Department of Medicine, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA,
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Napoli N, Strollo R, Paladini A, Briganti SI, Pozzilli P, Epstein S. The alliance of mesenchymal stem cells, bone, and diabetes. Int J Endocrinol 2014; 2014:690783. [PMID: 25140176 PMCID: PMC4124651 DOI: 10.1155/2014/690783] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 06/11/2014] [Indexed: 12/15/2022] Open
Abstract
Bone fragility has emerged as a new complication of diabetes. Several mechanisms in diabetes may influence bone homeostasis by impairing the action between osteoblasts, osteoclasts, and osteocytes and/or changing the structural properties of the bone tissue. Some of these mechanisms can potentially alter the fate of mesenchymal stem cells, the initial precursor of the osteoblast. In this review, we describe the main factors that impair bone health in diabetic patients and their clinical impact.
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Affiliation(s)
- Nicola Napoli
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA
- *Nicola Napoli:
| | - Rocky Strollo
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Angela Paladini
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Silvia I. Briganti
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Paolo Pozzilli
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
- Centre for Diabetes, The Blizard Building, Barts and The London School of Medicine, Queen Mary, University of London, London, UK
| | - Sol Epstein
- Division of Endocrinology, Mount Sinai School of Medicine, New York, USA
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Masuzaki H, Takemoto N, Kawamoto E, Nomiyama T, Tanaka H, Morita M. [Discussion meeting on the clinical update and topics in a variety of diseases closely related with diabetes mellitus]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2013; 102:938-954. [PMID: 23772510 DOI: 10.2169/naika.102.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Hiroaki Masuzaki
- Second Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Graduate School of Medicine, University of the Ryukyus, Japan
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de Paula FJA, Rosen CJ. Bone Remodeling and Energy Metabolism: New Perspectives. Bone Res 2013; 1:72-84. [PMID: 26273493 DOI: 10.4248/br201301005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 01/30/2013] [Indexed: 12/27/2022] Open
Abstract
Bone mineral, adipose tissue and energy metabolism are interconnected by a complex and multilevel series of networks. Calcium and phosphorus are utilized for insulin secretion and synthesis of high energy compounds. Adipose tissue store lipids and cholecalciferol, which, in turn, can influence calcium balance and energy expenditure. Hormones long-thought to solely modulate energy and mineral homeostasis may influence adipocytic function. Osteoblasts are a target of insulin action in bone. Moreover, endocrine mediators, such as osteocalcin, are synthesized in the skeleton but regulate carbohydrate disposal and insulin secretion. Finally, osteoblasts and adipocytes originate from the same mesenchymal progenitor. The mutual crosstalk between osteoblasts and adipocytes within the bone marrow microenvironment plays a crucial role in bone remodeling. In the present review we provide an overview of the reciprocal control between bone and energy metabolism and its clinical implications.
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Affiliation(s)
- Francisco J A de Paula
- Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo , Brazil
| | - Clifford J Rosen
- Center for Clinical and Translational Research, Maine Medical Center Research Institute , USA
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Girgis CM, Clifton-Bligh RJ, Hamrick MW, Holick MF, Gunton JE. The roles of vitamin D in skeletal muscle: form, function, and metabolism. Endocr Rev 2013; 34:33-83. [PMID: 23169676 DOI: 10.1210/er.2012-1012] [Citation(s) in RCA: 342] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Beyond its established role in bone and mineral homeostasis, there is emerging evidence that vitamin D exerts a range of effects in skeletal muscle. Reports of profound muscle weakness and changes in the muscle morphology of adults with vitamin D deficiency have long been described. These reports have been supplemented by numerous trials assessing the impact of vitamin D on muscle strength and mass and falls in predominantly elderly and deficient populations. At a basic level, animal models have confirmed that vitamin D deficiency and congenital aberrations in the vitamin D endocrine system may result in muscle weakness. To explain these effects, some molecular mechanisms by which vitamin D impacts on muscle cell differentiation, intracellular calcium handling, and genomic activity have been elucidated. There are also suggestions that vitamin D alters muscle metabolism, specifically its sensitivity to insulin, which is a pertinent feature in the pathophysiology of insulin resistance and type 2 diabetes. We will review the range of human clinical, animal, and cell studies that address the impact of vitamin D in skeletal muscle, and discuss the controversial issues. This is a vibrant field of research and one that continues to extend the frontiers of knowledge of vitamin D's broad functional repertoire.
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Affiliation(s)
- Christian M Girgis
- Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, New South Wales, Australia.
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Amelio PD, Panico A, Spertino E, Isaia GC. Energy metabolism and the skeleton: Reciprocal interplay. World J Orthop 2012; 3:190-8. [PMID: 23330074 PMCID: PMC3547113 DOI: 10.5312/wjo.v3.i11.190] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 07/31/2012] [Accepted: 10/20/2012] [Indexed: 02/06/2023] Open
Abstract
The relation between bone remodelling and energy expenditure is an intriguing, and yet unexplained, challenge of the past ten years. In fact, it was only in the last few years that the skeleton was found to function, not only in its obvious roles of body support and protection, but also as an important part of the endocrine system. In particular, bone produces different hormones, like osteocalcin (OC), which influences energy expenditure in humans. The undercarboxylated form of OC has a reduced affinity for hydroxyapatite; hence it enters the systemic circulation more easily and exerts its metabolic functions for the proliferation of pancreatic β-cells, insulin secretion, sensitivity, and glucose tolerance. Leptin, a hormone synthesized by adipocytes, also has an effect on both bone remodelling and energy expenditure; in fact it inhibits appetite through hypothalamic influence and, in bone, stimulates osteoblastic differentiation and inhibits apoptosis. Leptin and serotonin exert opposite influences on bone mass accrual, but several features suggest that they might operate in the same pathway through a sympathetic tone. Serotonin, in fact, acts via two opposite pathways in controlling bone remodelling: central and peripheral. Serotonin product by the gastrointestinal tract (95%) augments bone formation by osteoblast, whereas brain-derived serotonin influences low bone mineral density and its decrease leads to an increase in bone resorption parameters. Finally, amylin (AMY) acts as a hormone that alters physiological responses related to feeding, and plays a role as a growth factor in bone. In vitro AMY stimulates the proliferation of osteoblasts, and osteoclast differentiation. Here we summarize the evidence that links energy expenditure and bone remodelling, with particular regard to humans.
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Cakir I, Unluhizarci K, Tanriverdi F, Elbuken G, Karaca Z, Kelestimur F. Investigation of insulin resistance in patients with normocalcemic primary hyperparathyroidism. Endocrine 2012; 42:419-22. [PMID: 22327928 DOI: 10.1007/s12020-012-9627-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
Abstract
While derangements in glucose metabolism in patients with primary hyperparathyroidism are well-defined, this issue is not investigated in patients with normocalcemic primary hyperparathyroidism (NPHPT). The aim of this study was to investigate the presence of insulin resistance in patients with NPHPT. Eighteen patients with NPHPT (two males and 16 females) and 18 healthy volunteers were enrolled into the study. Secondary causes of parathyroid hormone elevations were excluded in all patients. Blood samples were obtained for the measurement of serum calcium, phosphate, alkaline phosphatase (ALP), albumin, creatinine, glucose, and serum lipid levels. Glucose and insulin responses to oral glucose tolerance test (OGTT) were obtained. Homeostasis model assessment (HOMA-IR) was also used as an indice of insulin resistance. Patients and control subjects had similar age, body mass index, and sex distribution. Although within normal limits, serum calcium and ALP levels were higher in patients than in the control subjects. None of the patients and the control subjects had diabetes mellitus, while eight patients and six control subjects had impaired glucose tolerance. Insulin responses to OGTT and HOMA-IR were not significantly different among the patient and control subjects. In addition, both groups have similar serum lipid levels. Patients with NPHPT do not exhibit insulin resistance and glucose intolerance. Since so little is known about this form of disease, subjects should be monitored regularly for the metabolic aspects of the disease as well as the progression of their disease.
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Affiliation(s)
- Ilkay Cakir
- Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey
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Coney P, Demers LM, Dodson WC, Kunselman AR, Ladson G, Legro RS. Determination of vitamin D in relation to body mass index and race in a defined population of black and white women. Int J Gynaecol Obstet 2012; 119:21-5. [PMID: 22818533 PMCID: PMC3438362 DOI: 10.1016/j.ijgo.2012.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 05/02/2012] [Accepted: 06/24/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the contributions of obesity and race to levels of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) in a defined cohort of black and white women. METHODS An interventional study was conducted from October 2004 to March 2008, among 219 healthy female volunteers. Serum 25(OH)D and PTH levels were determined in 117 African American women and 102 white women and the results were compared with body mass index (BMI), percentage body fat, serum lipids, and PTH levels. RESULTS Black women had lower median levels of 25(OH)D compared with white women (27.3 nmol/L vs 52.4 nmol/L; P<0.001). Serum levels of 25(OH)D below 50 nmol/L were found in 98% of black women and 45% of white women (P<0.001). The differences between the racial groups in the levels of 25(OH)D persisted despite adjustments for body weight, percentage body fat, and BMI. Black women had higher median serum levels of PTH than white women (31.9 pg/mL vs 22.3 pg/mL; P<0.01). CONCLUSION African American women are at significant risk for low vitamin D levels. Studies are needed to determine if low vitamin D status in young African American women is associated with a greater risk for vitamin D-related chronic diseases that can be reduced with vitamin D supplementation.
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Affiliation(s)
- PonJola Coney
- Departments of Obstetrics and Gynecology, Meharry Medical College, Nashville, TN, USA
| | - Laurence M. Demers
- MS Hershey Medical Center, Pennsylvania State University, Hershey, PA, USA
| | - William C. Dodson
- MS Hershey Medical Center, Pennsylvania State University, Hershey, PA, USA
| | - Allen R. Kunselman
- MS Hershey Medical Center, Pennsylvania State University, Hershey, PA, USA
| | - Gwinnett Ladson
- Departments of Obstetrics and Gynecology, Meharry Medical College, Nashville, TN, USA
| | - Richard S. Legro
- MS Hershey Medical Center, Pennsylvania State University, Hershey, PA, USA
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Håglin L, Bäckman L, Törnkvist B. A structural equation model for assessment of links between changes in serum triglycerides, -urate, and -glucose and changes in serum calcium, -magnesium and -phosphate in type 2 diabetes and non-diabetes metabolism. Cardiovasc Diabetol 2011; 10:116. [PMID: 22192330 PMCID: PMC3265426 DOI: 10.1186/1475-2840-10-116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 12/22/2011] [Indexed: 11/28/2022] Open
Abstract
Background This study investigates the associations between changes in serum Triglycerides (S-TG), -Urate (S-Urate), and -Glucose (S-Glu) and changes in serum Calcium (S-Ca), -Magnesium (S-Mg), and -Phosphate (S-P) in patients with type 2 diabetes compared with non-diabetic patients. Methods The analysis is based on data collected from a secondary prevention population of women and men (W/M) at risk for cardiovascular disease (type 2 diabetes, 212/200; non-diabetes 968/703). The whole population (n = 2083) had a mean age of 51.0 (9.7) years and was stratified for sex and according to type 2 diabetes or non-diabetes. The patients were followed for, either half a year or one year and changes in risk factors were calculated from follow-up to baseline, the time when patients were admitted to the health center. The pattern of relationships was evaluated using a structural equation model. Results Higher S-TG and S-Glu but lower S-Urate was revealed at baseline in type 2 diabetes women and men as compared to their counterparts, non-diabetes patients. Women with type 2 diabetes had higher S-Ca and lower S-Mg than non-diabetes women. Changes in S-Glu were associated with changes in S-Ca (+), baseline S-Ca (+), and S-Urate (-) in type 2 diabetes men. Changes in S-Urate were associated with changes in S-Mg (+) in type 2 diabetes women and non-diabetes men. In men with non-diabetes, changes in S-Glu were associated with changes in S-Mg (-). In women with non-diabetes, changes in S-Glu were associated with changes in S-P (-) and changes in S-Urate with changes in S-Ca (+). Conclusion With respect to metabolic disturbances in non-diabetes and the awareness of risk for type 2 diabetes, changes in S-Glu and changes in S-Ca, S-Mg, and S-P should be considered as risk factors for cardiovascular disease. Increased early detection and corrections of high S-Ca, low S-Mg, and S-P in obese patients may improve their metabolism and reduce the risk of CVD in patients with type 2 diabetes. Trial registration number ISRCTN: ISRCTN79355192
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Affiliation(s)
- Lena Håglin
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, SE-901 87 Umeå, Sweden.
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Hamed EA, Faddan NHA, Elhafeez HAA, Sayed D. Parathormone--25(OH)-vitamin D axis and bone status in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2011; 12:536-46. [PMID: 21426456 DOI: 10.1111/j.1399-5448.2010.00739.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Skeletal involvement in patients with type 1 diabetes mellitus (T1DM) has complex pathogenesis and despite numerous researches on this problem, many questions remain unanswered. OBJECTIVE This study aimed to assess bone status by measurement parathormone (PTH), 25-hydroxy vitamin D [25(OH)D] serum levels in children and adolescents with T1DM and its relation to insulin-like growth factor-1 (IGF-1), disease duration, puberty stage, and metabolic control. PATIENTS AND METHODS This study included 36 children and adolescents with T1DM and 15 apparently healthy controls. Serum levels of 25(OH)D, PTH, IGF-1 measured using enzyme-linked immunosorbent assay (ELISA), while glycosylated hemoglobin (HbA1c), calcium (Ca), inorganic phosphorus (PO(4) ) using autoanalyzer. Bone quality assessed using dual energy X-ray absorptiometry (DEXA). RESULTS Diabetic patients showed significant increase in PO(4) and PTH levels, while significant decrease in Ca, IGF-1, and 25(OH)D serum levels. As much as 52.8% of patients showed reduced 25(OH)D, and 30.65% showed elevated PTH serum levels. In diabetic patients, abnormal bone status (osteopenia-osteoporosis) found mostly in total body (94.40%) then lumber-spine (88.90%), ribs (88.90%), pelvis (86.10%), thoracic-spine (80.60%), arms (80.60%) and legs (77.80%), while head bones showed no abnormalities. Long diabetic duration had negative; meanwhile PTH, onset age, and puberty age had positive impact on bone status. CONCLUSIONS Children and adolescent with T1DM have abnormal bone status mostly in axial skeleton which may be contributed to impairment of formation of 25(OH)D and IGF-1. Physical activity, calcium and vitamin D supplement seem important in T1DM. Elevated serum PTH level in diabetic patients is not uncommon and its positive correlation with bone status needs further investigations.
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Affiliation(s)
- Enas A Hamed
- Department of Physiology, Faculty of Medicine, Assiut University, Assiut, P.O. Box 71526, Egypt.
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Saltevo J, Niskanen L, Kautiainen H, Teittinen J, Oksa H, Korpi-Hyövälti E, Sundvall J, Männistö S, Peltonen M, Mäntyselkä P, Vanhala M. Serum calcium level is associated with metabolic syndrome in the general population: FIN-D2D study. Eur J Endocrinol 2011; 165:429-34. [PMID: 21659455 DOI: 10.1530/eje-11-0066] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this cross-sectional study was to examine the association between serum calcium and the components of metabolic syndrome (MetS). METHODS As a part of the national prevention program of diabetes in Finland (FIN-D2D), a randomly selected study population of 4500 middle-aged men and women were recruited from three central hospital district areas. Anthropometric measurements were performed by a trained nurse. An oral glucose tolerance test was performed and serum calcium and lipids were measured. We assessed current medications, physical activity, smoking, alcohol consumption, calcium intake, and vitamin D intake. The MetS was defined according to the criteria of the updated National Education Program. The study population consisted of 2896 individuals: 1396 men (62% of invited individuals) and 1500 women (66.7% of invited individuals). RESULTS The mean age was 60.3±8.3 years in men and 59.8±8.5 years in women. The prevalence of MetS was 50.7% in women and 55.8% in men. The prevalence of MetS and its components, except high-density lipoprotein (HDL)-cholesterol, increased linearly with increasing serum calcium (P<0.001), even after adjustment for age, physical activity, alcohol, vitamin D intake, calcium intake, and smoking. The threshold value for serum calcium for MetS was 2.50 mmol/l in this population. The association of MetS with total serum calcium was similar even after exclusion of patients treated with hypertensive drugs. The drug treatments for hypertension, dyslipidemia, and diabetes increased in a similar pattern. CONCLUSIONS Serum calcium level is associated with MetS and its components, except HDL-cholesterol.
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Affiliation(s)
- J Saltevo
- Department of Medicine, Central Finland Central Hospital, 40620 Jyväskylä, Finland.
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Yamaguchi T, Kanazawa I, Takaoka S, Sugimoto T. Serum calcium is positively correlated with fasting plasma glucose and insulin resistance, independent of parathyroid hormone, in male patients with type 2 diabetes mellitus. Metabolism 2011; 60:1334-9. [PMID: 21489574 DOI: 10.1016/j.metabol.2011.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 02/04/2011] [Accepted: 02/05/2011] [Indexed: 12/31/2022]
Abstract
Patients with primary hyperparathyroidism have impaired glucose tolerance more often than do controls, and parathyroid resection sometimes improves this derangement. However, it is unclear whether serum calcium (Ca) or parathyroid hormone (PTH) is more strongly related to impaired glucose metabolism in subjects without primary hyperparathyroidism. In this cross-sectional study, we examined patients with type 2 diabetes mellitus (DM) (271 men and 209 women) and analyzed the relationships between serum concentrations of Ca or intact PTH and DM-related variables. Simple regression analyses showed that the level of serum Ca was significantly and positively correlated with the levels of fasting plasma glucose, immunoreactive insulin, and homeostasis model assessment insulin resistance in men (P < .05), but not in women. In contrast, intact PTH was not significantly correlated with DM-related parameters in either sex. Multiple regression analyses showed that the significant and positive correlations between serum Ca vs fasting plasma glucose and homeostasis model assessment insulin resistance in men still remained after adjustment for intact PTH as well as age, body weight, height, creatinine, albumin, phosphate, bone metabolic markers, and estradiol (P < .05). Serum Ca level is positively associated with impaired glucose metabolism, independent of PTH or bone metabolism, in men with type 2 DM.
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Affiliation(s)
- Toru Yamaguchi
- Internal Medicine 1, Shimane University Faculty of Medicine, Shimane 693-8501, Japan.
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Celik N, Andiran N. The relationship between serum phosphate levels with childhood obesity and insulin resistance. J Pediatr Endocrinol Metab 2011; 24:81-3. [PMID: 21528821 DOI: 10.1515/jpem.2011.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To investigate the relationship between serum phosphate levels with obesity and insulin resistance in childhood. METHODS A total of 298 children and adolescents (190 obese subjects and 108 controls) were included in the study. Serum glucose, insulin, phosphate, calcium and alkaline phosphatase levels were measured after 12 h fasting at 08:00-08:30 h. We assessed insulin sensitivity by using the HOMA-IR (homeostasis model of insulin resistance) index as a surrogate marker of insulin resistance. RESULTS Serum levels of phosphate were significantly lower in the 6- to 12-year-old obese subjects than controls (p = 0.02, p < 0.05). At the same time, there was a moderate negative correlation between serum phosphate levels and the HOMA-IR index in the 6- to 12-year-old IR (-) obese children (r = -0.26, p = 0.02). CONCLUSIONS Low serum phosphate levels could contribute to the development of insulin resistance in 6- to 12-year-old obese children.
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Affiliation(s)
- Nurullah Celik
- Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Fatih University, Ankara, Turkey.
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Romero JR, Germer S, Castonguay AJ, Barton NS, Martin M, Zee RY. Gene variation of the transient receptor potential cation channel, subfamily M, member 2 (TRPM2) and type 2 diabetes mellitus: A case–control study. Clin Chim Acta 2010; 411:1437-40. [DOI: 10.1016/j.cca.2010.05.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 05/21/2010] [Accepted: 05/23/2010] [Indexed: 10/19/2022]
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Kim MK, Kim G, Jang EH, Kwon HS, Baek KH, Oh KW, Lee JH, Yoon KH, Lee WC, Lee KW, Son HY, Kang MI. Altered calcium homeostasis is correlated with the presence of metabolic syndrome and diabetes in middle-aged and elderly Korean subjects: The Chungju Metabolic Disease Cohort study (CMC study). Atherosclerosis 2010; 212:674-81. [DOI: 10.1016/j.atherosclerosis.2010.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/16/2010] [Accepted: 07/07/2010] [Indexed: 01/23/2023]
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Abstract
The growing incidence of prediabetes and clinical type 2 diabetes, in part characterised by insulin resistance, is a critical health problem with consequent devastating personal and health-care costs. Vitamin D status, assessed by serum 25-hydroxyvitamin D levels, is inversely associated with diabetes in epidemiological studies. Several clinical intervention studies also support that vitamin D, or its active metabolite 1,25-dihydroxyvitamin D (1,25(OH)2D), improves insulin sensitivity, even in subjects with glucose metabolism parameters classified within normal ranges. The mechanisms proposed which may underlie this effect include potential relationships with improvements in lean mass, regulation of insulin release, altered insulin receptor expression and specific effects on insulin action. These actions may be mediated by systemic or local production of 1,25(OH)2D or by suppression of parathyroid hormone, which may function to negatively affect insulin sensitivity. Thus, substantial evidence supports a relationship between vitamin D status and insulin sensitivity; however, the underlying mechanisms require further exploration.
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Gulcelik NE, Bozkurt F, Tezel GG, Kaynaroglu V, Erbas T. Normal parathyroid hormone levels in a diabetic patient with parathyroid adenoma. Endocrine 2009; 35:147-50. [PMID: 19116787 DOI: 10.1007/s12020-008-9135-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 10/27/2008] [Accepted: 11/24/2008] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The incidence of diabetes mellitus in patients with primary hyperparathyroidism and, conversely, primary hyperparathyroidism in diabetic patients are approximately threefold higher than the respective expected prevalence in the general populace. The diagnosis is straightforward when the patient presents hypercalcemia and inappropriately elevated serum parathyroid hormone (PTH) levels. We report a case of parathyroid adenoma in a diabetic patient with persistent hypercalcemia and normal PTH levels. PATIENT A 50-year-old female patient who was referred to our outpatient clinic presented with persistent hypercalcemia (serum Ca levels between 10.5 and 11 mg/dl) with a normal serum intact PTH level of 46.1 pg/ml. Her blood pressure was 120/80 mmHg, and she was being treated with antihypertensive therapy. Her HbA1c was 7.2%, and her triglycerides were in the normal range. A bone densitometry exam revealed osteopenia of radius -1.39, femoral neck -1.39, and the total hip -1.04. A neck ultrasound revealed a mass of 13 mm next to the inferior and posterior of the right thyroid lobe. A dual phase Tc-99m-sestamibi scan revealed an area of increased uptake in the same region, which is indicative of a parathyroid adenoma. The parathyroid adenoma was removed, which resulted in the achievement of normocalcemia. CONCLUSION Diabetic patients should be evaluated for hyperparathyroidism as associated hypertension can complicate the course of the disease. These patients should be evaluated for primary hyperparathyroidism when they exhibit persistent hypercalcemia and when clinical suspicion is aroused even if the serum PTH levels are within the normal range.
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Affiliation(s)
- Nese Ersoz Gulcelik
- Department of Endocrinology and Metabolism, Hacettepe University Medical School, Sihhiye, Ankara, Turkey.
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Ybarra J, Doñate T, Jurado J, Pou JM. Primary hyperparathyroidism, insulin resistance, and cardiovascular disease: a review. Nurs Clin North Am 2007; 42:79-85, vii. [PMID: 17270592 DOI: 10.1016/j.cnur.2006.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The presentation of primary hyperthyroidism (PHPT) has changed substantially in the last decade. Before the introduction of routine calcium measurement in most automated biochemistry serum analyzers, it usually was diagnosed after renal and bony lesions already were present. Nowadays, its presentation is practically asymptomatic. Nevertheless, the cardiovascular morbidity and mortality of mild to moderate forms of PHPT reportedly are increasing. Individuals who have mild to moderate forms of PHPT have an increased risk for enduring cardiovascular disease, arterial hypertension, left ventricular hypertrophy, myocardial and valvular calcifications, altered vascular reactivity, and cardiac conduction. Finally, they also reveal alterations in carbohydrate metabolism, insulin resistance, dyslipidemia, and body composition.
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Affiliation(s)
- Juan Ybarra
- Servicio de Endocrinología y Nutrición, Hospital de Sant Pau, Mas Casanovas 90, Barcelona 08041, Spain.
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Hagström E, Hellman P, Lundgren E, Lind L, Arnlöv J. Serum calcium is independently associated with insulin sensitivity measured with euglycaemic-hyperinsulinaemic clamp in a community-based cohort. Diabetologia 2007; 50:317-24. [PMID: 17180664 DOI: 10.1007/s00125-006-0532-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 09/17/2006] [Indexed: 10/23/2022]
Abstract
AIMS/HYPOTHESIS Diabetes mellitus type 2 is associated with altered calcium metabolism. Moreover, in diseases with supranormal serum calcium levels, such as primary hyperparathyroidism, the prevalence of diabetes is increased. Relatively little is known about the relationship between serum calcium concentration and the underlying causes of diabetes-insulin resistance and defective insulin secretion-in the normocalcaemic general population. MATERIALS AND METHODS We investigated associations between serum calcium concentration and insulin sensitivity and secretion in a population-based cohort of elderly men (Uppsala Longitudinal Study of Adult Men, n = 961). Insulin sensitivity index (M/I; glucose disposal rate [M] divided by mean insulin concentration [I]) was assessed using euglycaemic-hyperinsulinaemic clamp, and insulin secretion was estimated from the early insulin response (EIR) during an OGTT. RESULTS In a multivariable linear regression model adjusting for BMI, physical activity, smoking, consumption of tea, alcohol, coffee and dietary calcium, serum phosphate and serum creatinine, 1 SD increase in serum calcium was associated with 0.17 mg kg(-1) min(-1) (mU/l)(-1) x 100 (0.024 mg kg(-1) min(-1) [pmol/l](-1) x 100) decrease in M/I (p = 0.01). The results remained robust in individuals with normal fasting glucose, normal glucose tolerance and serum calcium within the normal range (n = 413, regression coefficient for 1 SD increase -0.45, p = 0.001). Serum calcium was not associated with EIR. Dietary intake of calcium was not independently associated with insulin sensitivity or EIR. CONCLUSION/INTERPRETATION Our data support the notion that endogenous calcium may be involved early in the development of diabetes and that this effect is mediated mainly through effects on insulin sensitivity rather than defective insulin secretion. Dietary intake of calcium does not seem to influence insulin sensitivity.
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Affiliation(s)
- E Hagström
- Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden.
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